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Kim KD, Lee JE, Kim J, Ro J, Rhu J, Choi GS, Heo JS, Joh JW. Laparoscopic liver resection as a treatment option for intrahepatic cholangiocarcinoma. Updates Surg 2024; 76:869-878. [PMID: 38507173 DOI: 10.1007/s13304-024-01803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 02/24/2024] [Indexed: 03/22/2024]
Abstract
Laparoscopic liver resection (LLR) remains controversial in the treatment of intrahepatic cholangiocarcinoma (ICC). The aim of the present study is to investigate the outcomes of LLR for ICC compared to open liver resection (OLR). We retrospectively reviewed patients who underwent surgery for ICC between January 2013 and February 2020. OLR and LLR were compared after propensity score matching (PSM). Overall survival (OS) and recurrence-free survival (RFS) were compared between the matched groups. During the study period, 219 patients met the inclusion criteria (OLR = 170 patients, 77.6%; LLR = 49 patients, 22.4%). Two groups of 43 patients each were analyzed after PSM. The 5-year RFS and OS were 44.6% and 47.9% in the OLR group and 50.9% and 39.8% in the LLR group, respectively. Hospital stay and intensive care unit care were significantly shorter and lower in the LLR group than in the OLR group, respectively. Total postoperative complications and complication rates for those Clavien-Dindo grade 3 or higher were similar between the OLR group and the LLR group. Multiple tumors and lymph node metastases were predisposing factors for tumor recurrence and death in multivariate analysis. The present study suggests that LLR should be considered in selective ICC because of short hospitalization and similar oncologic outcome and overall survival.
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Affiliation(s)
- Kyeong Deok Kim
- Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Republic of Korea
| | - Ji Eun Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Jongman Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Republic of Korea.
| | - Junsoo Ro
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Republic of Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Republic of Korea
| | - Jin Seok Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Republic of Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06355, Republic of Korea
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Ratti F, Maina C, Clocchiatti L, Marino R, Pedica F, Casadei Gardini A, De Cobelli F, Aldrighetti LAM. Minimally Invasive Approach Provides Oncological Benefit in Patients with High Risk of Very Early Recurrence (VER) After Surgery for Intrahepatic Cholangiocarcinoma (iCCA). Ann Surg Oncol 2024; 31:2557-2567. [PMID: 38165575 DOI: 10.1245/s10434-023-14807-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/07/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Surgery for intrahepatic cholangiocarcinoma (iCCA) is jeopardized by significant risk of early recurrence (≤ 6 months). The aim of the present study is to analyze the oncological benefit provided by laparoscopic over open approach for iCCA in patients with high risk of very early recurrence (VER). MATERIALS AND METHODS A total of 532 liver resections (LR) were performed for iCCA [265 by minimally invasive surgery (MIS) and 267 with open approach, matched through a 1:1 propensity score] and stratified using the postoperative prediction model of VER. Outcomes were compared between open and laparoscopic approaches, specifically evaluating oncological benefit. RESULTS The percentage of patients with high risk of VER was similar (32.7% in the laparoscopic group and 35.3% in the open group, pNS). The number of retrieved nodes as well as the rate and depth of negative resection margins were comparable between laparoscopic and open. The surgery-adjuvant treatment interval was shorter in laparoscopic patients in the overall series, as well in the subgroup of high risk of VER. The rate of patients starting adjuvant treatments within 2 months from surgery was higher in laparoscopic group compared with open group. In VER high-risk group both disease-free survival (DFS) and overall survival (OS) were significantly improved in MIS compared with open group (p = 0.032 and p = 0.026, respectively). CONCLUSIONS In patients with high risk of VER, laparoscopy translates into an advantage in terms of recurrence-free survival, likely related to lower biological impact of surgery, together with a shorter interval between surgery and start of adjuvant treatments, even allowing for a higher number of patients to start adjuvant therapies within 2 months from resection.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Cecilia Maina
- Hepatobiliary Surgery Division, IRCCS San Raffaele, Milan, Italy
| | | | - Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele, Milan, Italy
| | - Federica Pedica
- Department of Experimental Oncology, Pathology Unit, San Raffaele Hospital, Milan, Italy
| | - Andrea Casadei Gardini
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco De Cobelli
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Hu YF, Hu HJ, Ma WJ, Jin YW, Li FY. Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: a systematic review of propensity score-matched studies. Updates Surg 2023; 75:2049-2061. [PMID: 37919559 PMCID: PMC10710389 DOI: 10.1007/s13304-023-01648-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
Outcomes of laparoscopic liver resection (LLR) versus open LR (OLR) for intrahepatic cholangiocarcinoma (ICCA) are heterogeneous. We aimed to compare LLR and OLR for ICCA based on propensity-score-matched (PSM) studies. Two reviewers independently searched the online databases (PubMed, Embase, and Cochrane Library) for PSM studies that compared LLR and OLR for ICCA. The Ottawa-Newcastle Quality Assessment Scale with a cutoff of ≥ 7 was used to define higher-quality literature. Only 'high-quality' PSM analyses of the English language that met all our inclusion criteria were considered. A total of ten PSM trials were included in the analyses. Compared with OLR, although the lymph node dissection (LND) (RR = 0.67) and major hepatectomy rates were lower in the LLR group (RR = 0.87), higher R0 resections (RR = 1.05) and lower major complications (Clavien-Dindo grade ≥ III) (RR = 0.72) were also observed in the LLR group. In addition, patients in the LLR group showed less estimated blood loss (MD = - 185.52 ml) and shorter hospital stays as well (MD = - 2.75 days). Further analysis found the overall survival (OS) (HR = 0.91), disease-free survival (DFS) (HR = 0.95), and recurrence-free survival (HR = 0.80) for patients with ICCA after LLR were all comparable to those of OLR. LLR for selected ICCA patients may be technically safe and feasible, providing short-term benefits and achieving oncological efficacy without compromising the long-term survival of the patients.
