Taiga Wakabayashi, Yuta Abe, Osamu Itano, Masahiro Shinoda, Minoru Kitago, Hiroshi Yagi, Taizo Hibi, Takuya Minagawa, Yuko Kitagawa. Department of Surgery, Keio University School of Medicine
Background: With the improvement in treatment outcomes for patients with liver cancer, there have been an increasing number of cases of repeat hepatectomy. Technological innovation and data accumulation on surgical cases are making it possible to use laparoscopic hepatectomy to treat even cases with postoperative adhesions or cicatricial changes. We investigated the treatment outcomes of laparoscopic repeat hepatectomy for cases of recurrent liver cancer following open hepatectomy.
Methods: A total of 260 cases underwent laparoscopic hepatectomy at our facility as of September 2016. Of these, we retrospectively analyzed 13 cases of recurrent liver cancer that underwent laparoscopic repeat hepatectomy following open hepatectomy.
Results: The subjects included 11 males and 2 females. The median age was 70 (54-88) years. There were 9 cases of hepatocellular carcinoma, 3 cases of metastatic liver cancer and one case of cholangiocarcinoma.; 5 cases had hepatitis B, 4 had hepatitis C, and 4 had neither. Grade A/B liver damage was noted in 12/1 cases undergoing initial surgery and in 11/2 cases undergoing repeat hepatectomy. Three cases (23.1%) were histologically diagnosed with liver cirrhosis. The surgical procedure performed was lateral segmentectomy in 1 case, S3+4 subsegmentectomy in 1 case and partial hepatectomy in 11 cases(anatomical resection was performed on 5 of these cases by treating the cancer-bearing Glisson’s sheath in advance). Six cases underwent resection in the same segment (medial segment: 2 cases, anterior segment: 4 cases) at both initial surgery and repeat hepatectomy. Despite the inclusion of some cases with severe adhesion, median surgical duration was 377 (212-885) min and median blood loss was 200 (trace-870) g. In terms of postoperative complications, we noted 2 cases of bile leakage and 1 case of portal vein thrombosis. However, good outcomes were achieved, with a median time to resumption of oral feeding of 2 (2-4) days postoperatively, and a median postoperative stay in hospital of 11 (6-46) days. The median recurrence-free period over a median observation period of 29 months was 14 (1-37) months for hepatocellular carcinoma and 22 (10-29) months for metastatic liver cancer.
Conclusions: Laparoscopic hepatectomy was performed safely in cases of recurrent liver cancer following open hepatectomy, resulting in good treatment outcomes. However, the indication should be carefully considered as the level of difficulty varies depending on the tumor location and resection area.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79258
Program Number: P440
Presentation Session: Poster (Non CME)
Presentation Type: Poster