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and radiofrequency ablation [RFA]) for recurrent HCC in which major hepatectomy is not recommended. No tumor
in cirrhosis (n = 17) and for recurrent metastases from was biopsied pre-operatively.
colorectal carcinoma (n = 7) after a previous open or
laparoscopic procedure. The primary surgical interventions The patients were divided into two groups according to the
were 7 open and 18 laparoscopic procedures (a laparoscopic first surgical approach [Table 2]. Group 1 underwent open
segmentectomy was associated with a laparoscopic RFA resection (OR) and laparoscopic procedure (7 patients),
in 1 patient). Details of hepatic procedures are explained and Group 2 underwent laparoscopic resection (LR) and
in Table 1. A wedge resection (WR) was performed in laparoscopic procedure (17 patients). Results from the
association with a laparoscopic left hemicolectomy in 1 case two groups were compared in a retrospective study.
of synchronous metastases; a left lateral sectionectomy with Between the two groups, we analyzed and compared
an open left hemicolectomy and a cholecystectomy was operative time for re-intervention, blood loss, hospital stay,
performed for a similar case. post-operative morbidity, and mortality. Data were expressed
as mean ± standard deviation and represented in Table 3.
The inclusion criteria for the laparoscopic re-intervention Differences in means between the groups were compared
were: A well-compensated chronic liver disease (Child-Pugh using Student’s t-test. P < 0.05 was considered statistically
Class A) without signs of severe portal hypertension in significant. The hospital review board approved this study.
cirrhotic patients, a performance status of Karnosky ≥ 70,
an American Society of Anesthesiology status ≤ 3, either a Surgical technique
single HCC (≤ 5 cm) or 1 or more metastases when located The surgical technique for the repeat laparoscopic hepatic
in the anterior hepatic segments (segments II, III, IVb, resection was described elsewhere. [6-8] In brief, continuous
V and VI), or a small (3 cm) deep HCC for laparoscopic RFA CO pneumoperitoneum was induced using access technique
2
Table 1: Features of hepatic procedures
Patients First First procedure Recurrence Second Redo procedure for Operative time Type of Size (mm)
approach site approach recurrence for second lesion
procedure (min) (number)
1 OR Subsegmentectomy II LR Left lateral sectionectomy 115 HCC (1) 40
2 OR Segmentectomy III LR Left lateral sectionectomy 100 HCC (1) 38
3 OR Segmentectomy IV LR Subsegmentectomy 120 HCC (1) 38
(converted to laparotomy)
4 OR Segmentectomy IV LR Subsegmentectomy 130 HCC (1) 40
5 OR Subsegmentectomy VIII L-RFA L-RFA 120 HCC (1) 28
6 LR Left lateral sectionectomy VII-VIII L-RFA L-RFA 100 HCC (1) 33
7 LR Subsegmentectomy II LR Left lateral sectionectomy 60 HCC (1) 48
8 LR Segmentectomy IV LR Subsegmentectomy 80 HCC (1) 30 exophityc
9 LR Subsegmentectomy IV LR Subsegmentectomy 60 HCC (1) 48 exophityc
10 LR Subsegmentectomy V LR Segmentectomy 50 HCC (1) 40
11 LR Subsegmentectomy VIII L-RFA L-RFA 80 HCC (1) 35
12 LR Segmentectomy VI LR Segmentectomy 40 HCC (1) 38
13 LR Segmentectomy II LR Left lateral sectionectomy 80 HCC (1) 45
14 LR Subsegmentectomy II-III LR Left lateral sectionectomy 65 HCC (1) 38
15 LR Subsegmentectomy V LR Segmentectomy 60 HCC (1) 45
16 LR Segmentectomy + L-RFA VII L-RFA L-RFA 50 HCC (1) 28
17 LR Left lateral sectionectomy II LR Segmentectomy 50 HCC (1) 35
18 LR WR IV LR WR 60 MTX (1) 28
19 LR WR III, VI LR WR 100 MTX (3) 10, 23, 25
20 LR WR VI, V LR WR 80 MTX (3) 17, 20, 27
21 OR WR II, V, VI LR WR 120 MTX (3) 10, 28, 25
22 OR Left hemicolectomy + IV-V LR Bisegmentectomy 220 MTX (1) 76
cholecystectomy + left Third procedure: WR
lateral sectionectomy
23 LR Left hemicolectomy + II, III, IV LR Left lateral sectionectomy 240 MTX (4) 28, 35, 30, 38
WR + WR
Third procedure: WR
24 LR WR VI LR WR 120 MTX (1) 22
OR: open resection; LR: laparoscopic resection; WR: wedge resection; MTX: metastases; HCC: hepatocellular carcinoma; L-RFA: laparoscopic radiofrequency ablation

Hepatoma Research | Volume 1 | Issue 1 | April 15, 2015 31