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Affiliation(s)
- Ya-Fei Hu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yan-Wen Jin
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
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Ratti F, Cipriani F, Ingallinella S, Tudisco A, Catena M, Aldrighetti L. Robotic Approach for Lymphadenectomy in Biliary Tumors: The Missing Ring Between the Benefits of Laparoscopic and Reproducibility of Open Approach? Ann Surg 2023; 278:e780-e788. [PMID: 36341600 DOI: 10.1097/sla.0000000000005748] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to evaluate the oncological adequacy of lymphadenectomy (LND) for biliary tumors and surgical outcomes of resections performed using robotic, laparoscopic, and open approaches and to compare the techniques within a weighted propensity score analysis. BACKGROUND The need to perform formal LND is considered a limit for the applicability of minimally invasive liver surgery. METHODS Overall, 25 robotic resections with LND (2021-2022) from a single-center constituted the study group (Rob group), matched by inverse probability treatment weighting with 97 laparoscopic (Lap group) and 113 open (Open group) procedures to address the primary endpoint. A "per-period" analysis was performed comparing the characteristics and outcomes of the Rob group with the first 25 consecutive laparoscopic liver resections with associated LND (LapInit group). RESULTS Minimally invasive techniques performed equally well regarding the number of harvested nodes, blood transfusions, functional recovery, length of stay, and major morbidity and provided a short-term benefit to patients when compared with the open technique. A better performance of the robotic approach over laparoscopic approach (and both approaches over the open technique) was recorded for patients achieving LND with retrieval of >6 nodes. The open approach reduced both the operative time and time for LND, and robotic surgery performed better than laparoscopic surgery. CONCLUSIONS Minimally invasive techniques are excellent tools for the management of LND in patients with biliary tumors, showing feasibility, and oncological adequacy. Robotics could contribute to the large-scale diffusion of these procedures with a high profile of complexity.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Milano, Italy
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Ratti F, Ferrero A, Guglielmi A, Cillo U, Giuliante F, Mazzaferro V, De Carlis L, Ettorre GM, Gruttadauria S, Di Benedetto F, Ercolani G, Valle RD, Belli A, Jovine E, Ravaioli M, Aldrighetti L. Ten years of Italian mini-invasiveness: the I Go MILS registry as a tool of dissemination, characterization and networking. Updates Surg 2023; 75:1457-1469. [PMID: 37488408 DOI: 10.1007/s13304-023-01597-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023]
Abstract
Purposes of this study are to evaluate the main changes that have occurred in the Italian MILS activity in the last decade in terms of indications, approaches and outcomes as reported in the national registry and to provide specific details on the main areas of development of MILS. Data from patients undergoing minimally invasive liver resections at centers included in the I Go MILS Registry from its start-up (November 2014) to March 2023 were analyzed for the purposes of this study. The registry is intention-to-treat and prospective. Global recruitment trends stratified by indication to surgery and type of approach were analysed. 7413 MILS procedures were performed across all centers (median number of procedures per center: 63). Years (2020-2023) displayed a significantly higher proportion of treated patients diagnosed with hepatocellular carcinoma (HCC) (38.2% vs. 28.9% and 33.9%, p < 0.001) and cholangiocarcinoma (6.7% vs. 6.5% and 4.2%, p < 0.001) compared to the preceding triennial periods. Additionally, technical complexity demonstrated an increased prominence in Years (2019-2023) with a significantly higher percentage of grade III cases compared to the earlier periods (39.3% vs. 21.7% and 25.6%, p < 0.001). Annual case trends focusing on laparoscopic and robotic techniques demonstrated a steadily increase in the use of these techniques for complex case mix of indications. Overall, attitude and attention to MILS approach has evolved, so that currently indications to hepatic mini-invasiveness have expanded and surgical technique has been refined: Areas mainly involved in increasing growth trends are hepatocellular carcinoma, possible applications of MILS in transplant setting, intrahepatic cholangiocarcinoma and robotic approach.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital Umberto I, Turin, Italy
| | - Alfredo Guglielmi
- Department of Surgery, Division of General and Hepatobiliary Surgery, School of Medicine, University of Verona, Verona, Italy
| | - Umberto Cillo
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Padua, Padua, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Mazzaferro
- Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Giuseppe Maria Ettorre
- Department of General and Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo-Forlanini Hospital, Rome, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | | | - Andrea Belli
- Department of Abdominal Oncology, Division of Hepatopancreatobiliary Surgical Oncology, National Cancer Center-IRCCS-G. Pascale, Naples, Italy
| | - Elio Jovine
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, Bologna, Italy
| | - Matteo Ravaioli
- Hepatobiliary and Transplant Unit, Policlinico Sant'Orsola IRCCS, University of Bologna, Bologna, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Lancellotti F, Coletta D, de'Liguori Carino N, Satyadas T, Jegatheeswaran S, Maruccio M, Sheen AJ, Siriwardena AK, Jamdar S. Venous thromboembolism (VTE) after open hepatectomy compared to minimally invasive liver resection: a systematic review and meta-analysis. HPB (Oxford) 2023:S1365-182X(23)00129-6. [PMID: 37169670 DOI: 10.1016/j.hpb.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Even though the risk of postoperative venous thromboembolism (VTE) after liver resection is well recognized, the association between surgical approach and VTE risk is unknown. This study aims to compare VTE rates following open liver resection (OLR) and minimally invasive liver resection (MILR). METHODS MEDLINE, Web Of Sciences and EMBASE databases were interrogated to identify eligible studies published between February 2016 and August 2022. Studies were considered suitable if they reported a comparison between OLR and MILR (including laparoscopic liver resection [LLR] or robotic liver resection [RLR]). RESULTS Fourteen studies including 11 356 patients met the inclusion criteria. 5622 patients underwent OLR and 5734 patients underwent MILR. The VTE rate was higher among patients who underwent OLR compared to MILR (2.8% vs 1.4%, OR (95% CI) = 1.84, p=<00001). Similarly, the subgroup analysis showed a higher rate of deep venous thrombosis (DVT) (1.4% vs 0.7%, OR (95% CI) = 1.98, p = 0.02) and pulmonary embolism (PE) (1.3% vs 0.7%, OR (95% CI) = 1.88, p = 0.002) in patients who underwent OLR compared to MILR. DISCUSSION Patients who undergo open hepatectomy have a higher incidence of postoperative VTE when compared to those undergoing minimally invasive liver resection. This finding was consistent for both DVT and PE.
