Laparoscopic Repeat Liver Resection-Selecting the Best Approach for Repeat Liver Resection.

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Repeat liver resection (RLR) is the primary curative option for liver cancer recurrence, including hepatocellular carcinoma and colorectal liver metastases.
• RLR carries a significant risk of complications, prompting investigation into less invasive approaches.
• Laparoscopic RLR is an emerging technique with ongoing debate regarding its indications, benefits, and drawbacks.

Purpose of the Study:

• To evaluate the feasibility and outcomes of laparoscopic versus open RLR for recurrent liver cancers.
• To discuss the advantages and disadvantages of laparoscopic RLR in the context of repeat liver surgery.
• To explore future advancements in laparoscopic RLR techniques.

Main Methods:

• Multi-institutional propensity-score matched analyses comparing laparoscopic and open RLR for hepatocellular carcinoma.
• Review of current literature on laparoscopic RLR, including its technical challenges and potential benefits.

Main Results:

• Laparoscopic RLR demonstrated feasibility with comparable short- and long-term outcomes to open RLR.
• Selected patients undergoing laparoscopic RLR experienced reduced blood loss and lower morbidity.
• Potential benefits include minimized functional liver deterioration by avoiding extensive adhesiolysis.

Conclusions:

• Laparoscopic RLR is a viable and potentially less damaging option for treating recurrent liver cancers.
• Challenges such as disorientation and dissection difficulties need to be addressed for wider adoption.
• Emerging technologies like fluorescence-guided surgery and robotic assistance may enhance future laparoscopic RLR procedures.