Selection criteria for minimally invasive resection of intrahepatic cholangiocarcinoma—a word of caution: a propensity score matched analysis using the national cancer database

Salehi, Omid; Казакова, В.А.; Vega, Eduardo; Kutlu, Onur; Alarcon, Sylvia V.; Freeman, Richard K.; Kozyreva, Olga; Conrad, Claudius

doi:10.1007/s00464-021-08842-y

Cited by 9 publications

(8 citation statements)

References 27 publications

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“…Unlike HCC, even today, when the concept of comprehensive systemic treatment is advocated extensively, an endless stream of targeted or immunotherapeutic drugs have not brought breakthrough survival benefits to ICC [ 18 , 19 ], and hepatectomy is still considered the essential treatment [ 20 ]. Given the superiorities of minimal trauma, high-quality surgery, and fewer complications, laparoscopic liver resection (LLR) is controversial in treating ICC for the biological characteristics of diseases [ 21 ]. Controversies about LLR for ICC concentrate on the insufficient quality of lymph node dissection [ 12 ], indistinct surgical margin due to the lack of tactile impression, and tumor dissemination caused by the vibration of surgical instruments with energy such as ultrasonic scalpel and pneumoperitoneum implantation.…”

Section: Discussionmentioning

confidence: 99%

Safety and feasibility of laparoscopic liver resection for intrahepatic cholangiocarcinoma: a propensity score-matched study

et al. 2023

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Background Laparoscopic liver resection (LLR) is controversial in treating intrahepatic cholangiocarcinoma (ICC). Therefore, this study aimed to evaluate the safety and feasibility of LLR for the treatment of ICC and explored the independent factors affecting the long-term prognosis of ICC. Methods We included 170 patients undergoing hepatectomy for ICC from December 2010 to December 2021 and divided them into LLR group and open liver resection (OLR) group. We used propensity score matching (PSM) analysis to reduce the impact of data bias and confounding variables and then compared the short-term and long-term prognosis of LLR and OLR in treating ICC; Cox proportional hazards regression model was adopted to explore the independent factors affecting the long-term prognosis of ICC. Results A total of 105 patients (70 in the LLR group and 35 in the OLR group) were included after 2:1 PSM analysis. There was no difference in demographic characteristics and preoperative indexes between the two groups. The perioperative results of the OLR group were worse than those of the LLR group, that is, the intraoperative blood transfusion rate (24 (68.6) vs 21 (30.0)), blood loss (500 (200–1500) vs 200 (100–525)), and the morbidity of major postoperative complications (9 (25.7) vs 6 (8.5)) in the OLR group were worse than those in LLR group. LLR could enable patients to obtain an equivalent long-term prognosis compared to OLR. The Cox proportional hazards regression model exhibited that no matter before or after PSM, preoperative serum CA12-5 and postoperative hospital stay were independent factors affecting overall survival, while only lymph node metastasis independently influenced recurrence-free survival. Conclusions Compared with ICC treated by OLR, the LLR group obtained superior perioperative period outcomes. In the long run, LLR could enable ICC patients to receive an equivalent long-term prognosis compared to OLR. In addition, ICC patients with preoperative abnormal CA12-5, lymph node metastasis, and more extended postoperative hospital stay might suffer from a worse long-term prognosis. However, these conclusions still need multicenter extensive sample prospective research to demonstrate.

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Section: Discussionmentioning

confidence: 99%

Safety and feasibility of laparoscopic liver resection for intrahepatic cholangiocarcinoma: a propensity score-matched study

et al. 2023

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“…Although laparoscopic liver surgery has undergone exponential diffusion in the recent years, because of the standardization of techniques and technological advances, its penetration for biliary tumors has not shown a uniform distribution. 1,[9][10][11][12]15,16 Consequently, the limited success of MILS for cholangiocarcinoma is likely due to the technical complexity of LND for biliary tumors, together with the complexity of liver surgery in specific settings, such as perihilar cholangiocarcinoma, leading to low reproducibility on a large scale and out of centers with a high volume of hepatic surgery, and specific commitment to minimally invasive procedures. 9,19,20 The caudal view conferred by the laparoscopic approach, together with the linear shape of the instruments, leads to technical complexities during LND, mainly enhanced in specific areas, such as the left side of the portal vein and the posterior aspect of the hepatic artery.…”

