title: Review of 103 Cases of Laparoscopic Repeat Liver Resection for Recurrent Hepatocellular Carcinoma.
abstract: BACKGROUND
  Laparoscopic repeat liver resection (LRLR) has been shown in small retrospective studies to be a safe and effective treatment for recurrent hepatocellular carcinoma (rHCC) in selected patients. The aim of this study was to perform a systematic review of the current literature to determine the safety, feasibility, and oncologic integrity of LRLR for rHCC.
  
  
  METHODS
  A computerized search of the PubMed database was performed for all English language studies evaluating LRLR for HCC from January 1, 2005 to March 31, 2016.
  
  
  RESULTS
  Ten studies reporting on 103 patients were included in this review. 30/51 (58.5%) patients had liver cirrhosis. In 66/95 (69.5%) patients, the index surgery was an open resection and this was a major hepatectomy in 8/49 (16.3%) patients. In 17/72 (23.6%) patients, LRLR was performed for tumors in the posterosuperior segments and in 21/60 (35%) for ipsilateral HCC recurrence. The median tumor size of rHCC ranged from 17-40 mm and 8/69 (11.6%) LRLR were for multifocal rHCC. In 100/103 (97%) patients LRLR was attempted via pure laparoscopy and 2 (1.9%) required open conversion. Median operation time of LRLR ranged from 73-343 minutes and the median blood loss ranged from 50 to 297 mL. The reported postoperative morbidity was 24/97 (24.7%) and there was no postoperative mortality. The median postoperative length of stay ranged from 3.5 to 11 days. Three studies compared the outcomes of LRLR versus open resection for rHCC and all three demonstrated a significant decrease in blood loss in favor of LRLR.
  
  
  CONCLUSIONS
  In highly selected patients; LRLR for rHCC is feasible and safe. LRLR can be performed for patients with previous open LR, previous major hepatectomy, two previous LR, multiple tumors, liver cirrhosis, ipsilateral HCC recurrence, and cancers located in the difficult posterosuperior segments. Comparative studies have demonstrated that LRLR is superior to open repeat liver resection in terms of perioperative outcomes such as decreased blood loss and length of stay.
authors: 1 Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital , Singapore, Singapore .|2 Duke-National University of Singapore Medical School , Singapore, Singapore .
authors: Brian K P
authors: BK
authors: Goh
authors: 1 Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital , Singapore, Singapore .
authors: Jin-Yao
authors: JY
authors: Teo
authors: 1 Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital , Singapore, Singapore .
authors: Chung-Yip
authors: CY
authors: Chan
authors: 1 Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital , Singapore, Singapore .
authors: Ser-Yee
authors: SY
authors: Lee
authors: 1 Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital , Singapore, Singapore .
authors: Peng-Chung
authors: PC
authors: Cheow
authors: 1 Department of Hepatopancreatobiliary and Transplantation Surgery, Singapore General Hospital , Singapore, Singapore .
authors: Alexander Y F
authors: AY
authors: Chung
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000601:surgery*; D061646:Operative Time; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: hepatectomy; hepatocellular carcinoma; laparoscopy; liver resection; minimally invasive; repeat resection