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Morise et al. Repeat LLR for recurrent HCC in cirrhotic liver

Table 2: Summary of previous reports of repeat laparoscopic hepatectomy that included cases of hepatocellular
carcinoma
First Hx Bleeding Operating Con. POHS
Authors n Age (year) Disease Procedure Morbidity Mortality
(open:lap) (mL) time (min) (n) (days)
LLS (n = 5),
[13]
Belli et al. * 297 ± 134 114.4 ± 11.0 7.4 ± 2.5
(2009) 12 69 (58-75) HCC 4:8 Pt (n = 4), 272.2 ± 120 63.9 ± 13.3 1 6.2 ± 3.0 26.6% 0%
Seg (n = 3)
3:3
Hu et al. [17] LLS (n = 2),
(2011) 6 49 (46-61) HCC (Lap RFA, Pt (n = 4) 283.3 ± 256.3 140.8 ± 35.7 0 5.67 ± 1.63 16.7% 0%
n = 2)
LLS (n = 4),
Met (n = 63),
Shafaee et al. [16] HCC (n = 3), Pt, seg
(2011) 76 61 (29-82) others 28:44 (n = 53), 300 (0-5000) 180 (80-570) 8 6 (2-42) 26% 0%
(n = 10) above-seg
(n = 19)
Ahn et al. [15] HCC (n = 3), LLS (n = 1),
(2011) 4 57 (54-60) Met (n =1) 0:4 Pt (n = 3) 481.7 ± 449.5 312.3 ± 158.4 1 10.6 ± 7.4 23.4% 0%
Tsuchiya et al. [19]
(2012) 3 73 (52-79) HCC 0:3 281.3 (mean) 264.6 (mean) 0 8.6 (mean) 0%
Kanazawa et al. [20] 2
(2013) 20 70 (46-83) HCC 15:5 Pt 78 (1-1500) 239 (69-658) (HALS) 9 (5-22) 5% 0%
HCC (n = 2), 400
Shelat et al. [23] 20 57.5 (23-79) Met (n = 16), 0:20 Minor (n = 14) (IQR 150- 285 3 4 (1-57) 10% 0%
(2014) Major (n = 6) (IQR 195-360)
others (n = 2) 200)
HCC (n = 8), Pt (n = 9),
Isetani et al. [22] 12 70 (57-81) Met (n = 2), 8:4 Subseg 50 301 (104-570) 0 12 (9-30) 0% 0%
(2015) (NC-840)
others (n = 2) (n = 3)
[13]
Data are expressed as median (range) or mean ± standard deviation, unless stated otherwise. *In the paper by Belli et al., operating time,
bleeding and POHS are described separately for patients whose previous hepatectomy was open (upper) or laparoscopic (lower). Con:
conversion to laparotomy; HALS: hand-assisted laparoscopic surgery; HCC: hepatocellular carcinoma; IQR: interquartile range; LLS: left lateral
sectorectomy; Met: metastasis; Minor: resection of 2 segments or less; Major: resection of more than 2 segments; NC: low, unquantifiable; POHS:
postoperative hospital stay; Pt: partial resection; RFA: radiofrequency ablation; Seg: segmentectomy; Subseg: subsegmentectomy

ICG-R15, and became HCV-negative, after taking a metachronous HCCs within impaired liver and for
newly developed oral anti-HCV therapy. The patient surface HCC in severe LC. [31,32] The deterioration
remained in compensated LC throughout the period in of liver function should be minimized with the
which the four LLRs were performed. As a result, and reduced adhesiolysis and dissection required during
because of the shortage of cadaver donors in Japan, a laparoscopic approach. In addition, LLR better
liver transplantation was not undertaken. During both prepared patients both physically and psychologically
the first and fourth LLRs, minor anatomical resections for a subsequent repeat LR, illustrated by a shortened
(extended segment 3 segmentectomy and 4ab hospital stay for the patient reported here. Thus, LLR
subsegmentectomy, respectively) were undertaken to is a powerful localized therapy which can be applied
remove multiple tumors in the same portal territories, repeatedly and may prolong the survival of patients
because the patient’s liver functional reserve (estimated with multicentric metachronous HCCs/CLD.
by ICGR15) was insufficient to support sectionectomy
or more extended resection. Furthermore, ablation Financial support and sponsorship
therapy was not performed for the protuberant tumors None.
necessitating the first and second LLRs and for the
tumor adjacent to the IVC at the time of third LLR, Conflicts of interest
owing to the technical challenges associated. Trans- There are no conflicts of interest.
arterial chemo-embolization (TACE) was used prior to
the third LLR, but the target tumor had regrown six Patient consent
months after TACE; therefore, LLR was selected for Obtained.
the follow-up treatment.
Ethics approval
LLR is highly suitable for repeated laparoscopic partial The patient was treated within the standards of our
or local anatomical LR for the treatment of multicentric institute and the report was approved.
Hepatoma Research ¦ Volume 2 ¦ September 19, 2016 257