Laparoscopic vs . open second hepatectomy for recurrent hepatocellular carcinoma: a propensity score matching analysis of Takasaki's Glissonean pedicle approach.

BACKGROUND

Comparative evidence of laparoscopic second hepatectomy using standardized anatomical resection techniques is limited. This study compared laparoscopic versus open second hepatectomy using Takasaki's Glissonean pedicle approach combined with Honda's laparoscopic innovations for recurrent hepatocellular carcinoma (HCC).

METHODS

A retrospective cohort study was conducted at Tokyo Women's Medical University Hospital (2010-2024). Of 152 patients who underwent a second hepatectomy for recurrent HCC, 72 were matched (36 per group) using the optimal Mahalanobis distance propensity score matching (PSM) across 25 covariates.

RESULTS

Laparoscopic surgery was associated with lower blood loss (27.5 vs. 366.5 mL; P<0.001), fewer complications (8.3% vs. 25.0%; P=0.048), and shorter postoperative hospital stay (7.0 vs. 11.0 days; P<0.001). No conversions occurred, and 90-day mortality was zero in both groups. R0 resection was universal. Five-year overall survival (OS; 43.7% vs. 44.4%; P=0.77) and recurrence-free survival (PFS; 26.7% vs. 23.6%; P=0.83) were comparable. Residual temporal confounding persisted after matching [standardized mean difference (SMD) for surgery phase =-0.72].

CONCLUSIONS

Laparoscopic second hepatectomy using the Glissonean pedicle approach was associated with favorable perioperative outcomes and survival rates comparable to those of open surgery in selected patients. Therefore, a multicenter prospective validation is warranted.