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Affiliation(s)
- Francesco Lancellotti
- Hepatobiliary and Pancreatic Surgery Unit, Manchester University NHS FT, Manchester, M13 9WL, UK
| | - Diego Coletta
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy; Department of Surgical Sciences, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Nicola de'Liguori Carino
- Hepatobiliary and Pancreatic Surgery Unit, Manchester University NHS FT, Manchester, M13 9WL, UK
| | - Thomas Satyadas
- Hepatobiliary and Pancreatic Surgery Unit, Manchester University NHS FT, Manchester, M13 9WL, UK
| | | | - Martina Maruccio
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Aali J Sheen
- Hepatobiliary and Pancreatic Surgery Unit, Manchester University NHS FT, Manchester, M13 9WL, UK
| | - Ajith K Siriwardena
- Hepatobiliary and Pancreatic Surgery Unit, Manchester University NHS FT, Manchester, M13 9WL, UK
| | - Saurabh Jamdar
- Hepatobiliary and Pancreatic Surgery Unit, Manchester University NHS FT, Manchester, M13 9WL, UK.
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Shen Z, Tao L, Cai J, Zheng J, Sheng Y, Yang Z, Gong L, Song C, Gao J, Ying H, Xu J, Liang X. Safety and feasibility of laparoscopic liver resection for intrahepatic cholangiocarcinoma: a propensity score-matched study. World J Surg Oncol 2023; 21:126. [PMID: 37032348 PMCID: PMC10084635 DOI: 10.1186/s12957-023-03004-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/22/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Laparoscopic liver resection (LLR) is controversial in treating intrahepatic cholangiocarcinoma (ICC). Therefore, this study aimed to evaluate the safety and feasibility of LLR for the treatment of ICC and explored the independent factors affecting the long-term prognosis of ICC. METHODS We included 170 patients undergoing hepatectomy for ICC from December 2010 to December 2021 and divided them into LLR group and open liver resection (OLR) group. We used propensity score matching (PSM) analysis to reduce the impact of data bias and confounding variables and then compared the short-term and long-term prognosis of LLR and OLR in treating ICC; Cox proportional hazards regression model was adopted to explore the independent factors affecting the long-term prognosis of ICC. RESULTS A total of 105 patients (70 in the LLR group and 35 in the OLR group) were included after 2:1 PSM analysis. There was no difference in demographic characteristics and preoperative indexes between the two groups. The perioperative results of the OLR group were worse than those of the LLR group, that is, the intraoperative blood transfusion rate (24 (68.6) vs 21 (30.0)), blood loss (500 (200-1500) vs 200 (100-525)), and the morbidity of major postoperative complications (9 (25.7) vs 6 (8.5)) in the OLR group were worse than those in LLR group. LLR could enable patients to obtain an equivalent long-term prognosis compared to OLR. The Cox proportional hazards regression model exhibited that no matter before or after PSM, preoperative serum CA12-5 and postoperative hospital stay were independent factors affecting overall survival, while only lymph node metastasis independently influenced recurrence-free survival. CONCLUSIONS Compared with ICC treated by OLR, the LLR group obtained superior perioperative period outcomes. In the long run, LLR could enable ICC patients to receive an equivalent long-term prognosis compared to OLR. In addition, ICC patients with preoperative abnormal CA12-5, lymph node metastasis, and more extended postoperative hospital stay might suffer from a worse long-term prognosis. However, these conclusions still need multicenter extensive sample prospective research to demonstrate.
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Affiliation(s)
- Zefeng Shen
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Liye Tao
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Jingwei Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Junhao Zheng
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Yubin Sheng
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Zaibo Yang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Linghan Gong
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Chao Song
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Jiaqi Gao
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Hanning Ying
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Junjie Xu
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China.
| | - Xiao Liang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China.
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Zhao X, Gao FW, Jiang KY, Yang J, Xie QY, Gong J, Yang MY, Mao TY, Lei ZH. Laparoscopic or open liver resection for intrahepatic cholangiocarcinoma: A meta-analysis and systematic review. Front Oncol 2023; 13:1096714. [PMID: 36937400 PMCID: PMC10014898 DOI: 10.3389/fonc.2023.1096714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/10/2023] [Indexed: 03/05/2023] Open
Abstract
Background Although laparoscopic hepatectomy has been widely used in the treatment of benign and malignant liver diseases, its applicability in intrahepatic cholangiocarcinoma (ICC) is controversial. We conducted a meta-analysis to compare the short-term and long-term outcomes of laparoscopic hepatectomy (Lap-ICC) and open hepatectomy (Open-ICC) in ICC patients. Methods The PubMed, Web of science, Cochrane Library, China National Knowledge Infrastructure and other databases were searched for the relevant literature. The research data were extracted according to the inclusion and exclusion criteria. Results Seventeen studies, including 3975 ICC patients, were selected for the meta-analysis. Compared to Open-ICC, Lap-ICC had lower rates of lymph node dissection (OR=0.44, P=0.01) and metastasis (OR=0.58, P=0.03), along with less intraoperative bleeding (MD=-128.43 ml, P<0.01) lower blood transfusion rate (OR=0.43, P<0.01), shorter hospital stay (MD=-2.75 day, P<0.01), higher R0 resection rate (OR=1.60, P<0.01), and lower tumor recurrence rate (OR=0.67, P=0.01). However, there was no difference between the two groups in terms of operation time, number of lymph node dissection, incision margin distance, overall complications rate, severe complications rate, and the 1-, 3- and 5-year DFS and OS rates. Conclusion Laparoscopic hepatectomy is partially superior to open hepatectomy in terms of less bleeding, shorter hospital stay and higher R0 resection rate, while the long-term efficacy of the two approaches is similar.
