title: Outcomes of repeat laparoscopic liver resection compared to the primary resection.
abstract: BACKGROUND
  Repeat laparoscopic liver resection (R-LLR) can be technically challenging. Data on this topic are scarce and many investigators would question its feasibility and outcomes. The aim of the present study was to evaluate the safety, feasibility, oncological efficiency and outcomes of R-LLR.
  
  
  METHODS
  We reviewed a prospectively collected database of 403 patients undergoing 422 laparoscopic liver resections (LLRs) from August 2003 to August 2013. Data of 19 patients undergoing R-LLR were analyzed and compared to the primary resection (P-LLR) in these patients. Demographic and clinical data were studied. A subgroup analysis was done for minor resections.
  
  
  RESULTS
  Twenty R-LLRs were performed in 19 patients (female 58 %; mean age: 57.5 years; age range: 23-79 years). Colorectal liver metastases (CRLM) were the commonest indication for R-LLR (60 %), followed by neuroendocrine tumor liver metastases (NETLM) (20 %) and hepatocellular carcinoma (HCC) (10 %). The majority (90 %) of resections were for malignant disease (18/20). There were three conversions (15 %), and two patients developed complications (10 %). The operative time (p = 0.005) and blood loss (p = 0.03) were both significantly greater in R-LLR compared to P-LLR, whereas length of stay (median 4 days; p = 0.30) and complications (p = 0.58) did not differ between the groups. R0 resection rates for P-LLR and R-LLR were 95 and 90 %, respectively (p = 0.73).
  
  
  CONCLUSIONS
  Repeat LLR is safe, feasible, and can be performed with minimal morbidity. It appears to be technically more challenging than P-LLR, but without any increase in complications or length of hospital stay.
authors.affiliation: University Hospital Southampton, NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.
authors.forename: V G
authors.initials: VG
authors.lastname: Shelat
authors.forename: K
authors.initials: K
authors.lastname: Serin
authors.forename: M
authors.initials: M
authors.lastname: Samim
authors.forename: M G
authors.initials: MG
authors.lastname: Besselink
authors.forename: H
authors.initials: H
authors.lastname: Al Saati
authors.forename: P Di
authors.initials: PD
authors.lastname: Gioia
authors.forename: N W
authors.initials: NW
authors.lastname: Pearce
authors.forename: M
authors.initials: M
authors.lastname: Abu Hilal
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000473:pathology*; D061887:Conversion to Open Surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000556:secondary / Q000601:surgery*; D061646:Operative Time; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult