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Hokuto et al. Hepatoma Res 2020;6:81 Hepatoma Research
DOI: 10.20517/2394-5079.2020.78

Review Open Access

Current status of laparoscopic repeat liver resection
for recurrent hepatocellular carcinoma

Daisuke Hokuto, Takeo Nomi, Takahiro Yoshikawa, Yasuko Matsuo, Naoki Kamitani, Masayuki Sho

Department of Surgery, Nara Medical University, Nara 634-8522, Japan.
Correspondence to: Dr. Takeo Nomi, Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara 634-
8522, Japan. E-mail: t.nomi45@gmail.com

How to cite this article: Hokuto D, Nomi T, Yoshikawa T, Matsuo Y, Kamitani N, Sho M. Current status of laparoscopic repeat liver
resection for recurrent hepatocellular carcinoma. Hepatoma Res 2020;6:81. http://dx.doi.org/10.20517/2394-5079.2020.78

Received: 8 Aug 2020 First Decision: 11 Sep 2020 Revised: 24 Sep 2020 Accepted: 16 Oct 2020 Published: 6 Nov 2020

Academic Editor: Ho-Seong Han Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Repeat liver resection (RLR) is an effective treatment approach for recurrent hepatocellular carcinoma (HCC) and
Received: First Decision: Revised: Accepted: Published: can provide acceptable long-term outcomes in select patients. Recent randomized controlled trials comparing
RLR with radiofrequency ablation revealed that the latter approach was associated with a higher rate of early
Science Editor: Copy Editor: Production Editor: Jing Yu recurrence compared with RLR. With recent advances in laparoscopic liver resection (LLR), RLR has been
increasingly performed using laparoscopy. Several propensity score-matched studies reported that laparoscopic
RLR achieved lower blood loss and shorter hospital stays compared to open RLR. However, laparoscopic RLR
requires more advanced techniques because of adhesions formed after the previous liver resection, changes
in anatomical landmarks, and deformity of the remnant liver. The recently described difficulty classification of
laparoscopic RLR is based on five factors including type of previous liver resection (open or laparoscopic), number
of previous liver resections, surgical procedure used in previous liver resections, tumor location in previous liver
resections, and difficulty score of LLR for recurrent HCC. We reviewed the available literature to summarize
available evidence suggesting that laparoscopic RLR might be considered a more minimally invasive surgical
treatment approach for recurrent HCC as long as the indication for laparoscopic RLR is carefully determined.

Keywords: Hepatocellular carcinoma, repeat liver resection, laparoscopic repeat liver resection

INTRODUCTION
Repeat liver resection (RLR) is an effective treatment approach for recurrent hepatocellular carcinoma
[1-3]
(HCC) and can provide acceptable long-term outcomes for select patients . However, RLR is considered
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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