Laparoscopic liver resection versus open liver resection for intrahepatic cholangiocarcinoma: 3-year outcomes of a cohort study with propensity score matching |
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| Affiliation: | 1. Department of Surgery, Gyeongsang National University Hospital, Jinju-si, Republic of Korea;2. Department of Surgery, Seoul National University College of Medicine, Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea;1. Johns Hopkins University School of Medicine, Baltimore, MD;2. University of Bologna, Ospedale S. Orsola-Malpighi, Bologna, Italy;3. Fundeni Clinical Institute, Bucharest, Romania;4. University of Verona, Policlinico GB Rossi, Verona, Italy;5. Curry Cabral Hospital, Lisbon, Portugal;6. Ospedale San Raffaele, Milan, Italy;7. Medical College of Wisconsin, Milwaukee, WI;8. Emory University, Atlanta, GA;9. University of Sydney, Sydney, Australia;10. University of Virginia, Charlottesville, VA;11. Eastern Hepatobiliary Surgery Hospital, Shanghai, China;12. Stanford University, Stanford, CA;13. University of Pittsburgh Medical Center, Pittsburgh, PA;1. Department of Hepatobiliary and Liver Transplantation Surgery, Hôpital de la Pitié–Salpêtrière, Assistance Publique-Hôpitaux de Paris, France;2. Department of General and Oncological Surgery, Ospedale Mauriziano, Torino, Italy;3. Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan;4. Hepatobiliary Unit, Department of Gastroenterology, University of São Paulo Medical School, São Paulo, Brazil;5. Department of Abdominal Surgery and Transplantation, CHU Liege (CHU-ULg), Liege, Belgium;6. General Surgery 2U, Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy;7. Department of Hepatobiliary and Liver Transplantation Surgery, Federal University Minas Gerais, Brazil;8. Department of General, Digestive and Endocrine Surgery, Robert-Debré University Hospital, Reims, France;9. Department of Hepatobiliary Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland;10. Department of General, Dept of General & Digestive Surgery, GZA Hospitals, Antwerp, Belgium;11. Division of General, HPB and Transplantation Surgery, Ospedale di Niguarda, Milano, Italy;12. Department of Biostatistics, Public Health and Medical Information Hôpital de la Pitié–Salpêtrière, Assistance Publique-Hôpitaux de Paris, France;1. Department of Surgery, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy;2. Department of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Clinical and Research Center - IRCCS, Humanitas University, Rozzano (Milan), Italy;3. Department of General and Emergency Surgery and Organ Transplantation, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy;4. Department of Surgery, Division of HPB Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina;5. Department of Surgery, Division of General and Endocrine Surgery, University of Cagliari, Cagliari, Italy |
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| Abstract: | IntroductionLaparoscopic liver resection(LLR) for intrahepatic cholangiocarcinoma is debatable due to technical challenges associated with major hepatectomy and lymph node dissection. This study aims to analyze the long-term outcomes with propensity score matching.MethodsPatients who underwent liver resection for intrahepatic cholangiocarcinoma from August 2004 to October 2015 were enrolled. Those who had combined hepatocellular-cholangiocarcinoma and palliative surgery were excluded. Medical records were reviewed for postoperative outcome, recurrence, and survival. The 3-year disease-free survival(DFS) and 3-year overall survival(OS) were set as the primary endpoint, and 3-year disease-specific survival, 1-year OS, 1-year DFS, operative outcome, and postoperative complications were secondary endpoints.ResultsA total of 91 patients were enrolled with 61 in the open group and 30 in the laparoscopic group. Propensity score matching included 24 patients in both groups. In total, the 3-year OS was 81.2% in the open group and 76.7% in the laparoscopic group(p = 0.621). For 3-year DFS, open was 42.5% and laparoscopic was 65.6%(p = 0.122). Mean operation time for the open group was 343.2 ± 106.0 min and laparoscopic group was 375.2 ± 204.0 min(p = 0.426). Hospital stay was significantly shorter in the laparoscopic group(9.8 ± 5.1 days) than the open group(18.3 ± 14.7, p=<0.001). There was no difference in complication rate and 30-day readmission rate. Tumor size, nodularity, and presence of perineural invasion showed an independent association with the 3-year DFS in multivariate analysis.ConclusionLaparoscopic liver resection for intrahepatic cholangiocarcinoma is technically feasible and safe, providing short-term benefits without increasing complications or affecting long-term survival. |
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| Keywords: | Laparoscopy Hepatectomy Cholangiocarcinoma Minimally invasive surgical procedures |
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