Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital, 2-13-22 Miyakojima Hondoori, Miyakojima-ku, Osaka 534-0021, Japan.
J Hepatobiliary Pancreat Sci. 2013 Jun;20(5):512-7. doi: 10.1007/s00534-012-0592-9.
It is still unknown whether laparoscopic liver resection is suitable for recurrent hepatocellular carcinoma (HCC) after previous curative hepatic resection.
The perioperative outcomes of 40 patients treated with second surgery for recurrent HCC by partial hepatectomy were studied retrospectively. The second surgery was performed under laparotomy in 20 patients (laparotomy group) and under laparoscopy in 20 patients (laparoscopy group).
Intraoperative blood loss (p < 0.0001) and the incidence of postoperative complications (p = 0.0004) were lower in the laparoscopy group than in the laparotomy group. The incidence rates of surgical site infection and intractable ascites were significantly higher in the laparotomy group than in the laparoscopy group (p = 0.0202, p = 0.0436, respectively). The proportion of patients classified as Clavien grade IIIa was higher in the laparotomy group than in the laparoscopy group (p = 0.0033). The duration of the postoperative hospital stay was significantly shorter in the laparoscopy group than in the laparotomy group (p < 0.0001).
Postoperative morbidity has been decreased by the introduction of laparoscopic liver resection in patients with recurrent HCC after curative hepatic resection. As a result, the duration of the postoperative stay is shorter.
腹腔镜肝切除术是否适用于既往根治性肝切除后复发的肝细胞癌（HCC）仍不清楚。
回顾性研究了 40 例接受再次部分肝切除术治疗复发性 HCC 患者的围手术期结果。20 例患者行剖腹手术（剖腹组），20 例患者行腹腔镜手术（腹腔镜组）。
腹腔镜组术中出血量（p<0.0001）和术后并发症发生率（p=0.0004）低于剖腹组。剖腹组手术部位感染和难治性腹水的发生率明显高于腹腔镜组（p=0.0202，p=0.0436）。剖腹组 Clavien 分级为 IIIa 级的患者比例高于腹腔镜组（p=0.0033）。腹腔镜组的术后住院时间明显短于剖腹组（p<0.0001）。
在根治性肝切除术后复发 HCC 患者中引入腹腔镜肝切除术可降低术后发病率，从而缩短术后住院时间。
