Shelat V G, Serin K, Samim M, Besselink M G, Al Saati H, Gioia P Di, Pearce N W, Abu Hilal M
University Hospital Southampton, NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.
World J Surg. 2014 Dec;38(12):3175-80. doi: 10.1007/s00268-014-2728-3.
Repeat laparoscopic liver resection (R-LLR) can be technically challenging. Data on this topic are scarce and many investigators would question its feasibility and outcomes. The aim of the present study was to evaluate the safety, feasibility, oncological efficiency and outcomes of R-LLR.
We reviewed a prospectively collected database of 403 patients undergoing 422 laparoscopic liver resections (LLRs) from August 2003 to August 2013. Data of 19 patients undergoing R-LLR were analyzed and compared to the primary resection (P-LLR) in these patients. Demographic and clinical data were studied. A subgroup analysis was done for minor resections.
Twenty R-LLRs were performed in 19 patients (female 58 %; mean age: 57.5 years; age range: 23-79 years). Colorectal liver metastases (CRLM) were the commonest indication for R-LLR (60 %), followed by neuroendocrine tumor liver metastases (NETLM) (20 %) and hepatocellular carcinoma (HCC) (10 %). The majority (90 %) of resections were for malignant disease (18/20). There were three conversions (15 %), and two patients developed complications (10 %). The operative time (p = 0.005) and blood loss (p = 0.03) were both significantly greater in R-LLR compared to P-LLR, whereas length of stay (median 4 days; p = 0.30) and complications (p = 0.58) did not differ between the groups. R0 resection rates for P-LLR and R-LLR were 95 and 90 %, respectively (p = 0.73).
Repeat LLR is safe, feasible, and can be performed with minimal morbidity. It appears to be technically more challenging than P-LLR, but without any increase in complications or length of hospital stay.
再次腹腔镜肝切除术（R-LLR）在技术上可能具有挑战性。关于这一主题的数据稀缺，许多研究者会质疑其可行性和结果。本研究的目的是评估R-LLR的安全性、可行性、肿瘤学疗效和结果。
我们回顾了一个前瞻性收集的数据库，该数据库包含2003年8月至2013年8月期间接受422例腹腔镜肝切除术（LLR）的403例患者。分析了19例接受R-LLR患者的数据，并与这些患者的初次肝切除术（P-LLR）进行比较。研究了人口统计学和临床数据。对小范围肝切除术进行了亚组分析。
19例患者共进行了20次R-LLR（女性占58%；平均年龄：57.5岁；年龄范围：23-79岁）。结直肠癌肝转移（CRLM）是R-LLR最常见的适应证（60%），其次是神经内分泌肿瘤肝转移（NETLM）（20%）和肝细胞癌（HCC）（10%）。大多数（90%）肝切除术针对恶性疾病（18/20）。有3例中转开腹（15%），2例患者出现并发症（10%）。与P-LLR相比，R-LLR的手术时间（p = 0.005）和失血量（p = 0.03）均显著增加，而住院时间（中位数4天；p = 0.30）和并发症发生率（p = 0.58）在两组之间没有差异。P-LLR和R-LLR的R0切除率分别为95%和90%（p = 0.73）。
再次LLR是安全、可行的，并且可以以最低的发病率进行。它在技术上似乎比P-LLR更具挑战性，但并发症或住院时间没有任何增加。
