Laparoscopic repeat liver resection for hepatocellular carcinoma: a multicentre propensity score-based study
Menée à partir des données de 42 centres chirurgicaux (25 asiatiques, 14 européens, 2 américains et 1 australien) portant sur 2 058 patients ayant subi une seconde résection pour un carcinome hépatocellulaire récidivant, cette étude multicentrique analyse, du point de vue de la survie et des données intra- et péri- opératoires (quantité de sang perdue, durée de l'opération, morbidité et durée de l'hospitalisation postopératoire), la possibilité de réaliser par voie laparoscopique une seconde résection hépatique
Background : In the absence of randomized controlled data and even propensity‐matched data, indications for, and outcomes of, laparoscopic repeat liver resection for hepatocellular carcinoma (HCC) remain uncertain. This study aimed to clarify the current indications for laparoscopic repeat liver resection for HCC, and to evaluate outcomes. Methods : Forty-two liver surgery centres around the world registered patients who underwent repeat liver resection for HCC. Patient characteristics, preoperative liver function, tumour characteristics, surgical method, and short- and long-term outcomes were recorded. Results : Analyses showed that the laparoscopic procedure was generally used in patients with relatively poor performance status and liver function, but favourable tumour characteristics. Intraoperative blood loss (mean(s.d.) 254(551) versus 748(1128) ml; P < 0·001), duration of operation (248(156) versus 285(167) min; P < 0·001), morbidity (12·7 versus 18·1 per cent; P = 0·006) and duration of postoperative hospital stay (10·1(14·3) versus 11·8(11·8) days; P = 0·013) were significantly reduced for laparoscopic compared with open procedures, whereas survival time was comparable (median 10·04 versus 8·94 years; P = 0·297). Propensity score matching showed that laparoscopic repeat liver resection for HCC resulted in less intraoperative blood loss (268(730) versus 497(784) ml; P = 0·001) and a longer operation time (272(187) versus 232(129); P = 0·007) than the open approach, and similar survival time (12·55 versus 8·94 years; P = 0·086). Conclusion : Laparoscopic repeat liver resection is feasible in selected patients with recurrent HCC.