Safety and feasibility of laparoscopic liver resection with associated lymphadenectomy for intrahepatic cholangiocarcinoma: a propensity score-based case-matched analysis from a single institution

Abstract

Compared with open surgery, laparoscopic resection of ICC is feasible and safe, providing short-term benefits without negatively affecting oncologic adequacy in terms of rate of R0 resections, depth of margins, and long-term overall and disease-free survivals. Laparoscopic regional lymphadenectomy is technically possible but should be the object of future focused studies.

The role of minimally invasive hepatectomy for hilar and intrahepatic cholangiocarcinoma: A systematic review of the literature

“…Regarding oncologic outcomes, there was no significant difference on R0 resection rates (OR, 0.71; 95% CI (0.07, 7.13); P = .77; heterogeneity, I 2 = 0%; Figure B), the findings are detailed in Table . Patients submitted to OLR had lymphadenectomy performed more frequently (OR, 0.09; 95% CI [0.04, 0.24]; P = 0 < 00001; heterogeneity, I 2 = 57%) (Figure C), and two studies reported number of harvested lymph nodes; pooled analysis data has shown that patients in LLR group had significantly lower number of harvested lymph nodes (OR, 0.46; 95% CI [−0.87, −0.06]; P = .03/heterogeneity I 2 = 0%) (Figure D). Also, there was no significant difference in 3‐year DFS between OLR and LLR (OR: 0.48, 95% CI: 0.2‐1.15 P = .1/heterogeneity I 2 = 0%; Figure E) and 3‐year OS (OR, 0.57; 95% CI, 0.22‐1.474; P = .24; heterogeneity I 2 = 0%; Figure F)…”

“…Among 186 patients from four comparative studies with intrahepatic cholangiocarcinoma, 57 patients were submitted to LLR and 129 to OLR, as described in Table . Pooled data analyses concerning intra and postoperative outcomes are depicted in Figures and .…”

“…Although no significant difference was found in operative time (SMD, −0.10; 95% CI [−0.86, 0.67]; P = .80; heterogeneity, I 2 = 82%; Figure B), LLR presented lower estimated blood losses (SMD, −0.55; 95% CI [−1.03,−0.06]; P < .03; heterogeneity, I 2 = 55%; Figure C), and need for Pringle maneuver (OR, 0.17; 95% CI [0.07, 0.44]; P = .0002; heterogeneity, I 2 = 0%; Figure D). During perioperative period, there were no postoperative deaths, and no difference was found regarding morbidities, neither for overall (OR, 0.64; 95% CI [0.28, 1.47]; P = .30; heterogeneity, I 2 = 0%; Figure E), nor for major morbidities (OR, 1.08; 95% CI [0.36, 3.27]; P = .89; heterogeneity, I 2 = 0 Figure F); and length of stay (SMD, −0.26; 95% CI [−0.58, 0.05]; P = .10; heterogeneity, I 2 = 0; Figure A) .…”

“…13 | 865 cohort studies) and nine noncomparative studies were included for analysis. 7,[26][27][28][29][30][31][32][33][34][35][36][37] For pCCA analysis, one comparative study (retrospective cohort) and nine noncomparative studies were included. [38][39][40][41][42][43][44][45][46][47][48][49] Two records had data regarding both iCCA and pCCA.…”

“…Theoretically, the increased intra‐abdominal pressure caused by the pneumoperitoneum controls back‐bleeding during liver parenchymal liver transections . Also, avoiding Pringle maneuver may prevent liver ischemia during procedure, decreasing risk of hepatic decompensation in patients with fibrosis or steatosis . Despite a phyisiologic rationale for lower estimated blood losses in LLR group this review has found that major liver resections, which are associated with greater blood losses were performed more frequently by the open approach, which are associated with greater blood losses.…”