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Hokuto et al. Hepatoma Res 2020;6:81 I http://dx.doi.org/10.20517/2394-5079.2020.78 Page 5 of 7

greater with open RLR (268 mL vs. 497 mL; P = 0.001) and operative duration was significantly longer with
laparoscopic LLR (272 min vs. 232 min; P = 0.007). These findings suggest acceptable long-term outcomes
with laparoscopic RLR for recurrent HCC.

LAPAROSCOPIC REPEAT LIVER RESECTION AND RADIOFREQUENCY ABLATION FOR
RECURRENT HEPATOCELLULAR CARCINOMA
Percutaneous RFA, a technique developed in the last two decades has been reported to be an effective and
safe treatment for small HCCs [18-20] . Nowadays, RFA is widely used as non-surgical treatment for HCCs
because the therapeutic effect was reported to be more effective than microwave coagulation therapy or
percutaneous ethanol injection therapy [47,48] . In general, recurrent HCCs are detected at a small diameter
because of routine screening after initial liver resection. Therefore, RFA for recurrent HCCs could be an
effective treatment.

However, a very recent randomized controlled trial comparing RLR with RFA for recurrent HCC revealed
that RFA was associated with a higher rate of early recurrence compared with RLR (40.3% vs. 23.3%, P =
[49]
0.04) . On the other hand, the trial results indicated that RLR had a higher complication rate than RFA
(22.4% vs. 7.3%, P = 0.001). These findings highlight that RLR remains an important treatment approach
for recurrent HCC even in the era of RFA. As mentioned previously, laparoscopic RLR can be performed
safely, with less blood loss and shorter postoperative hospital stay compared to open RLR in select cases.
Therefore, laparoscopic RLR for recurrent HCC might be considered a standard treatment with reduced
surgical invasiveness as long as the indication for RLR is carefully considered.

CONCLUSION
RLR for recurrent HCC remains an important treatment strategy even in the era of RFA. Laparoscopic
RLR could be considered a more minimally invasive surgical treatment than open RLR for patients with
recurrent HCC.

DECLARATIONS
Authors’ contributions
Wrote this article: Hokuto D
Supervised this article: Nomi T, Sho M
Treated the patients included in this article: Yoshikawa T, Matsuo Y, Kamitani N

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.