Association of Laparoscopic Surgery with Improved Perioperative and Survival Outcomes in Patients with Resectable Intrahepatic Cholangiocarcinoma: A Systematic Review and Meta-Analysis from Propensity-Score Matched Studies

Aliseda, Daniel; Martí‐Cruchaga, Pablo; Zozaya, Gabriel; Blanco, N; Goh, Brian K.P.; Rotellar, Fernando

doi:10.1245/s10434-023-13498-0

Cited by 9 publications

(3 citation statements)

References 45 publications

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“…Previous research has already associated laparoscopic approach to superior intraoperative, postoperative, and survival outcomes compared with open surgery in patients with colorectal liver metastases, intrahepatic cholangiocarcinoma, and HCC with Child-Pugh A and B cirrhosis. [38][39][40][41] The benefits of MILR in cirrhotic patients include better preservation of perihepatic collateral vessels, the supportive effect of pneumoperitoneum, reduced intraoperative blood loss, lower transfusion requirements, and limited nonsensory fluid loss. These advantages have shown a positive impact, reducing mortality and postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Portal Hypertension Assessment Method on the Outcomes of Hepatocellular Carcinoma Resection

Aliseda,

Zozaya,

Martí-Cruchaga

et al. 2023

Annals of Surgery

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Objective: Examine PHT impact on postoperative and survival outcomes in HCC patients after LR, specifically exploring distinctions between indirect signs and invasive measurements of PHT. Summary Background Data: PHT has historically discouraged LR in individuals with HCC, due to the elevated risk of morbidity, including liver decompensation (LD). Methods: A systematic review was conducted using 3 databases to identify prospective controlled and matched cohort studies until December 28, 2022. Focus on comparing postoperative outcomes (mortality, morbidity, and liver-related complications) and OS in HCC patients with and without PHT undergoing LR. Three meta-analysis models were utilized: For aggregated data (fixed-effects inverse variance model), for patient-level survival data (one-stage frequentist meta-analysis with gamma-shared frailty Cox proportional hazards model), and for pooled data (Freeman-Tukey exact and double arcsine method). Results: Nine studies involving 1,124 patients were analyzed. Indirect signs of PHT were not significantly associated with higher mortality, overall complications, PHLF or LD. However, LR in patients with HVPG ≥10 mmHg significantly increased the risk of overall complications, PHLF and LD. Despite elevated risks, the procedure resulted in a 5-year OS rate of 55.2%. Open LR significantly increased the risk of overall complications, PHLF and LD. Conversely, PHT did not show a significant association with worse postoperative outcomes in MILR. Conclusions: LR with indirect PHT signs poses no increased risk of complications. Yet, in HVPG ≥10 mmHg patients, LR increases overall morbidity and liver-related complications risk. Transjugular HVPG assessment is crucial for LR decisions. MI approach seems to be vital for favorable outcomes, especially in HVPG ≥10 mmHg patients.

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Section: Discussionmentioning

confidence: 99%

The Impact of Portal Hypertension Assessment Method on the Outcomes of Hepatocellular Carcinoma Resection

Aliseda,

Zozaya,

Martí-Cruchaga

et al. 2023

Annals of Surgery

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“…Secondly, we used stratified Cox models to adjust for inter-study heterogeneity by allowing patients from a given study to assume a baseline hazard unique to that study [ 23 ]. The Grambsch-Therneau tests for nonzero slope with a plotted scaled Schoenfeld residuals were applied to identify violations of the proportionality assumption of Cox regression models [ 24 ]. In addition, differences in survival outcomes between the LG and OG groups were also assessed via RMST, which can provide a robust estimation of survival at different cut-off time points in the presence of proportionality violation [ 25 ].…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic versus open gastrectomy for nonmetastatic T4a gastric cancer: a meta-analysis of reconstructed individual participant data from propensity score-matched studies

