{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T06:12:41Z","timestamp":1779257561994,"version":"3.51.4"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Repeat laparoscopic hepatic resection is an important treatment for recurrent hepatocellular carcinoma. However, intra-abdominal adhesions from prior open surgery and poor exposure of posterior segment lesions significantly increase surgical difficulty and risk. To address these challenges, we adopted an innovative retroperitoneal approach for recurrent segment VI hepatocellular carcinoma after previous open hepatectomy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a case of a patient who had previously undergone open non-anatomical resection of a liver tumor in segment VII, followed by multiple sessions of transarterial chemoembolization and microwave ablation after tumor recurrence. At the 6th year of follow-up after hepatic resection, contrast-enhanced magnetic resonance imaging revealed a recurrent lesion measuring 2.0\u2009\u00d7\u20091.6\u2005cm in segment VI of the liver, adjacent to the adrenal gland. Given the patient's history of prior open surgery and multiple minimally invasive treatments, the possibility of intra-abdominal adhesions was considered. Moreover, the retroperitoneal approach allows direct exposure of the tumor in segment VI of the liver. Therefore, we selected the retroperitoneal approach combined with intraoperative ultrasound and successfully performed a laparoscopic non-anatomical resection of the segment VI liver tumor. The patient recovered smoothly postoperatively and was discharged uneventfully.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>For highly selected patients with a small superficial segment VI tumor without major vascular invasion or severe cirrhosis, the retroperitoneal approach for repeat laparoscopic non-anatomical resection is feasible.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1826219","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:47:43Z","timestamp":1779256063000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Recurrent hepatocellular carcinoma treated by laparoscopic non-anatomical liver resection via the retroperitoneal approach: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Kecheng","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bing","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Urology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruiliang","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University","place":["Shanghai, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: gLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B2","doi-asserted-by":"publisher","first-page":"536","DOI":"10.1097\/01.sla.0000059988.22416.f2","article-title":"Liver resection for hepatocellular carcinoma on cirrhosis: univariate and multivariate analysis of risk factors for intrahepatic recurrence","volume":"237","author":"Ercolani","year":"2003","journal-title":"Ann Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1007\/s00423-017-1582-9","article-title":"Treatment and outcomes of recurrent hepatocellular carcinomas","volume":"402","author":"Joliat","year":"2017","journal-title":"Langenbecks Arch Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1364","DOI":"10.1016\/j.hpb.2024.07.414","article-title":"Repeat laparoscopic liver resection after an initial open hepatectomy","volume":"26","author":"Abdul","year":"2024","journal-title":"HPB (Oxford)"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2083","DOI":"10.1007\/s00464-019-06754-6","article-title":"Short-term outcomes of laparoscopic repeat liver resection after open liver resection: a systematic review","volume":"33","author":"Wakabayashi","year":"2019","journal-title":"Surg Endosc"},{"key":"B6","doi-asserted-by":"publisher","first-page":"963","DOI":"10.1097\/js9.0000000000000305","article-title":"Laparoscopic versus open repeat hepatectomy for recurrent hepatocellular carcinoma: a systematic review and meta-analysis of propensity score-matched cohort studies","volume":"109","author":"Xiang","year":"2023","journal-title":"International Journal of Surgery (London, England)"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1097\/tp.0000000000003344","article-title":"Timing for Introduction of total laparoscopic living donor right hepatectomy; 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