Short- and Long-term Outcomes of Laparoscopic Versus Open Repeat Hepatectomy for Hepatocellular Carcinoma

Repeat hepatectomy for recurrent hepatocellular carcinoma (rHCC) can, sometimes, be difficult due to postoperative adhesions and altered liver anatomy. This study aimed to examine the advantages of laparoscopic repeat hepatectomy (LRH) compared to open repeat hepatectomy (ORH).

One hundred and forty-six patients who underwent repeat hepatectomy for rHCC between April 2016 and December 2023 at Kurume University School of Medicine were enrolled. Of these, 105 patients underwent ORH, and 41 underwent LRH. The clinical characteristics and perioperative outcomes of the groups were compared using propensity score-matched (PSM) analysis.

In the PSM analysis, there were 13 patients in each group (ORH-PSM group versus LRH-PSM group). There were no significant differences in clinical characteristics between the groups. Intraoperative blood loss (390 ml vs. 30 ml, p=0.004) was lower and the operation time (335 min vs. 208 min, p=0.009) and postoperative hospital stay (15 days vs. 8 days, p=0.0006) were shorter in the LRH-PSM group than in the ORH-PSM group. Although there was no significant difference in the frequency of postoperative complications with a Clavien-Dindo classification grade of IIIa or higher, such problems were only observed in the ORH-PSM group. There was no significant difference in the early recurrence rate (within 6 months) between the ORH-PSM and LRH-PSM groups. Similarly, no significant differences were observed in overall survival (OS) or recurrence-free survival (RFS) between the two groups.

LRH showed better short-term outcomes than ORH, while long-term outcomes were comparable.