Systematic review of perioperative and oncologic outcomes of minimally-invasive surgery for hilar cholangiocarcinoma

Cipriani, Federica; Ratti, Francesca; Fiorentini, Guido; Reineke, Raffaella; Aldrighetti, Luca

doi:10.1007/s13304-021-01006-6

Cited by 31 publications

(34 citation statements)

References 80 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This evidence together with the appropriateness of loco-regional lymphadenectomy and the reduced intraoperative blood loss reported in the majority of the analyzed studies, allow us to consider the laparoscopic approach non inferior to the open one in terms of operative outcomes. Therefore, is not surprising that the minimally invasive approach has been recently extended to the surgical treatment of hilar type cholangiocarcinoma[ 36 ] and gallbladder cancer[ 37 , 38 ]. These encouraging pivotal experiences seem to demonstrate the feasibility of minimally invasive surgery in a setting often requiring the completion of a major hepatic resection in association with loco-regional lymphadenectomy and the challenge of biliary reconstructions.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma: A systematic review

Patrone¹,

Izzo²,

Palaia³

et al. 2021

WJGO

View full text Add to dashboard Cite

BACKGROUND Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer and is characterized by an aggressive behavior and a dismal prognosis. Radical surgical resection represents the only potentially curative treatment. Despite the increasing acceptance of laparoscopic liver resection for surgical treatment of malignant liver diseases, its use for ICC is not commonly performed. In fact, to achieve surgical free margins a major resection and/or vascular and/or biliary reconstructions is often needed, as well as an associated lymph node dissection. AIM To review and summarize the current evidences on the minimally invasive resection of ICC. METHODS A systematic review of the literature based on the criteria predetermined by the investigators was performed from the 1 st of January 2009 up to the 1 st of January 2021 in 4 databases (PubMed, Scopus, Google Scholar, and Cochrane databases). All retrospective and prospective studies reporting on the comparative outcomes of open vs minimally invasive treatment of ICC were included. An evaluation of manuscripts quality was achieved using Methodological Index for Non-Randomized Studies criteria and Newcastle-Ottawa Scale. RESULTS After a systematic search 9 studies fulfilled the inclusion criteria. Among the all 3012 included patients, 2450 were operated by an open approach and 562 by a minimally invasive (laparoscopic) approach. Baseline characteristics, tumor characteristics, surgical outcomes and oncological outcomes were collected and analyzed, highlighting values with a statistical significant difference between patients treated with open or laparoscopic approach. Shorter hospital stay and lower intraoperative blood losses were reported by some Authors in minimally invasive surgery, on the contrary, in the open group there was a higher number of lymphadenectomies and a higher percentage of major hepatectomies. CONCLUSION Minimally invasive resection of ICC has some short-term benefits and it is safe and feasible only in selected centers with a high experience in laparoscopic approach for liver surgery. Minimally invasive surgery, actually, was considered mainly in patients with a tumor with a diameter < 5 cm, without invasion of main biliary duct or main vessel and no vascular or biliary reconstructions were planned. Further studies are needed to elucidate its impact on long term oncologic outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma: A systematic review

Patrone¹,

Izzo²,

Palaia³

et al. 2021

WJGO

View full text Add to dashboard Cite

show abstract

“…14 Our patient experienced the typical benefits of a minimally invasive hepatobiliary resection, namely minimal blood loss without need for perioperative blood transfusion, uncomplicated postoperative course, and length of stay in hospital at 5 days, compared with the typical 14 days for resection of hilar CCA in the USA. 16 As a result of this expeditious, uncomplicated postoperative recovery, the patient was able to complete intended oncologic adjuvant therapy, known to reduce the risk of recurrent disease and improve survival. 17 There are certain limitations to this robotic resection of type I hilar CCA.…”

Section: Discussionmentioning

confidence: 99%

“…In our case presented, the patient underwent margin-negative resection with bile duct resection and lymphadenectomy alone, for which a concurrent hepatectomy would arguably not provide additional oncologic benefit but instead be associated with increased perioperative risks and morbidity. 16 Although the perioperative benefits of a minimally invasive surgical resection are well established for hepatobiliary cancers, the long-term oncologic efficacy has yet to be fully established. Several studies have demonstrated that robotic or laparoscopic hepatectomy is associated with decreased morbidity and length of hospital stay compared with open hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

Robotic Resection of Type I Hilar Cholangiocarcinoma with Intrapancreatic Bile Duct Dissection

