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Original Article

Repeat liver surgery by laparoscopy for a malignant recurrence
Repeat liver surgery by laparoscopy for a malignant recurrence
after previous open or laparoscopic resection
after previous open or laparoscopic resection

Luigi Cioffi , Andrea Belli , Corrado Fantini , Alberto D’Agostino , Gianluca Russo ,
2
1
1
1
1
Giulio Belli 1
1 Department of General and Hepato-Pancreato-Biliary Surgery, Loreto Nuovo Hospital, 80142 Naples, Italy
2 Department of Abdominal Oncology, Division of Surgical Oncology, Istituto Nazionale Tumori Fondazione G. Pascale-IRCCS,
80131 Naples, Italy

ABSTRACT
Aim: This paper reported the experience of one center on repeat laparoscopic liver surgery for metastasis and hepatocellular
carcinoma (HCC) with a review of the literature. Methods: This retrospective study included 24 patients who underwent
laparoscopic re-intervention (hepatic resection and radiofrequency ablation) for recurrent HCC in cirrhosis (n = 17) and for
recurrent malignant metastases (n = 7) after a previous open or laparoscopic procedure. Patients were divided into two
groups according to the fi rst surgical approach. Group 1 underwent open resection and laparoscopic procedure (7 patients),
and Group 2 underwent laparoscopic resection and laparoscopic procedure (17 patients). Results: Mean operative time for
re-intervention was signifi cantly longer for Group 1 (220.14 ± 80.06 min) than for Group 2 (150 ± 56.18 min; P = 0.001), whereas
the mean blood loss and mean hospital stay were comparable in both groups. According to Dindo-Clavien classifi cation,
overall morbidity ranged between Grade I and IIIa and was similar in both groups. Conclusion: This study suggests that
repeat laparoscopic surgery for recurrent hepatic malignant diseases in selected patients is a feasible and safe procedure
with good short-term outcomes, but further prospective studies are needed to support these results.

Key words: Recurrence; repeat liver surgery; resection

Address for correspondence:
Prof. Giulio Belli, Department of General and Hepato-Pancreato-Biliary Surgery, Loreto Nuovo Hospital, Via A. Vespucci, 80142 Naples, Italy.
E-mail: giubelli@unina.it
Received: 20-01-2015, Accepted: 09-03-2015

INTRODUCTION anterior segments of the liver. Nevertheless, at the present,
few studies have been done on repeat laparoscopic surgery
Current literature reports significant efficacy of repeat of the liver because of some technical difficulties of repeated
hepatectomies in the treatment of recurrent malignant interventions, which is even more challenging if carried out
diseases (both primary and secondary) of the liver. [1-5] The by a minimally invasive approach.
improved clinical outcomes after multidisciplinary treatment
have led surgeons and oncologists to work on a new We previously published data on laparoscopic re-interventions
challenge - the management of recurrence. In hepatic surgery, for hepatocellular carcinoma (HCC) in cirrhotic liver that
the laparoscopic approach is becoming a widely accepted described peri-operative outcomes, safety, and feasibility
alternative to open approach especially for tumors located on of this procedure. In this paper, our experience on repeat
[6]
laparoscopic liver surgery for malignant primary and
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Quick Response Code secondary diseases with a review of the literature is reported.
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DOI: Patients and inclusion criteria
10.4103/2394-5079.153915 From January 2004 to December 2013, 24 patients
underwent a laparoscopic re-intervention (hepatic resection

30 Hepatoma Research | Volume 1 | Issue 1 | April 15, 2015