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Table 1. Outcome of treatment after recurrent hepatocellular carcinoma
Laparoscopic repeat liver Open repeat liver resection
resection (laparoscopic RLR) (open RLR) P value
Morise et al. [11] (2020)
Blood loss (mL) 268 497 0.001
Duration of operation (min) 272 232 0.007
90-day morbidity, beyond Clavien-dindo II (%) 15.1 13.0 0.611
90-day Mortality (%) 0.42 0.84 0.623
Postoperative hospital stay (days) 10.4 9.6 0.327
van der Poel et al. [40] (2019)
Blood loss (mL) 200 (50-450) 300 (100-600) 0.077
Duration of operation (min) 200 (123-273) 256 (199-320) < 0.001
90-day morbidity, beyond Clavien-dindo II (%) 5.7 5.7 0.319
90-day Mortality (%) 1.9 0 0.5
Postoperative hospital stay (days) 5 (3-8) 6 (5-8) 0.028
Onoe et al. [39] (2020)
Blood loss(mL) 100 (0-1050) 435 (30-1920) 0.001
Duration of operation (min) 276 (125-589) 292 (96-972) 0.861
90-day morbidity, beyond Clavien-dindo III (%) 6.75 14.3 0.297
90-day Mortality (%) 0 0 1
Postoperative hospital stay (days) 10 (4-50) 14.5 (10-76) 0.002
Goh et al. [12] (2019)
Blood loss (mL) 200 (100-425) 250 (125-475) 0.345
Duration of operation (min) 315 (181-395) 125 (99-184) < 0.001
30-day morbidity, beyond Clavien-dindo III (%) 0 5 0.48
30-day Mortality (%) 0 10 0.56
Postoperative hospital stay (days) 4 (3-5) 7.5 (6-10) 0.001
Ome et al. [38] (2018)
Blood loss (mL) 30 (0-1012) 652 (20-12046) < 0.001
Duration of operation (min) 217 (43-356) 222 (84-923) 0.56
30-day morbidity, beyond Clavien-dindo III (%) 6.1 10.8 0.393
30-day Mortality (%) 3 0 0.471
Postoperative hospital stay (days) 6.5 (3-47) 9.0 (5-78) < 0.001
Noda et al. [37] (2018)
Blood loss (mL) 159 502 0.004
Duration of operation (min) 225 237 0.601
30-day morbidity, beyond Clavien-dindo III (%) 0 14.5 0.009
30-day Mortality (%) 0 0 1
Postoperative hospital stay (days) 14.2 19.2 0.028

LONG-TERM OUTCOMES AFTER LAPAROSCOPIC REPEAT LIVER RESECTION FOR

RECURRENT HEPATOCELLULAR CARCINOMA
A global systematic review and meta-analysis in 2013 reported that the long-term outcomes were
[41]
comparable between LLR and OLR for initial HCC . Subsequently, propensity score-matched studies
comparing LLR and OLR for initial HCC revealed that overall survival (OS) and recurrence-free survival
(RFS) were not different between LLR and OLR, while short-term outcomes were significantly better with
[45]
LLR [42-44] . Similar results were obtained in a study limited to patients undergoing major hepatectomy .
However, no randomized controlled trials have compared LLR and OLR for initial HCC. LLR might be
[46]
performed in select patients. Moreover, Stiles et al. reported that unplanned conversion to OLR from
LLR for HCC was associated with inferior OS compared to non-converted cases. Therefore, the long-term
prognosis of LLR might be comparable to OLR as long as the indication for LLR is carefully evaluated.
Regarding RLR, few studies have compared long-term survival outcomes between laparoscopic RLR and
[11]
open RLR. A recent multicenter, propensity score-based study by Morise et al. , which included 42
surgery centers around the world, reported comparable median survival times between laparoscopic RLR
and open RLR (12.55 years vs. 8.94 years; P = 0.086), although intraoperative blood loss was significantly