Laparoscopic vs. Open Repeat Hepatectomy for Recurrent Liver Tumors: A Propensity Score–Matched Study and Meta-Analysis

Abstract

Background: It remains unclear whether the short-term benefits of laparoscopic repeat hepatectomy (LRH) accrue to patients with recurrent liver tumors. The present study aimed to report our own center's experience and perform a meta-analysis to evaluate the safety and feasibility of LRH in comparison with open repeat hepatectomy (ORH) for treating recurrent liver tumors.Patients and Methods: A propensity score–matched study was performed including 426 patients receiving LRH or ORH for recurrent hepatocellular carcinoma between January 2017 and December 2018. Surgical outcomes and perioperative inflammation-based markers, including monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune–inflammation index were collected from medical records and analyzed. Additionally, a systematic literature review was performed to identify relevant studies in PubMed, EMBASE, Web of Science, and Cochrane library databases up to October 1, 2020. Information including patient demographics, pathologic characteristics, and short-term outcomes was extracted and analyzed using random- or fixed-effects models.Results: Of 68 LRHs, 57 were matched with an ORH finally. Our study demonstrated that LRH was significantly associated with less intraoperative blood loss (50 vs. 100 mL; P < 0.001), lower rate of hepatic inflow occlusion (10.52 vs. 33.3%; P = 0.003), and shorter postoperative hospital stay (5 vs. 6 days; P = 0.001) after 1:1 propensity score matching. The operation time, rate of blood transfusion, and postoperative complications were similar between the two groups. Moreover, all four inflammation-based markers were significantly lower in LRH group on postoperative day 1. In the meta-analysis, a total of 12 studies comprising 1,315 patients receiving repeat hepatectomy met the selection criteria. Similar to our own study, the meta-analysis showed shorter hospital stay [standard mean difference (SMD) = −0.51, 95% confidence interval (CI) = −0.79 to −0.22, P < 0.001], less intraoperative blood loss (SMD = −0.79, 95% CI = −1.11 to −0.47, P < 0.001), and lower rate of major postoperative complications [odds ratio (OR) = 0.35, 95% CI = 0.19–0.66, P = 0.001] in the LRH group. There was no difference in the field of overall postoperative complication and operation time between LRH and ORH groups.Conclusion: Compared with ORH, LRH results in relatively better surgical outcomes and faster postoperative recovery. It could be considered a feasible and effective option for the treatment of recurrent liver tumors.

Laparoscopic repeat hepatectomy versus conventional open repeat hepatectomy for recurrent hepatocellular carcinoma: A systematic review and meta-analysis

“…Blood transfusion data were available in six studies ( 23 , 27 – 30 , 32 ). There was no statistical difference in blood transfusion between the two groups (OR: 0.31; 95% CI:0.06 to 1.63; p = 0.17), indicating that LRH and ORH had similar effects on this item.…”

“…Currently, evidence on the role of LRH in the treatment of RHCC is limited ( 28 ). Abdominal adhesions have been reported in 67%–93% of patients following abdominal surgery, particularly in patients with severe portal hypertension ( 30 , 35 ). Such adhesions restricted liver mobilization and made the recognition of vital blood vessels and specific anatomical structures more difficult, which could lead to accidental vascular or biliary damage ( 30 ).…”

“…Abdominal adhesions have been reported in 67%–93% of patients following abdominal surgery, particularly in patients with severe portal hypertension ( 30 , 35 ). Such adhesions restricted liver mobilization and made the recognition of vital blood vessels and specific anatomical structures more difficult, which could lead to accidental vascular or biliary damage ( 30 ). Handling the serried or vascularized adhesions, especially those around the hepatic hilum or hepatoduodenal ligaments, presented manipulation challenges for LRH ( 27 , 31 ).…”

Clinical practice guidelines and real-life practice in hepatocellular carcinoma: A Chinese perspective

“…With the development of minimally invasive techniques, especially the use of ICG fluorescence [32], indications for LLR are expanded without strict restrictions on tumor size and tumor location in experienced center in China. Although propensity score-matched(PSM) studies [33][34][35] have affirmed comparable oncologic outcomes between LLR and open resection, especially for early-stage HCC [33], multicenter, randomized, controlled studies are warranted to validify the equal long-term efficacy of LLR compared to open resection.…”

A novel difficulty scoring system of laparoscopic liver resection for liver tumor

“…With the first case of laparoscopic liver resection (LLR) reported in 1992, LLR as a treatment for liver tumors has been developed in major centres ( 1 , 2 ). In the early days after LLR was introduced, it was limited to local hepatectomy, but now expanded hemihepatectomy and laparoscopic repeat liver resection (LRLR) are no longer contraindicated ( 3 ).…”