To evaluate the safety and efficacy of laparoscopic microwave ablation (MWA) via retroperitoneal approach in the treatment of recurrent hepatocellular carcinoma (HCC).

Clinical data of 29 patients with recurrent HCC who underwent laparoscopic MWA via retroperitoneal approach in the Affiliated Hospital of Kunming University of Science and Technology from January 2020 to December 2022 were retrospectively analyzed. Among them, 16 patients were male and 13 female, aged from 34 to 72 years, with a median age of 45 years. The tumors were all located in the right lobe, with a total of 41 lesions, including 9 in segment 5, 12 in segment 6, 11 in segment 7 and 9 in segment 8, respectively. 18 patients were diagnosed with a single lesion, 10 cases with 2 lesions and 1 case with 3 lesions. The average maximum diameter of the tumor was (2.9±0.9) cm. Preoperative and postoperative tumor indexes, liver function and postoperative complications were analyzed. Clinical efficacy of laparoscopic MWA through retroperitoneal approach for recurrent HCC was evaluated.

All 29 patients successfully completed MWA. The operation time was (135±30) min. Intraoperative blood loss was (178±46) ml. The indwelling time of drainage tube was (4.1±1.3) d. The liver function of all patients was restored to normal at postoperative 2 weeks. A slight amount of pneumoperitoneum was observed in 1 case. After conservative treatment, the patient did not develop any subsequent complications. 9 cases presented with atelectasis and pleural effusion. Following puncture drainage and anti-infection treatment, these patients were discharged after stable condition. 2 patients experienced a slight amount of ascites, and did not develop subsequent complications such as fever and abdominal abscess. No perioperative complications such as abdominal bleeding, infection, liver failure and bile leakage occurred in the remaining patients. The length of postoperative hospital stay was (8.3±5.3) d. The complete ablation rate was 95%(38/41), and the local residual rate was 5%(2/41). The postoperative median overall survival was 23 months, and the 6-month, 1- and 2-year cumulative overall survival rates were 100%, 96.6% and 48.5%, respectively. The 6-month, 1- and 2-year cumulative progression-free survival rates were 100%, 66.7% and 24.0%, respectively.

For patients with recurrent HCC, laparoscopic MWA through retroperitoneal approach can achieve favorable efficacy, high safety, low incidence of postoperative complications, mild trauma and rapid recovery.