Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2022; 14(5): 409-418
Published online May 27, 2022. doi: 10.4240/wjgs.v14.i5.409
Laparoscopic vs open liver re-resection for cirrhotic patients with post-hepatectomy hepatocellular carcinoma recurrence: A comparative study
Kai-Chi Cheng, Kit-Man Ho
Kai-Chi Cheng, Kit-Man Ho, Department of Surgery, Kwong Wah Hospital, Hong Kong 999077, China
Author contributions: Cheng KC designed the research study, performed the research, analyzed the data and drafted the manuscript; Ho KM wrote and revised the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: The protocol was approved by The Hong Kong Hospital Authority Research Ethics Committee (Kowloon Central/Kowloon East) (Ref: KC/KC-21-0278/ER-4) following the applicable laws and regulations (including Hong Kong laws), hospital authority policy, professional code of conduct, International Council for Harmonisation, Good Clinical Practice, and the Declaration of Helsinki.
Informed consent statement: Written consent was not required as this was a retrospective study, and no data were collected prospectively.
Conflict-of-interest statement: The authors declare that they have no conflicting interests.
Data sharing statement: The datasets generated during and/or analysed during the current study are not publicly available due to the potential that individual privacy could be compromised, but they are available in an anonymized form from the corresponding author upon reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kai-Chi Cheng, FRCS (Ed), Doctor, Department of Surgery, Kwong Wah Hospital, No. 25 Waterloo Road, Kowloon, Hong Kong 999077, China. thomascheng@hotmail.com
Received: December 30, 2021
Peer-review started: December 30, 2021
First decision: March 10, 2022
Revised: March 12, 2022
Accepted: April 26, 2022
Article in press: April 26, 2022
Published online: May 27, 2022
Processing time: 145 Days and 23 Hours
Abstract
BACKGROUND

Repeated liver resection is an effective treatment for recurrent hepatocellular carcinoma (HCC). However, few studies have compared the outcome of laparoscopic repeat hepatectomy (LRH) and open repeat hepatectomy (ORH) for recurrent HCC, and few of those have included cirrhotic patients.

AIM

To compare short-term and long-term outcomes of cirrhotic patients with LRH and ORH for recurrent HCC.

METHODS

We retrospectively analysed the clinical records retrieved from a prospectively collected database of all patients who underwent hepatectomy for post-hepatectomy recurrent HCC at our institute between May 2006 and June 2021. Cases of recurrent HCCs larger than 7 cm were excluded. Patient demographics, operative details, perioperative outcomes, pathologic details, disease-free survival (DFS), and overall survival (OS) data of LRH and ORH were compared.

RESULTS

Data from 29 patients with LRH and 22 with ORH were compared. The LRH group showed significantly better outcomes for blood loss (median 300 mL vs 750 mL, P = 0.013) and length of hospital stay (median 5 d vs 7 d, P = 0.003). The 1-, 3- and 5-year OS rates in the LRH group were 100.0%, 60.0% and 30.0%, respectively; the corresponding rates in the ORH group were 81.8%, 36.4% and 18.2% (P = 0.336). The 1-, 3- and 5-year DFS rates in the LRH group were 68.2%, 27.3% and 4.5%, respectively; the corresponding rates in the ORH group were 31.3%, 6.3% and 6.3% (P = 0.055). There were no significant differences in overall and DFS between the two groups.

CONCLUSION

Laparoscopic re-resection should be considered for patients presenting with recurrent HCC less than or equal to 7 cm after previous hepatectomy.

Keywords: Hepatocellular carcinoma; Recurrence; Repeat hepatectomy; Laparoscopic hepatectomy; Outcome; Overall survival; Disease-free survival

Core Tip: Laparoscopic liver re-resection for recurrent hepatocellular carcinoma had similar oncological outcomes compared with open surgery, even in patients with cirrhosis. Laparoscopic re-resection should be considered for all patients suitable for liver re-resection for recurrent hepatocellular carcinoma.