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Affiliation(s)
- Xin Zhao
- Department of Hepatopancreatobiliary Surgery, The People’s Hospital of Leshan, Leshan, Sichuan, China
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases of Leshan, Leshan, Sichuan, China
| | - Feng-wei Gao
- Department of Hepatopancreatobiliary Surgery, The People’s Hospital of Leshan, Leshan, Sichuan, China
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases of Leshan, Leshan, Sichuan, China
- North Sichuan Medical College, Nanchong, Sichuan, China
- *Correspondence: Feng-wei Gao, ; Ze-hua Lei,
| | - Kang-yi Jiang
- Department of Hepatopancreatobiliary Surgery, The People’s Hospital of Leshan, Leshan, Sichuan, China
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases of Leshan, Leshan, Sichuan, China
| | - Jie Yang
- Department of Hepatopancreatobiliary Surgery, The People’s Hospital of Leshan, Leshan, Sichuan, China
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases of Leshan, Leshan, Sichuan, China
| | - Qing-yun Xie
- Department of Hepatopancreatobiliary Surgery, The People’s Hospital of Leshan, Leshan, Sichuan, China
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases of Leshan, Leshan, Sichuan, China
| | - Jie Gong
- Department of Hepatopancreatobiliary Surgery, The People’s Hospital of Leshan, Leshan, Sichuan, China
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases of Leshan, Leshan, Sichuan, China
| | - Man-yu Yang
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Tian-yang Mao
- North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ze-hua Lei
- Department of Hepatopancreatobiliary Surgery, The People’s Hospital of Leshan, Leshan, Sichuan, China
- Diagnosis and Treatment Center for Liver, Gallbladder, Pancreas and Spleen System Diseases of Leshan, Leshan, Sichuan, China
- *Correspondence: Feng-wei Gao, ; Ze-hua Lei,
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Liao CY, Wang DF, Jiang BH, Huang L, Lin TS, Qiu FN, Zhou SQ, Wang YD, Zheng XC, Tian YF, Chen S. Optimization of a laparoscopic procedure for advanced intrahepatic cholangiocarcinoma based on the concept of "waiting time": a preliminary report. BMC Cancer 2022; 22:1222. [PMID: 36443693 PMCID: PMC9703772 DOI: 10.1186/s12885-022-10323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Clinicians increasingly perform laparoscopic surgery for intrahepatic cholangiocarcinoma (ICC). However, this surgery can be difficult in patients with advanced-stage ICC because of the complicated procedures and difficulty in achieving high-quality results. We compared the effects of a three-step optimized procedure with a traditional procedure for patients with advanced-stage ICC. METHODS Forty-two patients with advanced-stage ICC who received optimized laparoscopic hemihepatectomy with lymph node dissection (LND, optimized group) and 84 propensity score-matched patients who received traditional laparoscopic hemihepatectomy plus LND (traditional group) were analyzed. Surgical quality, disease-free survival (DFS), and overall survival (OS) were compared. RESULTS The optimized group had a lower surgical bleeding score (P = 0.038) and a higher surgeon satisfaction score (P = 0.001). Blood loss during hepatectomy was less in the optimized group (190 vs. 295 mL, P < 0.001). The optimized group had more harvested LNs (12.0 vs. 8.0, P < 0.001) and more positive LNs (8.0 vs. 5.0, P < 0.001), and a similar rate of adequate LND (88.1% vs. 77.4%, P = 0.149). The optimized group had longer median DFS (9.0 vs. 7.0 months, P = 0.018) and median OS (15.0 vs. 13.0 months, P = 0.046). In addition, the optimized group also had a shorter total operation time (P = 0.001), shorter liver resection time (P = 0.001), shorter LND time (P < 0.001), shorter hospital stay (P < 0.001), and lower incidence of total morbidities (14.3% vs. 36.9%, P = 0.009). CONCLUSIONS Our optimization of a three-step laparoscopic procedure for advanced ICC was feasible, improved the quality of liver resection and LND, prolonged survival, and led to better intraoperative and postoperative outcomes.
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Affiliation(s)
- Cheng-Yu Liao
- grid.256112.30000 0004 1797 9307Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ,grid.415108.90000 0004 1757 9178Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Dan-Feng Wang
- grid.256112.30000 0004 1797 9307Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ,grid.415108.90000 0004 1757 9178Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Bin-Hua Jiang
- grid.256112.30000 0004 1797 9307Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ,grid.415108.90000 0004 1757 9178Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Long Huang
- grid.256112.30000 0004 1797 9307Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ,grid.415108.90000 0004 1757 9178Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Tian-Sheng Lin
- grid.256112.30000 0004 1797 9307Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ,grid.415108.90000 0004 1757 9178Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Fu-Nan Qiu
- grid.256112.30000 0004 1797 9307Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ,grid.415108.90000 0004 1757 9178Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Song-Qiang Zhou
- grid.256112.30000 0004 1797 9307Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ,grid.415108.90000 0004 1757 9178Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Yao-Dong Wang
- grid.256112.30000 0004 1797 9307Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ,grid.415108.90000 0004 1757 9178Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Xiao-Chun Zheng
- grid.256112.30000 0004 1797 9307Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ,grid.415108.90000 0004 1757 9178Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, 350001 China ,Fujian Emergency Medical Center, Fujian Emergency Medical Center, Fujian Provincial Key Laboratory of Emergency Medicine, Fujian Provincial Key Laboratory of Critical Medicine, Fujian Provincial Coconstructed Laboratory of “Belt and Road”, Fuzhou, China
| | - Yi-Feng Tian
- grid.256112.30000 0004 1797 9307Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ,grid.415108.90000 0004 1757 9178Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
| | - Shi Chen
- grid.256112.30000 0004 1797 9307Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China ,grid.415108.90000 0004 1757 9178Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou, 350001 China
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10
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Sahakyan MA, Aghayan DL, Edwin B, Alikhanov R, Britskaia N, Brudvik KW, D'Hondt M, De Meyere C, Efanov M, Fretland ÅA, Hoff R, Ismail W, Ivanecz A, Kazaryan AM, Lassen K, Magdalenić T, Parmentier I, Røsok BI, Villanger O, Yaqub S. Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: a multicenter propensity score-matched study. Scand J Gastroenterol 2022; 58:489-496. [PMID: 36373379 DOI: 10.1080/00365521.2022.2143724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The role of laparoscopy in the treatment of intrahepatic cholangiocarcinoma (ICC) remains unclear. This multicenter study examined the outcomes of laparoscopic liver resection for ICC. METHODS Patients with ICC who had undergone laparoscopic or open liver resection between 2012 and 2019 at four European expert centers were included in the study. Laparoscopic and open approaches were compared in terms of surgical and oncological outcomes. Propensity score matching was used for minimizing treatment selection bias and adjusting for confounders (age, ASA grade, tumor size, location, number of tumors and underlying liver disease). RESULTS Of 136 patients, 50 (36.7%) underwent laparoscopic resection, whereas 86 (63.3%) had open surgery. Median tumor size was larger (73.6 vs 55.1 mm, p = 0.01) and the incidence of bi-lobar tumors was higher (36.6 vs 6%, p < 0.01) in patients undergoing open surgery. After propensity score matching baseline characteristics were comparable although open surgery was associated with a larger fraction of major liver resections (74 vs 38%, p < 0.01), lymphadenectomy (60 vs 20%, p < 0.01) and longer operative time (294 vs 209 min, p < 0.01). Tumor characteristics were similar. Laparoscopic resection resulted in less complications (30 vs 52%, p = 0.025), fewer reoperations (4 vs 16%, p = 0.046) and shorter hospital stay (5 vs 8 days, p < 0.01). No differences were found in terms of recurrence, recurrence-free and overall survival. CONCLUSION Laparoscopic resection seems to be associated with improved short-term and with similar long-term outcomes compared with open surgery in patients with ICC. However, possible selection criteria for laparoscopic surgery are yet to be defined.
