Laparoscopic repeat liver resection for hepatocellular carcinoma: a multicentre propensity score-based study

Background In the absence of randomized controlled data and even propensity-matched data, indications for, and outcomes of, laparoscopic repeat liver resection for hepatocellular carcinoma (HCC) remain uncertain. This study aimed to clarify the current indications for laparoscopic repeat liver resection for HCC, and to evaluate outcomes. Methods Forty-two liver surgery centres around the world registered patients who underwent repeat liver resection for HCC. Patient characteristics, preoperative liver function, tumour characteristics, surgical method, and short- and long-term outcomes were recorded. Results Analyses showed that the laparoscopic procedure was generally used in patients with relatively poor performance status and liver function, but favourable tumour characteristics. Intraoperative blood loss (mean(s.d.) 254(551) versus 748(1128) ml; P < 0 center dot 001), duration of operation (248(156) versus 285(167) min; P < 0 center dot 001), morbidity (12 center dot 7 versus 18 center dot 1 per cent; P = 0 center dot 006) and duration of postoperative hospital stay (10 center dot 1(14 center dot 3) versus 11 center dot 8(11 center dot 8) days; P = 0 center dot 013) were significantly reduced for laparoscopic compared with open procedures, whereas survival time was comparable (median 10 center dot 04 versus 8 center dot 94 years; P = 0 center dot 297). Propensity score matching showed that laparoscopic repeat liver resection for HCC resulted in less intraoperative blood loss (268(730) versus 497(784) ml; P = 0 center dot 001) and a longer operation time (272(187) versus 232(129); P = 0 center dot 007) than the open approach, and similar survival time (12 center dot 55 versus 8 center dot 94 years; P = 0 center dot 086). Conclusion Laparoscopic repeat liver resection is feasible in selected patients with recurrent HCC.