Impact of laparoscopic repeat hepatectomy on the outcomes of recurrent hepatocellular carcinoma.

PURPOSE: This study compared the clinical background, surgical factors, and short- and long-term outcomes of patients who underwent laparoscopic versus open surgery for recurrent hepatocellular carcinoma (HCC). Furthermore, we investigated whether surgical factors were influenced by the use of the Pringle maneuver and adhesion prevention agents in previous laparoscopic surgeries. METHODS: We retrospectively analyzed the clinicopathological factors and outcomes of 106 consecutive patients who underwent repeat hepatectomy for recurrent hepatocellular carcinoma between January 2010 and December 2025. RESULTS: Sixty-seven patients underwent laparoscopic hepatectomy (laparoscopic group), whereas 39 underwent open hepatectomy or conversion from laparoscopic to open surgery (open group). The open group had fewer women, more anatomical resections, a higher proportion of prior open liver resections, and a larger tumor size than the laparoscopic group. The open group had poorer recurrence-free and overall survival rates than the laparoscopic group. Surgery without the Pringle maneuver had a shorter surgical time, less blood loss, and fewer postoperative complications than surgery with the Pringle maneuver. The use of adhesion inhibitors before liver resection did not significantly affect operation time, blood loss, or postoperative complications. CONCLUSIONS: Attempting laparoscopic surgery for repeat hepatectomy is a reasonable option for patients with recurrent hepatocellular carcinoma.