Pang,

Yan,

Zhao

et al. 2024

World J Surg Onc

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Background The applicability of laparoscopy to nonmetastatic T4a patients with gastric cancer remains unclear due to the lack of high-quality evidence. The purpose of this study was to compare the survival rates of laparoscopic gastrectomy (LG) versus open gastrectomy (OG) for these patients through a meta-analysis of reconstructed individual participant data from propensity score-matched studies. Methods PubMed, Embase, Web of Science, Cochrane library and CNKI were examined for relevant studies without language restrictions through July 25, 2023. Individual participant data on overall survival (OS) and disease-free survival (DFS) were extracted from the published Kaplan-Meier survival curves. One-stage and two-stage meta-analyses were performed. In addition, data regarding surgical outcomes and recurrence patterns were also collected, which were meta-analyzed using traditional aggregated data. Results Six studies comprising 1860 patients were included for analysis. In the one-stage meta-analyses, the results demonstrated that LG was associated with a significantly better DFS (Random-effects model: P = 0.027; Restricted mean survival time [RMST] up to 5 years: P = 0.033) and a comparable OS (Random-effects model: P = 0.135; RMST up to 5 years: P = 0.053) than OG for T4a gastric cancer patients. Two-stage meta-analyses resulted in similar results, with a 13% reduced hazard of cancer-related death (P = 0.04) and 10% reduced hazard of overall mortality (P = 0.11) in the LG group. For secondary outcomes, the pooled results showed an association of LG with less estimated blood loss, faster postoperative recovery and more retrieved lymph nodes. Conclusion Laparoscopic surgery for patients with nonmetastatic T4a disease is associated with a potential survival benefit and improved surgical outcomes.

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“…A meta-analysis conducted by Aliseda et al [70] reported interesting data related to laparoscopic resection for iCCA compared to open resection.…”

Section: Minimally Invasive Surgerymentioning

confidence: 99%

New Insights into Surgical Management of Intrahepatic Cholangiocarcinoma in the Era of “Transplant Oncology”

Melandro,

Ghinolfi,

Gallo

et al. 2023

Gastroenterology Insights

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Intrahepatic cholangiocarcinoma (iCCA) represents the second most frequent type of primary liver neoplasm. The diagnosis and treatment of patients with iCCA involves many challenges. To date, surgical resection with negative margins is the main curative option, achieving an acceptable long-term survival. Despite enabling a considerable improvement in the outcome, iCCA recurrence after surgery is still common. Tumor extension and the histological subtype, as well as vascular and lymph node involvements, are key factors used to define the prognosis. In this narrative review, we aimed to discuss the potential benefits of using different surgical strategies in the field of iCCA, including vascular resection, the mini-invasive approach, liver transplantation, the mechanism used to enable future liver remnant augmentation, and lymph node dissection. We also discussed the new protocols developed in the field of systemic treatment, including immunotherapy and molecular targeted therapy. Recent advancements in the diagnosis, surgical treatment, and understanding of tumor biology have changed the landscape in terms of treatment options. Creating a multidisciplinary tumor board is essential to achieving the best patient outcomes. Further investigational trials are required with the intent of tailoring the treatments and establishing the right patient population who would benefit from the use of new therapeutics algorithms.

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Association of Laparoscopic Surgery with Improved Perioperative and Survival Outcomes in Patients with Resectable Intrahepatic Cholangiocarcinoma: A Systematic Review and Meta-Analysis from Propensity-Score Matched Studies

Cited by 9 publications

References 45 publications

The Impact of Portal Hypertension Assessment Method on the Outcomes of Hepatocellular Carcinoma Resection

The Impact of Portal Hypertension Assessment Method on the Outcomes of Hepatocellular Carcinoma Resection

Laparoscopic versus open gastrectomy for nonmetastatic T4a gastric cancer: a meta-analysis of reconstructed individual participant data from propensity score-matched studies

New Insights into Surgical Management of Intrahepatic Cholangiocarcinoma in the Era of “Transplant Oncology”

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