Status and perspective of laparoscopic repeat liver resection

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Procedures
• Surgical Oncology

Background:

• Liver resection (LR) is a key treatment for intrahepatic recurrence of liver metastases and hepatocellular carcinoma.
• Laparoscopic LR (LLR) indications are expanding, but repeat LLR carries risks of complications and conversion.
• Evidence on repeat LLR is limited to small series, with ongoing debate regarding its optimal use.

Purpose of the Study:

• To evaluate the efficacy and safety of repeat laparoscopic liver resection (LLR) for recurrent liver malignancies.
• To compare short-term and long-term outcomes of repeat LLR versus open liver resection.
• To assess the impact of repeat LLR on liver function, particularly in cirrhotic patients.

Main Methods:

• Systematic review and analysis of 16 small series reports on repeat LLR.
• Comparison of outcomes between repeat LLR and open repeat liver resection.
• Evaluation of intraoperative complications, conversion rates, morbidity, hospital stay, and long-term survival.

Main Results:

• Repeat LLR generally shows better short-term outcomes than open surgery, including reduced bleeding, similar or lower morbidity, and shorter hospital stays.
• Long-term outcomes are not compromised by repeat LLR.
• Repeat LLR can avoid extensive adhesiolysis, potentially shortening operation time compared to prior open procedures.
• LLR may minimize liver function deterioration in minor repeat resections of cirrhotic livers.

Conclusions:

• Repeat LLR is a viable option with favorable short-term results and comparable long-term outcomes to open surgery.
• Further research is needed for complex repeat LLR, including anatomical resections and those involving major vessels.
• LLR can be a powerful, repeatable local therapy to potentially prolong patient survival with minimal liver function compromise.