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Advantages of the Laparoscopic Approach for the Initial Operation in Patients who Underwent Repeat Hepatectomy

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

Less intra-abdominal adhesions are expected following laparoscopic surgery. Although an initial laparoscopic approach for primary liver tumors may have advantages in patients who require repeat hepatectomies for recurrent liver tumors, this has not been sufficiently investigated.

Methods

Patients who underwent repeat hepatectomies for recurrent liver tumors at our hospital between 2010 and 2022 were retrospectively analyzed. Of 127 patients, 76 underwent laparoscopic repeat hepatectomy (LRH), of whom 34 patients initially underwent laparoscopic hepatectomy (L-LRH) and 42, open hepatectomy (O-LRH). Fifty-one patients underwent open hepatectomy as both the initial and second operation (O-ORH). We analyzed surgical outcomes between L-LRH and O-LRH groups and between L-LRH and O-ORH groups using propensity-matching analysis for each pattern.

Results

Twenty-one patients each were included in L-LRH and O-LRH propensity-matched cohorts. The L-LRH group had a lower rate of postoperative complications than the O-LRH group (0 vs 19%, P = 0.036). When we compared surgical outcomes between L-LRH and O-ORH groups in another matched cohort with 18 patients in each group, in addition to the lower rate of postoperative complications, the L-LRH group had additional favorable surgical outcomes including shorter operation time and lower blood loss volume than the O-ORH group (291 vs 368 min, P = 0.037 and 10 vs 485 mL, P < 0.0001).

Conclusions

An initial laparoscopic approach would be favorable for patients undergoing repeat hepatectomies, as it leads to lower risk of postoperative complications. Compared with O-ORH, the advantage of the laparoscopic approach may be enhanced when it is repeatedly adopted.

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Data Availability

The data that support the findings of this study are available from the corresponding author, Hidetoshi Gon, upon reasonable request.

References

  1. Nakajima Y, Ko S, Kanamura T, Nagao M, Kanehiro H, Hisanaga M, Aomatsu Y, Ikeda N, Nakano H (2001) Repeat liver resection for hepatocellular carcinoma. J Am Coll Surg 192:339-344

    Article  CAS  PubMed  Google Scholar 

  2. Minagawa M, Makuuchi M, Takayama T, Kokudo N (2003) Selection criteria for repeat hepatectomy in patients with recurrent hepatocellular carcinoma. Ann Surg 238:703-710

    Article  PubMed  PubMed Central  Google Scholar 

  3. Souche R, Addeo P, Oussoultzoglou E, Herrero A, Rosso E, Navarro F, Fabre JM, Bachellier P (2016) First and repeat liver resection for primary and recurrent intrahepatic cholangiocarcinoma. Am J Surg 212:221-229

    Article  PubMed  Google Scholar 

  4. Valenzuela CD, Moaven O, Gawdi R, Stauffer JA, Del Piccolo NR, Cheung TT, Corvera CU, Wisneski AD, Cha C, Pourhabibi Zarandi N, Dourado J, Perry KC, Russell G, Shen P (2022) Outcomes after repeat hepatectomy for colorectal liver metastases from the colorectal liver operative metastasis international collaborative (COLOMIC). Journal of surgical oncology 126:1242-1252

    Article  PubMed  PubMed Central  Google Scholar 

  5. Liu K, Chen Y, Wu X, Huang Z, Lin Z, Jiang J, Tan W, Zhang L (2017) Laparoscopic liver re-resection is feasible for patients with posthepatectomy hepatocellular carcinoma recurrence: a propensity score matching study. Surg Endosc 31:4790-4798

    Article  PubMed  Google Scholar 

  6. Ome Y, Hashida K, Yokota M, Nagahisa Y, Yamaguchi K, Okabe M, Kawamoto K (2018) The feasibility and efficacy of pure laparoscopic repeat hepatectomy. Surg Endosc 32:3474-3479

    Article  PubMed  Google Scholar 

  7. Kaibori M, Ichihara N, Miyata H, Kakeji Y, Nanashima A, Kitagawa Y, Yamaue H, Yamamoto M, Endo I (2022) Surgical outcomes of laparoscopic versus open repeat liver resection for liver cancers: A report from a nationwide surgical database in Japan. Journal of hepato-biliary-pancreatic sciences 29:833-842

    Article  PubMed  Google Scholar 

  8. Noda T, Eguchi H, Wada H, Iwagami Y, Yamada D, Asaoka T, Gotoh K, Kawamoto K, Takeda Y, Tanemura M, Umeshita K, Doki Y, Mori M (2018) Short-term surgical outcomes of minimally invasive repeat hepatectomy for recurrent liver cancer. Surg Endosc 32:46-52