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Affiliation(s)
- Mushegh A Sahakyan
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Davit L Aghayan
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Bjørn Edwin
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ruslan Alikhanov
- Department of HPB Surgery, Moscow Clinical Research Center, Moscow, Russia
| | - Natalia Britskaia
- Department of HPB Surgery, Moscow Clinical Research Center, Moscow, Russia
| | | | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Celine De Meyere
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Mikhail Efanov
- Department of HPB Surgery, Moscow Clinical Research Center, Moscow, Russia
| | - Åsmund A Fretland
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Rune Hoff
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Warsan Ismail
- Medical Department, Baerum Hospital, Vestre Viken HF, Baerum, Norway
| | - Arpad Ivanecz
- Department of Abdominal and General Surgery, University Medical Centre Maribor, Maribor, Slovenia
| | - Airazat M Kazaryan
- The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.,Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway.,Department of Faculty Surgery N2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Surgery, Fonna Hospital Trust, Odda, Norway
| | - Kristoffer Lassen
- Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Tomislav Magdalenić
- Department of Abdominal and General Surgery, University Medical Centre Maribor, Maribor, Slovenia
| | - Isabelle Parmentier
- Department of Oncology and Statistics, Groeninge Hospital, Kortrijk, Belgium
| | - Bård Ingvald Røsok
- Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Olaug Villanger
- Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Sheraz Yaqub
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.,Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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11
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Piccolo G, Barabino M, Lecchi F, Santambrogio R, Nava C, Opocher E, Bianchi PP. Laparoscopic Indocyanine Green Fluorescence Imaging for Intrahepatic Cholangiocarcinoma. Am Surg 2022:31348221103659. [PMID: 35605160 DOI: 10.1177/00031348221103659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Indocyanine green fluorescence (ICG) is one of the first fluorophore that found a clinical application in medicine. In the liver, ICG fluorescence is due to the preserved uptake but impaired washout of the dye from hepatocellular cells into the bile ducts. Therefore, some hepatobiliary surgeons proposed the technique of intravenous ICG injection before surgery for the detection of superficial hepatocarcinomas (HCCs) and colorectal liver metastases (CRLMs). Little evidence exists regarding the use of ICG to identify other hepatic tumors, such as intrahepatic cholangiocarcinoma (ICC). We report two patients affected by ICC who underwent laparoscopic liver resection with lymphadenectomy, the ICG staining was routinely performed not only to evaluate the site of the hepatic lesions but also to guide the extension of liver resection. METHODS It was injected intravenously a single dose of ICG dye (0.5 mg/kg) during liver function tests 5 days before scheduled surgery. All patients underwent laparoscopic staging with both laparoscopic ultrasound and ICG fluorescence imaging. RESULTS It was identified two different patter of ICG imaging: rim and segmental fluorescence for mass forming and mixed ICC subtype respectively. CONCLUSIONS Identification of the ICC subtype before definitive histological examination may have an impact on the surgical plan.
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Affiliation(s)
- Gaetano Piccolo
- Unit of Hepato-Bilio-Pancreatic and Digestive Surgery, Department of Health Sciences, 9304University of Milan, San Paolo Hospital, Milan, Italy
| | - Matteo Barabino
- Unit of Hepato-Bilio-Pancreatic and Digestive Surgery, Department of Health Sciences, 9304University of Milan, San Paolo Hospital, Milan, Italy
| | - Francesca Lecchi
- General Surgery Residency Program, 9304University of Milan, Milan, Italy
| | - Roberto Santambrogio
- Unit of General Surgery, ASST Fatebenefratelli Sacco, Aziende Socio Sanitarie Territoriale Fatebenefratelli, Sacco, Italy
| | - Claudia Nava
- Unit of Hepato-Bilio-Pancreatic and Digestive Surgery, Department of Health Sciences, 9304University of Milan, San Paolo Hospital, Milan, Italy
| | - Enrico Opocher
- Unit of Hepato-Bilio-Pancreatic and Digestive Surgery, Department of Health Sciences, 9304University of Milan, San Paolo Hospital, Milan, Italy
| | - Paolo Pietro Bianchi
- Division of General and Robotic Surgery, Department of Health Sciences, 9304University of Milan, San Paolo Hospital, Milan, Italy
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12
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Jinhuan Y, Yi W, Yuanwen Z, Delin M, Xiaotian C, Yan W, Liming D, Haitao Y, Lijun W, Tuo D, Kaiyu C, Jiawei H, Chongming Z, Daojie W, Bin J, Gang C. Laparoscopic Versus Open Surgery for Early-Stage Intrahepatic Cholangiocarcinoma After Mastering the Learning Curve: A Multicenter Data-Based Matched Study. Front Oncol 2022; 11:742544. [PMID: 35070961 PMCID: PMC8777042 DOI: 10.3389/fonc.2021.742544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 12/08/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Surgical resection is the only widely accepted curative method for intrahepatic cholangiocarcinoma (ICC). However, little is known about the efficacy of laparoscopic liver resection for ICC, especially in patients with early-stage disease. The aim of this study was to compare the short-term and long-term effects of laparoscopy and open surgery for the treatment of ICC. METHODS Data from 1,084 patients treated at three hospitals from January 2011 to December 2018 were selected and analyzed. Propensity score matching was performed to compare the long-term outcomes (overall survival and recurrence-free survival) and short-term outcomes (perioperative outcomes) of all-stage and early-stage patients. RESULTS After matching, 244 patients (122 vs. 122) in the all-stage group and 65 patients (27 vs. 38) in the early-stage group were included. The baseline of the two groups was balanced, and no significant differences were found in sex or age. The short-term results of the laparoscopic group were better than those of the open group, including less blood loss [blood loss ≥400 ml 27 (22.1%) vs. 6 (4.92%), p<0.001 for all-stage, 12 (31.6%) vs. 2 (7.41%), p=0.042 for early stage), shorter surgery [200 (141; 249) min vs. 125 (115; 222) min, p=0.025 for early stage] and shorter hospital stay [11.0 (9.00; 16.0) days vs. 9.00 (7.00; 12.0) days, p=0.001 for all stage, 11.0 (8.50; 17.8) days vs. 9.00 (6.50; 11.0) days, p=0.011 for early stage]. Regarding long-term outcomes, no significant differences were found for all-stage patients, while there were significant differences observed for the early-stage group (p=0.013 for OS, p=0.014 for RFS). For the early-stage patients, the 1-, 3-, and 5-year OS rates of the OLR group were 84.2, 65.8, and 41.1%, respectively, and those of the LLR group were 100, 90.9, and 90.9%, respectively. The RFS rates of the OLR group were 84.2, 66.7, and 41.7%, respectively, and those of the LLR group were and 92.3, 92.3, and 92.3%, respectively. CONCLUSION Patients treated with laparoscopy seemed to have better short-term outcomes, such as less blood loss, shorter operation duration, and shorter hospital stay, than patients undergoing open surgery. Based on the long-term results, laparoscopic treatment for early ICC may have certain advantages.
