Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis

Abstract

Background The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND). Methods Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching. Results In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012). Conclusion The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC.

Liver Transplantation for Intrahepatic Cholangiocarcinoma: Ready for Prime Time?

“…[23][24][25] When possible, minimally invasive surgery may have a role in enhancing recovery and potentially reducing complications, though this is not always feasible, and comparative data between open and minimally invasive surgery in this setting are lacking. [26][27][28] Unfortunately, despite achieving a margin-negative resection, long-term oncological outcomes are poor, with 5-year survivals between 30% and 40% and low cure rates (9.7%; 95% CI, 6.1-13.4). [29][30][31] Recurrence rates after LR are high, with the initial recurrence being intrahepatic in 60%-70%.…”

Textbook outcome in hepato-pancreato-biliary surgery: systematic review

“…All studies found better TO rates in patients undergoing a laparoscopic procedure compared with an open procedure. Two of these studies included only patients with ICC 32 , 35 and three studies compared the laparoscopic and open approach in patients with HCC, portal hypertension and cirrhosis, and patients with any liver disease 9 , 31 , 33 . In both studies focusing on HCC, the laparoscopic approach proved to be a predictor of TO in multivariable analysis with Ors of 2.81 (95 per cent c.i.…”

Laparoscopic vs. open anatomical hepatectomy for intrahepatic cholangiocarcinoma: A retrospective cohort study

“…This is not a coincidental finding and has been mentioned in several previous studies. Hobika et al found a lower probability of LND in the laparoscopic group than in the open group in a nationwide study ( 12 ). In addition, Martin et al suggested that laparoscopic treatment for ICC was associated with worse lymph node evaluations than open surgery ( 22 ), while several other meta-analyses also concluded that the LND rate was lower in the laparoscopic group ( 23 , 24 ).…”

“…In 2002, Chen first reported LH for ICC and successfully performed LND laparoscopically ( 11 ); since then, studies on LH for ICC have emerged. In most of these studies, laparoscopic surgery has been suggested to be associated with lower morbidity rates, less pain, faster recovery, and shorter hospital stays than conventional open surgery in terms of short-term outcomes ( 12 – 15 ). However, none of those studies have explored the advantages and disadvantages of the two approaches in terms of short-term outcomes after anatomical hepatectomy.…”