The Long-Term Outcome of Laparoscopic Resection for Perihilar Cholangiocarcinoma Compared with the Open Approach: A Real-World Multicentric Analysis

Abstract

Objective The aim of this study was to compare the short- and long-term outcomes of laparoscopic surgery (LS) and open surgery (OP) for perihilar cholangiocarcinoma (PHC) using a large real-world dataset in China. Methods Data of patients with PHC who underwent LS and OP from January 2013 to October 2018, across 10 centers in China, were extracted from medical records. A comparative analysis was performed before and after propensity score matching (PSM) in the LS and OP groups and within the study subgroups. The Cox proportional hazards mixed-effects model was applied to estimate the risk factors for mortality, with center and year of operation as random effects. Results A total of 467 patients with PHC were included, of whom 161 underwent LS and 306 underwent OP. Postoperative morbidity, such as hemorrhage, biliary fistula, abdominal abscess, and hepatic insufficiency, was similar between the LS and OP groups. The median overall survival (OS) was longer in the LS group than in the OP group (NA vs. 22 months; hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.02–1.39, p = 0.024). Among the matched datasets, OS was comparable between the LS and OP groups (NA vs. 35 months; HR 0.99, 95% CI 0.77–1.26, p = 0.915). The mixed-effect model identified that the surgical method was not associated with long-term outcomes and that LS and OP provided similar oncological outcomes. Conclusions Considering the comparable long-term prognosis and short-term outcomes of LS and OP, LS could be a technically feasible surgical method for PHC patients with all Bismuth–Corlett types of PHC.

Survival analysis of laparoscopic surgery and open surgery for hilar cholangiocarcinoma: a retrospective cohort study

“…Few previous studies have compared the prognosis of HCCA patients who have undergone these two different types of surgical resection. Our findings, mirroring those of Qin et al [ 16 ] in their study on LS and OP for perihilar cholangiocarcinoma, also indicate comparable long-term prognoses and short-term outcomes for both approaches. However, our study uniquely observed a higher rate of short-term complications and 90-day mortality in the LS group, likely due to our specific patient cohort and our center’s initial experience with laparoscopic HCCA surgery.…”

Minimally Invasive Surgery for Perihilar Cholangiocarcinoma: A Systematic Review of the Short- and Long-Term Results

“…Over the years, an increasing trend in the number of publications was noted, with 12 out of 18 studies published after 2019 (see Figure 2). The vast majority of the studies (78%) were conducted in East Asia (13 from China [28][29][30][31][32][33][34][35][36][37][38][39][40], 1 in South Korea [41]), 2 in Italy [42,43], 1 in France [44] and 1 in the United States [45]. The articles consisted of 7 case-control studies and 11 case series; 15 studies reported on 310 patients undergoing laparoscopic procedures while 3 focused on 62 patients undergoing robotic surgery (see Table 1).…”

Safety and feasibility of laparoscopic radical resection for bismuth types III and IV hilar cholangiocarcinoma: a single-center experience from China

“…Their results suggested that LS was equivalent to OS in terms of short-term outcomes but poorer in terms of long-term outcomes. In contrast, He et al (38) and Qin et al (39) reported that the short-term and long-term outcomes were comparable. In our study, there were no advantages in most intraoperative outcomes and postoperative outcomes in the LS group compared with OS group.…”