Appropriate indications for laparoscopic repeat hepatectomy

Background: Laparoscopic repeat hepatectomy (LRH) has increased, but appropriate indications for LRH are unclear. This study aimed to clarify appropriate indications for LRH. Methods: : We retrospectively compared surgical outcomes between open RH (ORH) (n=57) and LRH (n=40) groups. To detect difficult cases of complete pure LRH, we examined patients with unplanned intraoperative hand-assisted laparoscopic surgery (HALS)/open conversion (n=6). Results: : In the LRH versus ORH group, as previous hepatectomy, laparoscopic (75% vs. 12%, p<0.001) and Hr0 (73% vs. 37%, p=0.002) were more frequently performed, and as RH procedure, Hr0 (88% vs. 47%, p=0.0002)was more frequently performed. S1 tumor cases were higher in ORH group (11% vs. 0%), but S2-6 cases were higher in LRH group(73% vs. 49%) (p=0.02). In LRH group, compared to the pure LRH patients, HALS/open conversion patients underwent significantly more previous hepatectomy with Hr2-3 (33% vs. 2.9%, p=0.033) and more RH procedures with HrS (33% vs. 2.9%, p=0.03). All LRH requiring a second hepatic hilar approach were HALS conversions. Conclusion: Appropriate indications for LRH were previous hepatectomy was laparoscopic Hr0, and RH procedure was Hr0 for S2-6 tumor location. When RH is more than HrS requiring a second hepatic hilar approach, LRH should not be selected due to the high possibility of HALS/open conversion.