Total laparoscopic versus open radical resection for hilar cholangiocarcinoma

Zhang, Yuhua; Dou, Changwei; Wu, Weiding; Liu, Jie; Jin, Liming; Hu, Zhiming; Zhang, Chengwu

doi:10.1007/s00464-019-07211-0

Cited by 43 publications

(60 citation statements)

References 15 publications

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“…Transection of the left hepatic duct (#), which varies in length from 1 to 5 cm, can commonly be performed before its segmentation into corresponding liver segments 2 and 3. In extended left hemihepatectomies or left trisectionectomies, which include the removal of liver segments [1,2,3,4,5,8], the transection of right biliary structures (*) commonly requires reconstruction of several small orifices OPEN ACCESS This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.…”

Section: Discussionmentioning

confidence: 99%

“…1 Although technically highly demanding, all the aforementioned critical steps of cholangiocarcinoma (CCA) surgery recently have been performed totally by minimally invasive techniques for selected groups of patients. [2][3][4] Furthermore, a recent analysis of patients with pCCA treated in one of the leading European centers for laparoscopic liver surgery showed no oncologic inferiority of a laparoscopic resection, which might have been a major concern of surgeons preparing for the final step toward minimally invasiveness in pCCA surgery. 5 However, from the expert's point of view, minimally invasive pCCA surgery remains in an exploratory phase, with the conversion rate of 18.8% reaching the rate generally reported for major laparoscopic hepatectomies.…”

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confidence: 99%

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Total Laparoscopic Resection of Hilar Cholangiocarcinoma Type 3b: Applying a Parachute Technique for Hepaticojejunostomy

2020

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Background Laparoscopic liver resection for perihilar cholangiocarcinoma (pCCA) is still in its infancy. The biliary-enteric reconstruction represents one of the most delicate parts of this minimally invasive procedure. Methods In this study, a 78-year old woman with perihilar cholangiocarcinoma (pCCA) type 3b underwent a hepaticojejunostomy performed by a parachute technique. Results The operation, performed totally by minimally invasive resections, was completed in 386 min, with a blood loss of less than 400 ml and no transfusion requirements. Two intraluminal stents were placed during the hepaticojenunostomy for splinting of the biliary-enteric anastomosis. The patient required prolonged antibiotic treatment for postoperative cholangitis and finally was discharged on postoperative day 15. The histopathologic grading displayed a G 2–3 adenocarcinoma, pT3 pN0, M0, L1, V1, pN1, UICC IIIc R0, and the patient was referred to adjuvant chemotherapy. Conclusion Resections of pCCAs, performed totally by minimally invasive techniques, may be feasible and safe for a selected group of patients. With this approach, a running-suture hepaticojejunostomy using the parachute technique represents a worthwhile strategy for biliary-enteric reconstruction.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Total Laparoscopic Resection of Hilar Cholangiocarcinoma Type 3b: Applying a Parachute Technique for Hepaticojejunostomy

2020

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“…In retrospect, there were many technical boundaries that were torn down one after the other. Therefore, it is not surprising that in the meantime, there are first case series of minimally invasive surgery for perihilar cholangiocarcinoma (PHC) [63][64][65]. Evidence has been provided that both extended hepatectomy as well as biliary reconstruction should be considered technically possible.…”

Section: Biliary Reconstructionmentioning

confidence: 99%

“…However, these reports are not sufficient for a robust assessment. Experience with PHC is up to now limited to individual cases and small case series from highly experienced centers [63,65,66]. Larger series or ideally comparative studies are not to be expected in the near future due to the rarity of these interventions alone.…”

Section: Biliary Reconstructionmentioning

confidence: 99%

Laparoscopic liver resection: indications, limitations, and economic aspects

Schmelzle

Krenzien

Schöning

et al. 2020

Langenbecks Arch Surg

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Background Minimally invasive techniques have increasingly found their way into liver surgery in recent years. A multitude of mostly retrospective analyses suggests several advantages of laparoscopic over open liver surgery. Due to the speed and variety of simultaneous technical and strategic developments, it is difficult to maintain an overview of the current status and perspectives in laparoscopic liver surgery. Purpose This review highlights up-to-date aspects in laparoscopic liver surgery. We discuss established indications with regard to their development over time as well as continuing limitations of applied techniques. We give an assessment based on the current literature and according to our own center experiences, not least with regard to a highly topical cost discussion. Conclusions While in the beginning mainly benign tumors were laparoscopically operated on, liver metastasis and hepatocellular carcinoma are now among the most frequent indications. Technical limitations remain and should be evaluated with the overall aim not to endanger quality standards in open surgery. Financial aspects cannot be neglected with the necessity of cost-covering reimbursement.

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“…In the past decade, with the accumulation of surgical experience in complicated hepatobiliary operations, the individual procedure that is essential for laparoscopic radical resection of HC has already been reported [21,29]. Some studies recently described the application of minimally invasive surgery in patients with HC [30][31][32][33][34][35][36]. However, most of these studies have either enrolled a small number of patients or only included patients with HC in early stages.…”

Section: Introductionmentioning

confidence: 99%

Complete laparoscopic radical resection of hilar cholangiocarcinoma: technical aspects and long-term results from a single center.

Li¹,

Xiong²,

Ye³

et al. 2020

Videosurgery and Other Miniinvasive Techniques

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Introduction: The landscape of surgical treatments for hepatobiliary disease was significantly changed after the advent of laparoscopy. Many kinds of complex laparoscopic procedures can be routinely performed at present, but radical resection of hilar cholangiocarcinoma (HC) by laparoscopy is still highly contentious. Aim: To describe our primary experience with laparoscopic radical resection for HC and determine the safety and feasibility of this procedure. Material and methods: Between December 2015 and November 2019, 32 patients planned to undergo curative-intent laparoscopic resection of HC in our department. The perioperative and long-term outcomes of these patients were retrospectively analyzed. Results: Laparoscopic surgery with radical resection was ultimately performed in 24 (75.0%) patients; 3 (9.3%) patients were found to be unresectable at the preliminary exploration stage, and 5 (15.7%) patients converted from laparoscopy to laparotomy. The operation time and blood loss were 476.95 ±133.89 min and 568.75 ±324.01 ml, respectively. A negative margin was achieved in 19 (79.1%) of the laparoscopy patients. Three (12.5%) patients were identified with microscopic positive margins, and 2 (8.4%) patients underwent macroscopic residual tumor resection (R2). The length of postoperative stay was 23.3 ±11.7 days. Severe morbidity occurred in 4 (16.6%) patients. The actuarial 3-year overall survival and disease-free survival for patients who underwent laparoscopic surgery were 49.1% and 47.0%, respectively. Conclusions: Laparoscopic radical resection for HC is safe and feasible in experienced hands for highly selected patients but is still in its initial stages. When adequate oncologic resection is performed, the laparoscopic approach does not adversely influence the prognosis of the patient.

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Total laparoscopic versus open radical resection for hilar cholangiocarcinoma

Cited by 43 publications

References 15 publications

Total Laparoscopic Resection of Hilar Cholangiocarcinoma Type 3b: Applying a Parachute Technique for Hepaticojejunostomy

Total Laparoscopic Resection of Hilar Cholangiocarcinoma Type 3b: Applying a Parachute Technique for Hepaticojejunostomy

Laparoscopic liver resection: indications, limitations, and economic aspects

Complete laparoscopic radical resection of hilar cholangiocarcinoma: technical aspects and long-term results from a single center.

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