2021

View full text Add to dashboard Cite

Background. Type I hilar cholangiocarcinoma is a malignancy of the extrahepatic bile duct for which marginnegative resection with sufficient lymphadenectomy may provide curative treatment. The aim of this video is to highlight the advantages of optical magnification, articulating instruments, and indocyanine green fluorescent cholangiography to demonstrate extrahepatic bile duct resection from the biliary confluence to the intrapancreatic bile duct with comprehensive hilar lymphadenectomy for pathologic staging. Methods. A 58-year-old male presented with obstructive jaundice and was found to have a biliary stricture arising from the cystic duct and bile duct junction. Endoscopic biopsy of the bile duct confirmed adenocarcinoma. His case was presented at a multidisciplinary tumor conference where consensus was to proceed with upfront robotic en bloc extrahepatic bile duct resection with hilar lymphadenectomy and Roux-en-Y hepaticojejunostomy. Results. Final pathology demonstrated margin-negative resection of moderately differentiated adenocarcinoma, 1 out of 12 lymph nodes involved with disease, and pathologic stage T2N1M0 (stage IIIC). The patient had no postoperative complications and was discharged home on postoperative day 5. At 6 weeks from his operative date, he was initiated on four cycles of adjuvant gemcitabine/capecitabine, followed by 50 Gray external beam radiation therapy with capecitabine, then four cycles of gemcitabine/capecitabine, completed after 6 months of therapy. Conclusions. Robotic extrahepatic bile duct resection, hilar lymphadenectomy, and biliary enteric reconstruction is feasible and should be considered for selected cases of bile duct resection.

show abstract

“…HCCA is easy to invade the adjacent hepatic artery and the portal vein, resulting in a low radical resection rate, only 40.0% ~ 60.0% 2,3 . Therefore, early diagnosis and preoperative resectability assessment are the keys to success in treatment, which is of great significance to improving the 5‐year survival rate of patients and guiding clinical treatment 4,5 …”

Section: Introductionmentioning

confidence: 99%

“…2,3 Therefore, early diagnosis and preoperative resectability assessment are the keys to success in treatment, which is of great significance to improving the 5-year survival rate of patients and guiding clinical treatment. 4,5 Bismuth-Corlette classification is the most commonly used method for the clinical classification of HCCA. 6 The type of surgical resection and the rate of surgical resection of HCCA are directly related to the Bismuth-Corlette classification.…”

mentioning

confidence: 99%

Intravenous combined with intrabiliary contrast‐enhanced ultrasound in the evaluation of resectability of hilar cholangiocarcinomas

Wang

et al. 2022

J of Clinical Ultrasound

View full text Add to dashboard Cite

Objective To investigate the application value of combined intravenous contrast‐enhanced ultrasound (IV‐CEUS) with intrabiliary contrast‐enhanced ultrasound (IB‐CEUS) in the preoperative evaluation of hilar cholangiocarcinoma (HCCA) resectability. Methods Clinical data from 82 patients with HCCA confirmed by surgery and pathology were retrospectively analyzed. Preoperative IV‐CEUS + IB‐CEUS and magnetic resonance cholangiopancreatography (MRCP) were performed and the results were compared with surgical and pathological findings. Results The accuracy of the Bismuth‐Corlette classification confirmed by IV‐CEUS + IB‐CEUS and MRCP was 95.12% (78/82) and 87.8% (72/82), respectively. The diagnostic precision of IV‐CEUS + IB‐CEUS was better than MRCP (p = 0.001). The sensitivity, specificity, and precision of CEUS for diagnosing lymph node metastases (72.7%, 93.3%, and 87.8%), intrahepatic metastases (78.6%, 98.5%, and 93.9%), invasion of the hepatic artery (92.9%, 98.5%, and 97.6%) and invasion of the portal vein (93.8%, 98.5%, and 97.6%) of HCCA were, respectively. The consistency between the preoperative evaluation of resectability confirmed by IV‐CEUS +IB‐CEUS and MRCP was 85.4% (70/82) and 78.0% (64/82), respectively. In addition, the evaluations did not have statistically significant differences (p > 0.05). There were no significant differences between the two evaluations (p = 0.266). Conclusion IV‐CEUS combined with IB‐CEUS has significant value in classifying HCCA and evaluating the resectability of lymph node metastases, liver metastases, and vessel invasion.

show abstract

Systematic review of perioperative and oncologic outcomes of minimally-invasive surgery for hilar cholangiocarcinoma

Cited by 31 publications

References 80 publications

Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma: A systematic review

Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma: A systematic review

Robotic Resection of Type I Hilar Cholangiocarcinoma with Intrapancreatic Bile Duct Dissection

Intravenous combined with intrabiliary contrast‐enhanced ultrasound in the evaluation of resectability of hilar cholangiocarcinomas

Contact Info

Product

Resources

About