Laparoscopic Hepatectomy for Recurrent Hepatocellular Carcinoma

KuoHsin Chen, MD, Tiing Foong Siow, MD, U-Chon Chio, MD, Ying-Da Chen. Far-Eastern Memorial Hospital

Objective of the Study: To evaluate the feasibility, safety and results of laparoscopic hepatectomy (LH) for recurrent hepatocellular carcinoma (HCC).

High recurrence rate after hepatectomy for HCC is well known. Despite this, rehepatectomy for recurrent HCC for selected patients offers favorable results comparing to other modalities. However, when it comes to laparoscopic hepatectomy for recurrent HCC, intraabdominal adhesion is a major concern.

Methods and Procedures: This is a retrospective review of 509 LH from a single institute. Patients receiving laparoscopic repeat hepatectomy for recurrent HCC were enrolled excluding those who receiving laparoscopic local ablation or hepatectomy with ablation. The initial treatment for HCC included open or laparoscopic hepatectomy, radiofrequency ablation or repeat transarterial chemoembolization. The perioperative profile and long term follow-up data were analyzed. Tumor recurrence was defined as image documented lesions mandating further intervention.

Results: From Feb 2002 until March 2015, total 458 patients received 509 minimally invasive hepatectomy (including laparoscopic and robotic approach) in our institute. Laparoscopic hepatectomy has been in 295 HCC patients.

Total 30 patients receiving LH for recurrent HCC were collected. There were 21 male and 9 female aged from 39 to 78 years (mean 61). Surgical procedure included subsegmetectomy in 21, left lateral sectionectomy in 2, S4 and ventral portion of S58 in 3, S458 in 1 and right hepatectomy in 3. There is no open conversion. The postOP stay ranged from 2 to 14 d (mean :6.4d) the blood loss was 378 c.c. (20~2400). 16.7% of patients needed intraoperative blood transfusion. There was no bowel injury or postOP bleeding needing intervention. PostOP complications included bile leak in 3 and pneumonia in 1. There was no mortality in this series. Although the recurrence of HCC after laparoscopic rehapectomy is common, the overall survival at 5 years was 82%.

Conclusions: Laparoscopic rehepatectomy for recurrent HCC is feasible with acceptable perioperative results. The follow-up survival data is comparable to that after open hepatectomy. No additional complication related to the intraabdominal adhesion has been observed in this study. Therefore, we suggest that laparoscopic hepatectomy is still a valid choice for selected patients with recurrent HCC.

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