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Affiliation(s)
- Yang Jinhuan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wang Yi
- Department of Epidemiology and Biostatistics, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Zheng Yuanwen
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Jinan, China
| | - Ma Delin
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Chen Xiaotian
- Department of Clinical Medicine, The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Wang Yan
- Department of Clinical Medicine, The Second School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Deng Liming
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Haitao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wu Lijun
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Deng Tuo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chen Kaiyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hu Jiawei
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zheng Chongming
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wang Daojie
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jin Bin
- Department of Hepatobiliary Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Chen Gang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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13
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Krenzien F, Nevermann N, Krombholz A, Benzing C, Haber P, Fehrenbach U, Lurje G, Pelzer U, Pratschke J, Schmelzle M, Schöning W. Treatment of Intrahepatic Cholangiocarcinoma-A Multidisciplinary Approach. Cancers (Basel) 2022; 14:cancers14020362. [PMID: 35053523 PMCID: PMC8773654 DOI: 10.3390/cancers14020362] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary This review discusses multimodality treatment strategies for intrahepatic cholangiocarcinoma (iCC). Surgical resection remains the only potentially curative therapeutic option and the central cornerstone of treatment. Adjuvant systemic treatment will be recommended after resection or in the palliative setting. Increasing knowledge of phenotypic subclassification and molecular profiling allows investigation of targeted therapies as (neo-)adjuvant treatment. High-dose brachytherapy, internal radiation therapy, and transarterial chemoembolization are among the interventional treatment options being evaluated for unresectable iCC. Given the multiple options of multidisciplinary management, any treatment strategy should be discussed in a multidisciplinary tumor board and treatment should be directed by a specialized treatment center. Abstract Intrahepatic cholangiocarcinoma (iCC) is distinguished as an entity from perihilar and distal cholangiocarcinoma and gallbladder carcinoma. Recently, molecular profiling and histopathological features have allowed further classification. Due to the frequent delay in diagnosis, the prognosis for iCC remains poor despite major technical advances and multimodal therapeutic approaches. Liver resection represents the therapeutic backbone and only curative treatment option, with the functional residual capacity of the liver and oncologic radicality being deciding factors for postoperative and long-term oncological outcome. Furthermore, in selected cases and depending on national guidelines, liver transplantation may be a therapeutic option. Given the often advanced tumor stage at diagnosis or the potential for postoperative recurrence, locoregional therapies have become increasingly important. These strategies range from radiofrequency ablation to transarterial chemoembolization to selective internal radiation therapy and can be used in combination with liver resection. In addition, adjuvant and neoadjuvant chemotherapies as well as targeted therapies and immunotherapies based on molecular profiles can be applied. This review discusses multimodal treatment strategies for iCC and their differential use.
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Affiliation(s)
- Felix Krenzien
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
- Berlin Institute of Health (BIH), 13353 Berlin, Germany
| | - Nora Nevermann
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
- Correspondence:
| | - Alina Krombholz
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Christian Benzing
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Philipp Haber
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Uli Fehrenbach
- Clinic for Radiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Georg Lurje
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Uwe Pelzer
- Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
| | - Wenzel Schöning
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.K.); (A.K.); (C.B.); (P.H.); (G.L.); (J.P.); (M.S.); (W.S.)
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14
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Patrone R, Izzo F, Palaia R, Granata V, Nasti G, Ottaiano A, Pasta G, Belli A. Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma: A systematic review. World J Gastrointest Oncol 2021; 13:2203-2215. [PMID: 35070052 PMCID: PMC8713325 DOI: 10.4251/wjgo.v13.i12.2203] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/30/2021] [Accepted: 10/31/2021] [Indexed: 02/06/2023] Open
Abstract
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 1st of January 2009 up to the 1st 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.
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Affiliation(s)
- Renato Patrone
- PhD ICTH, University of Naples Federico II, Naples 80100, Italy
| | - Francesco Izzo
- Department of Abdominal Oncology, Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples 80131, Italy
| | - Raffaele Palaia
- Department of Abdominal Oncology, Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples 80131, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples 80131, Italy
| | - Guglielmo Nasti
- SSD-Innovative Therapies for Abdominal Metastases, Clinical and Experimental Abdominal Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples 80131, Italy
| | - Alessandro Ottaiano
- SSD-Innovative Therapies for Abdominal Metastases, Clinical and Experimental Abdominal Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples 80131, Italy
| | - Gilda Pasta
- Division of Anesthesia, Pain medicine and Supportive Care, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples 80131, Italy
| | - Andrea Belli
- Department of Abdominal Oncology, Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples 80131, Italy
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15
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Owen ML, Beal EW. Minimally Invasive Surgery for Intrahepatic Cholangiocarcinoma: Patient Selection and Special Considerations. Hepat Med 2021; 13:137-143. [PMID: 35221734 PMCID: PMC8866996 DOI: 10.2147/hmer.s319027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/16/2021] [Indexed: 12/29/2022] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) is an aggressive primary hepatic malignancy. Unfortunately, despite advancements in diagnosis, staging and management, mortality is high. Surgery remains the only curative treatment, but many patients present with advanced, unresectable disease. For patients able to undergo surgical resection, overall survival is improved, but remains low, with high rates of disease recurrence. Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, are increasingly used in surgical resection for ICC. These approaches variably demonstrate faster recovery times, less blood loss, decreased postoperative pain and fewer postoperative complications, with adequate oncologic resections. This review examines patient selection and special considerations for MIS for ICC. Patient selection is critical and includes evaluation of a patient’s anatomic and oncologic resectability, as well as comorbidities.
