Outcomes of laparoscopic repeat liver resection for recurrent liver cancer A system review and meta-analysis

Background: With the improvements of surgical instruments and surgeons' experience, laparoscopic liver resection has been applied for recurrent tumors. However, the value of laparoscopic repeat liver resection (LRLR) is still controversial nowadays, which compelled us to conduct this meta-analysis to provide a comprehensive evidence about the efficacy of LRLR for recurrent liver cancer. Methods: A computerized search was performed to identify all eligible trials published up to April 2019. This meta-analysis was conducted to estimate the perioperative data and oncological outcomes of LRLR by compared with open repeat liver resection (ORLR) and laparoscopic primary liver resection (LPLR). A fixed or random-effect modal was established to collect the data. Results: A total of 1232 patients were included in this meta-analysis (LRLR: n=364; ORLR: n=396; LPLR: n=472). LRLR did not increase the operative time compared to ORLR (WMD=15.92 min; 95%CI: -33.53 to 65.37; P=.53). Conversely, LRLR for patients with recurrent tumors was associated with less intraoperative blood loss (WMD=-187.33mL; 95%CI: -249.62 to -125.02; P<.00001), lower transfusion requirement (OR=0.24; 95%CI: 0.06-1.03; P=.05), fewer major complications (OR=0.42; 95%CI: 0.23-0.76; P=.004), and shorter hospital stays (WMD=-2.31; 95%CI: -3.55 to -1.07; P=.0003). In addition, the oncological outcomes were comparable between the two groups. However, as for the safety of LRLR compared with LPLR, although the operative time in LRLR group was longer than LPLR group (WMD=58.63 min; 95%CI: 2.99-114.27; P=.04), the blood loss, transfusion rates, R0 resection, conversion, postoperative complications, and mortality were similar between the two groups. Conclusions: LRLR for recurrent liver cancer could be safe and feasible in selected patients when performed by experienced surgeons.