Laparoscopic vs open liver re-resection for cirrhotic patients with post-hepatectomy hepatocellular carcinoma recurrence: A comparative study

Table 1 Details of hepatectomy in previous liver resection

Previous liver resection	LRH, n = 29	ORH, n = 22	P value
Approach			0.395
Laparoscopic	14 (48.3)	8 (36.4)
Open	15 (51.7)	14 (63.6)
Type of resection			0.224
Major	24 (82.8)	15 (68.2)
Minor	5 (17.2)	7 (31.8)
Tumour location, segment			0.780
II, III, IV, V, VI	16 (55.2)	13 (59.1)
VII, VIII	13 (44.8)	9 (40.9)
Number of previous hepatectomy			0.478
1	17 (58.6)	16 (72.7)
2	9 (31.0)	5 (22.7)
3	2 (6.9)	0 (0.0)
4	0 (0.0)	1 (4.5)
5	1 (3.4)	0 (0.0)
Microscopic lymphovascular invasion			1.000
No	20 (69.0)	15 (68.2)
Yes	4 (13.8)	4 (18.2)
Not assessed	5 (17.2)	3 (13.6)

Values are n (%). LRH: Laparoscopic repeat hepatectomy; ORH: Open repeat hepatectomy.

Table 2 Patient and tumour characteristics

Characteristic	LRH, n = 29	ORH, n = 22	P value
Age	64 (57.5-67.5)	65.5 (59.75-69.25)	0.607
Sex			0.688
Male	25 (86.2)	20 (90.9)
Female	4 (13.8)	2 (9.1)
Cirrhosis on histology	19 (65.5)	13 (59.1)	0.638
HBsAg-positive	27 (93.1)	20 (90.9)	1.000
Albumin in g/L	39 (36-41)	36 (34-40)	0.109
Total bilirubin in µmol/L	17 (13-20)	13 (10-16)	0.007
International normalized ratio	1.1 (1.05-1.20)	1.085 (1.055-1.148)	0.587
Platelet count as × 109/L	123 (99-173)	161.5 (115.25-201.00)	0.092
Alpha-fetoprotein in IU/mL	11 (4.25-288.00)	17 (4.0-174.5)	0.814
Type of resection			0.055
Sub-segmentectomy	19 (65.5)	8 (36.4)
Segmentectomy	5 (17.2)	2 (9.1)
Left lateral sectionectomy	2 (6.9)	1 (4.5)
Right bisegmentectomy	1 (3.4)	4 (18.2)
Left hepatectomy +/− extended	1 (3.4)	1 (4.5)
Right hepatectomy +/− extended	1 (3.4)	5 (22.7)
Central bisectionectomy	0 (0.0)	1 (4.5)
Intraoperative ablation	1 (3.4)	2 (9.1)	0.571
Tumour size in cm			0.054
< 1	2 (6.9)	1 (4.5)
≥ 1-2	15 (51.7)	7 (31.8)
≥ 2-3	5 (17.2)	3 (13.6)
≥ 3-4	5 (17.2)	2 (9.1)
≥ 4-5	1 (3.4)	8 (36.4)
≥ 5	1 (3.4)	1 (4.5)
Number of tumours			0.295
Single	25 (86.2)	16 (72.7)
Multiple	4 (13.8)	6 (27.3)
Tumour location, segment			0.491
I	2 (6.9)	0 (0.0)
II, III, IV, V, VI	14 (48.3)	9 (40.9)
VII, VIII	13 (44.8)	13 (59.1)

Values are n (%) or median (interquartile range). HBsAg: Hepatitis B surface antigen; LRH: Laparoscopic repeat hepatectomy; ORH: Open repeat hepatectomy. Right bisegmentectomy: Right anterior sectionectomy or right posterior sectionectomy; Left hepatectomy +/− extended: Left hepatectomy or extended left hepatectomy; Right hepatectomy +/− extended: Right hepatectomy or extended right hepatectomy.

Table 3 Operative outcomes

Outcome	LRH, n = 29	ORH, n = 22	P value
Operative time in min	250 (177.5-320.5)	300.5 (223.00-378.75)	0.224
Pringle manoeuvre used	2 (6.9)	3 (13.6)	0.641
Blood loss in mL	300 (200-700)	750 (300-1450)	0.013
Blood transfusion	6 (20.7)	8 (36.4)	0.214
Conversion	6 (20.7)
Hospital stay in d	5 (4-7)	7 (5.75-11.50)	0.003
Resection margin in mm	7.25 (5.00-13.25)	4.25 (1.00-8.25)	0.073
Positive margin	2 (7.1)	2 (9.1)	0.801
Complications	3 (10.3)	6 (27.3)	0.150
Chest infection	0	1
Pleural effusion	1	3
Arrhythmia	2	0
Bile leak	0	2
Liver failure	0	0
UTI	0	1
Intra-abdominal infection	1	1
Clavien-Dindo severity of complications
IIIa	1 (1.1)	5 (22.7)	0.073
IIIb	0	0
IV	0	0
V	0 (0.0)	1 (4.5)	0.431

Values are n (%) or median (interquartile range). LRH: Laparoscopic repeat hepatectomy; ORH: Open repeat hepatectomy; UTI: Urinary tract infection.