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Affiliation(s)
- MacKenzie L Owen
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Eliza W Beal
- The Ohio State University Comprehensive Cancer Center, Department of Surgery, Division of Surgical Oncology, Columbus, OH, USA
- Correspondence: Eliza W Beal The Ohio State University Comprehensive Cancer Center, 410 W. 10th Ave, Suite 836, Columbus, OH, USATel +1 614 293-8000Fax +1 614 293-4653 Email
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16
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Salehi O, Kazakova V, Vega EA, Kutlu OC, Alarcon SV, Freeman R, Kozyreva O, Conrad C. Selection criteria for minimally invasive resection of intrahepatic cholangiocarcinoma-a word of caution: a propensity score matched analysis using the national cancer database. Surg Endosc 2021; 36:5382-5391. [PMID: 34750709 DOI: 10.1007/s00464-021-08842-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND While minimally invasive liver resection (MILR) vs. open approach (OLR) has been shown to be safe, the perioperative and oncologic safety for intrahepatic cholangiocarcinoma (ICC) specifically, necessitating often complex hepatectomy and extended lymphadenectomy, remains ill-defined. METHODS The National Cancer Database was queried for patients with ICC undergoing liver resection from 2010 to 2016. After 1:1 Propensity Score Matching (PSM), Kruskal-Wallis and χ2 tests were applied to compare short-term outcomes. Kaplan-Meier survival analyses and Cox multivariable regression were performed. RESULTS 988 patients met inclusion criteria: 140 (14.2%) MILR and 848 (85.8%) OLR resulting in 115 patients MILR and OLR after 1:1 PSM with c-index of 0.733. MILR had lower unplanned 30-day readmission [OR 0.075, P = 0.014] and positive margin rates [OR 0.361, P = 0.011] and shorter hospital length of stay (LOS) [OR 0.941, P = 0.026], but worse lymph node yield [1.52 vs 2.07, P = 0.001]. No difference was found for 30/90-day mortality. Moreover, multivariate analysis revealed that MILR was associated with poorer overall survival compared to OLR [HR 2.454, P = 0.001]. Subgroup analysis revealed that survival differences from approach were dependent on major hepatectomy, tumor size > 4 cm, or negative margins. CONCLUSION MILR vs. OLR is associated with worse lymphadenectomy and survival in patients with ICC greater than 4 cm requiring major hepatectomy. Hence, MILR major hepatectomy for ICC should only be approached selectively and if surgeons are able to perform an appropriate lymphadenectomy.
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Affiliation(s)
- Omid Salehi
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Vera Kazakova
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Onur C Kutlu
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Sylvia V Alarcon
- Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA.,Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA, USA
| | - Richard Freeman
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA.,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA
| | - Olga Kozyreva
- Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA.,Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA, USA
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, 11 Nevins St., Suite 201, Brighton, MA, 02135, USA. .,Department of Surgery, Miller School of Medicine, University of Miami Health System, Miami, FL, USA.
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17
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Dorovinis P, Machairas N, Kykalos S, Stamopoulos P, Vernadakis S, Sotiropoulos GC. Safety and Efficacy of Laparoscopic Caudate Lobectomy: A Systematic Review. J Clin Med 2021; 10:jcm10214907. [PMID: 34768426 PMCID: PMC8584428 DOI: 10.3390/jcm10214907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/22/2021] [Indexed: 01/22/2023] Open
Abstract
Resection of the caudate lobe of the liver is considered a highly challenging type of liver resection due to the region’s intimacy with critical vascular structures and deep anatomic location inside the abdominal cavity. Laparoscopic resection of the caudate lobe is considered one of the most challenging laparoscopic liver procedures. The objective of our systematic review was to evaluate the safety, technical feasibility and main outcomes of laparoscopic caudate lobectomy LCL. A systematic review of the literature was undertaken for studies published until September 2021. A total of 20 studies comprising 221 patients were included. Of these subjects, 36% were women, whereas the vast majority of resections (66%) were performed for malignant tumors. Tumor size varied significantly between 2 and 160 mm in the largest diameter. The mean operative time was 210 min (range 60–740 min), and estimated blood loss was 173.6 mL (range 50–3600 mL). The median hospital length of stay LOS was 6.5 days (range 2–15 days). Seven cases of conversion to open were reported. The vast majority of patients (93.7%) underwent complete resection (R0) of their tumors. Thirty-six out of 221 patients developed postoperative complications, with 5.8% of all patients developing a major complication (Clavien–Dindo classification ≥ III).No perioperative deaths were reported by the included studies. LCL seems to be a safe and feasible alternative to open caudate lobectomy OCL in selected patients when undertaken in high-volume centers by experienced surgeons.
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Affiliation(s)
- Panagiotis Dorovinis
- 2nd Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.K.); (P.S.); (G.C.S.)
- Correspondence: (P.D.); (N.M.)
| | - Nikolaos Machairas
- 2nd Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.K.); (P.S.); (G.C.S.)
- Correspondence: (P.D.); (N.M.)
| | - Stylianos Kykalos
- 2nd Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.K.); (P.S.); (G.C.S.)
| | - Paraskevas Stamopoulos
- 2nd Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.K.); (P.S.); (G.C.S.)
| | | | - Georgios C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.K.); (P.S.); (G.C.S.)
