Minimally invasive repeat liver resection for recurrent hepatocellular carcinoma: a systematic review of the current literature

Background: The diffusion of minimally invasive liver surgery led to its application to the most complex resections. Some reports reported the possibility to perform a laparoscopic or robotic repeat hepatectomy. The present study aims to review the available series of patients undergoing a minimally invasive repeat liver resection for recurrent hepatocellular carcinoma (HCC). Methods: A systematic review was carried out through the PubMed and Embase databases. All English language original articles (randomized controlled trials, cohort studies, case-control studies, and case series) pertinent to minimally invasive (laparoscopic or robotic) repeat resection for recurrent HCC and published before December 2021 were considered. The following exclusion criteria were used: topic out of the scope of the review; mixed series including HCC patients without the possibility to extract specific data for HCC; studies on animals or simulation; case reports; and reviews. The quality of comparative studies was assessed using the Newcastle-Ottawa Scale (NOS). Short- and long-term results were identified and summarized. Results: Eastern centers) with a total of 1,143 patients. Only two studies reported procedures; 492 were performed after a previous open hepatectomy. Most had a small recurrence (only had multifocal HCC; the median tumor size 30 mm in one study and ranged between 12 and 25 mm in the Major hepatectomy was performed in 3% of patients (33/1,065, missing data in 78 patients), resection of posterosuperior segments in 29% (303/1,046), and anatomic resection in 19% (92/475). Overall, the conversion rate was 6% (32/495). blood loss ranged from 50 to 200 mL. Only three patients (0.3%) had 90-day mortality. The overall and severe morbidity rates were 5–27% and 0–9%, respectively. Ascites occurred in 14/1,024 patients (1.4%) and bile in 20/1,021 (2%). Liver failure and were anecdotal (two and one cases). Ten studies compared the outcomes of laparoscopic and open repeat hepatectomies: the first group had less blood loss, shorter hospital stay, and, in two series, lower morbidity rates. status and survival rates were similar between groups but rarely analyzed. Four studies compared the laparoscopic repeat hepatectomies vs. laparoscopic first resections: the two had similar results except for a longer operative time for the repeat procedures. low risk of liver failure and ascites and, in comparison with open resections, less blood loss and a shorter hospital stay. Further data is needed to confirm its oncological adequacy.