Laparoscopic vs. open anatomical hepatectomy for intrahepatic cholangiocarcinoma: A retrospective cohort study

Jianlei Wang; Delin Ma; Gang Du; Baokun An; Tong Xia; Tao Zhou; Qingmei Sun; Fengyue Liu; Yadong Wang; Deling Sui; Xiangyu Zhai; Bin Jin

doi:10.3389/fsurg.2022.1003948

Laparoscopic vs. open anatomical hepatectomy for intrahepatic cholangiocarcinoma: A retrospective cohort study

Front Surg. 2022 Oct 17:9:1003948. doi: 10.3389/fsurg.2022.1003948. eCollection 2022.

Authors

Jianlei Wang¹, Delin Ma², Gang Du³, Baokun An¹, Tong Xia¹, Tao Zhou⁴, Qingmei Sun⁵, Fengyue Liu³, Yadong Wang³, Deling Sui⁶, Xiangyu Zhai⁷, Bin Jin³

Affiliations

¹ Department of Organ Transplantation, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
² Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China.
³ Department of Organ Transplantation, Qilu Hospital, Shandong University, Jinan, China.
⁴ Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China.
⁵ Department of Anesthesia, Qilu Hospital, Shandong University, Jinan, China.
⁶ Department of General Surgery, The Second People's Hospital of Liaocheng, Liaocheng, China.
⁷ Department of General Surgery, Second Hospital of Shandong University, Jinan, China.

Abstract

Background: Intrahepatic cholangiocarcinoma is a highly malignant and invasive cancer originating from biliary epithelial cells. The current study was designed to evaluate the feasibility, safety, and clinical outcomes of laparoscopic anatomical hepatectomy in patients with intrahepatic cholangiocarcinoma.

Methods: After screening, 95 patients who underwent anatomical hepatectomy for intrahepatic cholangiocarcinoma at our center were enrolled and divided into two groups according to the surgical approach; the baseline characteristics, pathological findings, surgical outcomes, and long-term outcomes were compared. Moreover, univariate and multivariate analyses were performed to identify independent prognostic factors for overall survival (OS) and disease-free survival (DFS).

Results: There were no significant differences in baseline characteristics or pathological findings between the two groups. Regarding short-term outcomes, the intraoperative blood loss, incision length, and length of postoperative hospital stay were more favorable in the laparoscopic anatomical hepatectomy group than the open anatomical hepatectomy group (P < 0.05). The two groups differed significantly in the extent of liver resection, with a lower lymph node dissection rate and lymph node yield in the laparoscopic anatomical hepatectomy group (P < 0.05). Furthermore, the postoperative complication rate was similar in the two groups (P > 0.05). The median postoperative follow-up times were 10.7 and 13.8 months in the laparoscopic anatomical hepatectomy and open anatomical hepatectomy groups, respectively. Regarding the long-term follow-up results, OS and DFS were similar in the two groups (P > 0.05). On multivariate analysis, the independent prognostic factors for OS were CA-199, CEA, HGB, tumor diameter, and T stage, and those for DFS were CA-199 (P < 0.05), and T stage (P < 0.05).

Conclusion: laparoscopic anatomical hepatectomy for intrahepatic cholangiocarcinoma is safe and feasible when performed by experienced surgeons. Compared with open anatomical hepatectomy, laparoscopic anatomical hepatectomy provides better short-term outcomes and a comparable long-term prognosis.

Keywords: disease-Free survival; laparoscopic anatomical hepatectomy; open anatomical hepatectomy; outcomes; overall survival.