Section: Discussionmentioning

confidence: 99%

“…9,15,16 Nevertheless, this possibility still raises some skepticism because of the divergences in the reported results: the data available in the literature are indeed still discordant, especially when older series or series not belonging to high-volume centers are analyzed; thus, this scenario still limits the reproducibility of MILS for biliary tumors. [9][10][11][12][15][16][17] In a previous study by our group, the outcomes of laparoscopic and open LND were specifically compared, demonstrating the oncological equivalence of these techniques and the short-term superiority of the laparoscopic approach. 10 However, laparoscopic LND is a complex and time-consuming intervention, and the possibility of simplifying it and improving its reproducibility owing to the dexterity conferred by the robotic approach is a topic that deserves to be explored.…”

mentioning

confidence: 92%

“…8,9 Specifically, the topic of lymph node dissection (LND) in liver tumors and its relationship with minimal invasiveness has only recently been debated. [10][11][12] In fact, the role of LND of stations 8 and 12-routinely performed in biliary neoplasms-has a widely recognized staging value and has prognostic implications that are still under investigation. 13,14 Alternately, minimally invasive surgery for these tumors has shown perioperative advantages and oncological noninferiority compared with the open approach in recent reports.…”

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confidence: 99%

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Robotic Approach for Lymphadenectomy in Biliary Tumors

et al. 2022

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Objective: This study aimed to evaluate the oncological adequacy of lymphadenectomy (LND) for biliary tumors and surgical outcomes of resections performed using robotic, laparoscopic, and open approaches and to compare the techniques within a weighted propensity score analysis. Background: The need to perform formal LND is considered a limit for the applicability of minimally invasive liver surgery. Methods: Overall, 25 robotic resections with LND (2021-2022) from a single-center constituted the study group (Rob group), matched by inverse probability treatment weighting with 97 laparoscopic (Lap group) and 113 open (Open group) procedures to address the primary endpoint. A "per-period" analysis was performed comparing the characteristics and outcomes of the Rob group with the first 25 consecutive laparoscopic liver resections with associated LND (LapInit group). Results: Minimally invasive techniques performed equally well regarding the number of harvested nodes, blood transfusions, functional recovery, length of stay, and major morbidity and provided a short-term benefit to patients when compared with the open technique. A better performance of the robotic approach over laparoscopic approach (and both approaches over the open technique) was recorded for patients achieving LND with retrieval of > 6 nodes. The open approach reduced both the operative time and time for LND, and robotic surgery performed better than laparoscopic surgery. Conclusions: Minimally invasive techniques are excellent tools for the management of LND in patients with biliary tumors, showing feasibility, and oncological adequacy. Robotics could contribute to the large-scale diffusion of these procedures with a high profile of complexity.

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“…A total of 365 articles were retrieved from the initial screening. Seventeen articles (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37), including 15 that were published in English and 2 in Chinese, were incorporated into the meta-analysis. There were 8 propensity matching score (PSM) studies and 9 retrospective studies which unused propensity matching score, including a total of 3975 patients (1083 in the Lap-ICC group and 2892 in the Open-ICC group).…”

Section: Study Selectionmentioning

confidence: 99%

Laparoscopic or open liver resection for intrahepatic cholangiocarcinoma: A meta-analysis and systematic review

et al. 2023

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BackgroundAlthough laparoscopic hepatectomy has been widely used in the treatment of benign and malignant liver diseases, its applicability in intrahepatic cholangiocarcinoma (ICC) is controversial. We conducted a meta-analysis to compare the short-term and long-term outcomes of laparoscopic hepatectomy (Lap-ICC) and open hepatectomy (Open-ICC) in ICC patients.MethodsThe PubMed, Web of science, Cochrane Library, China National Knowledge Infrastructure and other databases were searched for the relevant literature. The research data were extracted according to the inclusion and exclusion criteria.ResultsSeventeen studies, including 3975 ICC patients, were selected for the meta-analysis. Compared to Open-ICC, Lap-ICC had lower rates of lymph node dissection (OR=0.44, P=0.01) and metastasis (OR=0.58, P=0.03), along with less intraoperative bleeding (MD=-128.43 ml, P<0.01) lower blood transfusion rate (OR=0.43, P<0.01), shorter hospital stay (MD=-2.75 day, P<0.01), higher R0 resection rate (OR=1.60, P<0.01), and lower tumor recurrence rate (OR=0.67, P=0.01). However, there was no difference between the two groups in terms of operation time, number of lymph node dissection, incision margin distance, overall complications rate, severe complications rate, and the 1-, 3- and 5-year DFS and OS rates.ConclusionLaparoscopic hepatectomy is partially superior to open hepatectomy in terms of less bleeding, shorter hospital stay and higher R0 resection rate, while the long-term efficacy of the two approaches is similar.

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Selection criteria for minimally invasive resection of intrahepatic cholangiocarcinoma—a word of caution: a propensity score matched analysis using the national cancer database

Cited by 9 publications

References 27 publications

Safety and feasibility of laparoscopic liver resection for intrahepatic cholangiocarcinoma: a propensity score-matched study

Safety and feasibility of laparoscopic liver resection for intrahepatic cholangiocarcinoma: a propensity score-matched study

Robotic Approach for Lymphadenectomy in Biliary Tumors

Laparoscopic or open liver resection for intrahepatic cholangiocarcinoma: A meta-analysis and systematic review

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