    Article  PubMed  Google Scholar 

  9. Hallet J, Sa Cunha A, Cherqui D, Gayet B, Goere D, Bachellier P, Laurent A, Fuks D, Navarro F, Pessaux P (2017) Laparoscopic Compared to Open Repeat Hepatectomy for Colorectal Liver Metastases: a Multi-institutional Propensity-Matched Analysis of Short- and Long-Term Outcomes. World J Surg 41:3189-3198

    Article  PubMed  Google Scholar 

  10. Dowson HM, Bong JJ, Lovell DP, Worthington TR, Karanjia ND, Rockall TA (2008) Reduced adhesion formation following laparoscopic versus open colorectal surgery. The British journal of surgery 95:909-914

    Article  CAS  PubMed  Google Scholar 

  11. Stommel MWJ, Ten Broek RPG, Strik C, Slooter GD, Verhoef C, Grünhagen DJ, van Duijvendijk P, Bemelmans MHA, den Dulk M, Sietses C, van Heek TNT, van den Boezem PB, de Wilt JHW, van Goor H (2018) Multicenter Observational Study of Adhesion Formation After Open-and Laparoscopic Surgery for Colorectal Cancer. Ann Surg 267:743-748

    Article  PubMed  Google Scholar 

  12. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R (1973) Transection of the oesophagus for bleeding oesophageal varices. The British journal of surgery 60:646-649

    Article  CAS  PubMed  Google Scholar 

  13. Dindo D, Demartines N, Clavien P-A (2004) Classification of Surgical Complications. Annals of Surgery 240:205-213

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gon H, Kido M, Tanaka M, Kuramitsu K, Komatsu S, Awazu M, So S, Toyama H, Fukumoto T (2021) Laparoscopic repeat hepatectomy is a more favorable treatment than open repeat hepatectomy for contralateral recurrent hepatocellular carcinoma cases. Surg Endosc 35:2896-2906

    Article  PubMed  Google Scholar 

  15. Chan AC, Poon RT, Chok KS, Cheung TT, Chan SC, Lo CM (2014) Feasibility of laparoscopic re-resection for patients with recurrent hepatocellular carcinoma. World J Surg 38:1141-1146

    Article  PubMed  Google Scholar 

  16. Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G (2016) Comparative Short-term Benefits of Laparoscopic Liver Resection: 9000 Cases and Climbing. Ann Surg 263:761-777

    Article  PubMed  Google Scholar 

  17. Pringle JH (1908) V. Notes on the Arrest of Hepatic Hemorrhage Due to Trauma. Ann Surg 48:541-549

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We thank S. Murakami MD, PhD (Division of Clinical and Translational Research Center, Kobe University Hospital, Kobe, Japan) for assistance with statistical analysis.

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Authors and Affiliations

  1. Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan

    Hidetoshi Gon MD, PhD, Shohei Komatsu MD, PhD, Masahiro Kido MD, PhD, Kenji Fukushima MD, PhD, Takeshi Urade MD, PhD, Shinichi So MD, PhD, Toshihiko Yoshida MD, PhD, Keisuke Arai MD, PhD, Jun Ishida MD, PhD, Yoshihide Nanno MD, PhD, Daisuke Tsugawa MD, PhD, Hiroaki Yanagimoto MD, PhD, Hirochika Toyama MD, PhD & Takumi Fukumoto MD, PhD

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  1. Hidetoshi Gon MD, PhD
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  2. Shohei Komatsu MD, PhD
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  3. Masahiro Kido MD, PhD
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  4. Kenji Fukushima MD, PhD
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  6. Shinichi So MD, PhD
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  7. Toshihiko Yoshida MD, PhD
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  8. Keisuke Arai MD, PhD
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  10. Yoshihide Nanno MD, PhD
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  11. Daisuke Tsugawa MD, PhD
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  13. Hirochika Toyama MD, PhD
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  14. Takumi Fukumoto MD, PhD
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Corresponding author

Correspondence to Hidetoshi Gon MD, PhD.

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Conflict of interest

Drs. Hidetoshi Gon, Shohei Komatsu, Masahiro Kido, Kenji Fukushima, Takeshi Urade, Shinichi So, Toshihiko Yoshida, Keisuke Arai, Jun Ishida, Yoshihide Nanno, Daisuke Tsugawa, Hiroaki Yanagimoto, Hirochika Toyama, and Takumi Fukumoto have no conflicts of interest or financial ties to disclose.

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Gon, H., Komatsu, S., Kido, M. et al. Advantages of the Laparoscopic Approach for the Initial Operation in Patients who Underwent Repeat Hepatectomy. J Gastrointest Surg 27, 1621–1631 (2023). https://doi.org/10.1007/s11605-023-05739-0

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  • DOI: https://doi.org/10.1007/s11605-023-05739-0

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