Is minimally invasive liver surgery a reasonable option in recurrent HCC? A snapshot from the I Go MILS registry

Abstract

Laparoscopic liver resection (LLR) for Hepatocellular carcinoma (HCC) is a safe procedure. Repeat surgery is more often required, and the role of minimally invasive liver surgery (MILS) is not yet clearly defined. The present study analyzes data compiled by the Italian Group of Minimally Invasive Liver Surgery (IGoMILS) on LLR. To compare repeated LLR with the first LLR for HCC is the primary endpoint. The secondary endpoint was to evaluate the outcome of repeat LLR in the case of primary open versus primary MILS surgery. The data cohort is divided into two groups. Group 1: first liver resection and Group 2: Repeat LLR. To compare the two groups a 3:1 Propensity Score Matching is performed to analyze open versus MILS primary resection. Fifty-two centers were involved in the present study, and 1054 patients were enrolled. 80 patients underwent to a repeat LLR. The type of resection was different, with more major resections in the group 1 before matching the two groups. After propensity score matching 3:1, each group consisted of 222 and 74 patients. No difference between the two groups was observed. In the subgroup analysis, in 44 patients the first resection was performed by an open approach. The other 36 patients were resected with a MILS approach. We found no difference between these two subgroups of patients. The present study in repeat MILS for HCC using the IGoMILS Registry has observed the feasibility and safety of the MILS procedure.

Case report: Conversion therapy to permit resection of initially unresectable hepatocellular carcinoma

“…Some studies have shown that for cirrhotic patients with HCC, laparoscopic liver resection (LLR) is superior to open liver resection in perioperative safety and postoperative recovery time, and there is no significant difference in OS ( 16 , 17 ). In addition, LLR can reduce postoperative abdominal adhesion and provide opportunities for reoperation or salvage liver transplantation after tumor recurrence, further prolonging OS ( 18 ).…”

Robotic Approach for the Treatment of Hepatocellular Carcinoma

“…Cirrhotic patients with HVPG >10 mmHg should be evaluated case by case, according to the extension of the resection needed. In the case of repeated resections, minimally invasive approaches and in particular the use of the robot proved to be safe and effective [9,10].…”

“Re-Do” Surgery for Hepatocellular Carcinoma: Indications and Results

“…A history of previous abdominal surgery was traditionally considered a contraindication for laparoscopic surgery. Nevertheless, laparoscopic RH is increasingly adopted worldwide and has proven feasible, safe, and effective [28,29]. In a recent meta-analysis, laparoscopic RH has shown less blood loss, fewer major complications, and a higher R0 resection rate compared to open RH [30].…”