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18
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Abstract
OPINION STATEMENT Biliary malignancies, although rare, can be some of the most challenging to manage surgically. Intrahepatic cholangiocarcinomas are resectable if there is no evidence of metastatic disease. These tumors are managed with anatomic resection and portal lymphadenectomy when centrally located or multiple in a single lobe. Non-anatomic resection can be performed for solitary peripheral tumors with minimally invasive techniques. It is not our practice to routinely employ neoadjuvant chemotherapy prior to resection of these tumors. Hepatic arterial infusion chemotherapy is utilized at our institution in highly selected patients in the context of an ongoing clinical trial for unresectable tumors. Hilar cholangiocarcinomas, when resectable (i.e., ipsilateral arterial involvement or lack of vascular involvement), are managed with right or left (extended) hepatectomy, caudate resection, and portal lymphadenectomy. Distal cholangiocarcinomas are managed with pancreaticoduodenectomy. Neoadjuvant chemotherapy is not routinely used in our treatment algorithm of extrahepatic cholangiocarcinomas. Nodal involvement and positive margin (R1) resection necessitates adjuvant chemotherapy. Finally, gallbladder carcinoma is managed with radical cholecystectomy, anatomic segment IVb/V resection, and portal lymphadenectomy. Adjuvant chemotherapy is employed routinely amongst patients with T2 or higher tumors and those with positive lymph nodes.
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Affiliation(s)
- Kimberly Washington
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health & Science University, 3181 S.W. Sam Jackson, Portland, OR, 97239, USA
| | - Flavio Rocha
- Division of Surgical Oncology, Knight Cancer Institute, Oregon Health & Science University, 3181 S.W. Sam Jackson, Portland, OR, 97239, USA.
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19
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Current Surgical Management of Peri-Hilar and Intra-Hepatic Cholangiocarcinoma. Cancers (Basel) 2021; 13:cancers13153657. [PMID: 34359560 PMCID: PMC8345178 DOI: 10.3390/cancers13153657] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/06/2021] [Accepted: 07/19/2021] [Indexed: 01/17/2023] Open
Abstract
Cholangiocarcinoma accounts for approximately 10% of all hepatobiliary tumors and represents 3% of all new-diagnosed malignancies worldwide. Intrahepatic cholangiocarcinoma (i-CCA) accounts for 10% of all cases, perihilar (h-CCA) cholangiocarcinoma represents two-thirds of the cases, while distal cholangiocarcinoma accounts for the remaining quarter. Originally described by Klatskin in 1965, h-CCA represents one of the most challenging tumors for hepatobiliary surgeons, mainly because of the anatomical vascular relationships of the biliary confluence at the hepatic hilum. Surgery is the only curative option, with the goal of a radical, margin-negative (R0) tumor resection. Continuous efforts have been made by hepatobiliary surgeons in order to achieve R0 resections, leading to the progressive development of aggressive approaches that include extended hepatectomies, associating liver partition, and portal vein ligation for staged hepatectomy, pre-operative portal vein embolization, and vascular resections. i-CCA is an aggressive biliary cancer that arises from the biliary epithelium proximal to the second-degree bile ducts. The incidence of i-CCA is dramatically increasing worldwide, and surgical resection is the only potentially curative therapy. An aggressive surgical approach, including extended liver resection and vascular reconstruction, and a greater application of systemic therapy and locoregional treatments could lead to an increase in the resection rate and the overall survival in selected i-CCA patients. Improvements achieved over the last two decades and the encouraging results recently reported have led to liver transplantation now being considered an appropriate indication for CCA patients.
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20
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Ratti F, Casadei-Gardini A, Cipriani F, Fiorentini G, Pedica F, Burgio V, Cascinu S, Aldrighetti L. Laparoscopic Surgery for Intrahepatic Cholangiocarcinoma: A Focus on Oncological Outcomes. J Clin Med 2021; 10:jcm10132828. [PMID: 34206930 PMCID: PMC8268981 DOI: 10.3390/jcm10132828] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background: The aim of the present study was to analyze the long-term outcomes of laparoscopic and open surgery for intrahepatic cholangiocarcinoma (iCCA) in a series, collected in a tertiary referral center with a high annual volume of laparoscopic activity. Methods: Between January 2004 and June 2020, 446 liver resections (LR) were performed for iCCA: of these, 179 were performed by laparoscopic surgery (LS) and 267 with the open approach. The two groups were matched through a 1:1 propensity score using covariates representative of patient and disease characteristics. The study and control groups were compared, with specific attention given to oncological outcomes (rate of R0, depth of resection margins, overall and disease-free survival, rate, and site of recurrence). Results: The number of retrieved nodes, rate, and depth of negative resection margins were comparable between the two groups. The interval time between surgery and subsequent adjuvant treatments was significantly shorter in LS patients. No differences were shown even in the comparison between the LS and the open group in terms of median disease-free and overall survival. Moreover, the disease recurrence rate was comparable between the LS and the open groups (45.2% versus 56.7%), and the recurrence pattern was similar. Conclusions: The minimally invasive approach for iCCA was once again confirmed to be associated with advantages in terms of intraoperative and short-term outcomes, but was also proven to be oncologically non-inferior to the open counterpart. In the present study, overall and disease-free survival were found to be similar between the two approaches.
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Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (F.C.); (G.F.); (L.A.)
- Correspondence: ; Tel.: +39-02-26435778 (ext. 7808) or +39-348-2411961; Fax: +39-02-26437807
| | - Andrea Casadei-Gardini
- Department of Medical Oncology, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (A.C.-G.); (V.B.); (S.C.)
| | - Federica Cipriani
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (F.C.); (G.F.); (L.A.)
| | - Guido Fiorentini
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (F.C.); (G.F.); (L.A.)
| | - Federica Pedica
- Department of Experimental Oncology, Pathology Unit, San Raffaele Hospital, 20132 Milano, Italy;
| | - Valentina Burgio
- Department of Medical Oncology, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (A.C.-G.); (V.B.); (S.C.)
| | - Stefano Cascinu
- Department of Medical Oncology, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (A.C.-G.); (V.B.); (S.C.)
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, 20132 Milano, Italy; (F.C.); (G.F.); (L.A.)
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21
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Predicting the Risk of Postoperative Complications in Patients Undergoing Minimally Invasive Resection of Primary Liver Tumors. J Clin Med 2021; 10:jcm10040685. [PMID: 33578875 PMCID: PMC7916554 DOI: 10.3390/jcm10040685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/23/2021] [Accepted: 02/07/2021] [Indexed: 12/15/2022] Open
Abstract
Minimal-invasive techniques are increasingly applied in clinical practice and have contributed towards improving postoperative outcomes. While comparing favorably with open surgery in terms of safety, the occurrence of severe complications remains a grave concern. To date, no objective predictive system has been established to guide clinicians in estimating complication risks as the relative contribution of general patient health, liver function and surgical parameters remain unclear. Here, we perform a single-center analysis of all consecutive patients undergoing laparoscopic liver resection for primary hepatic malignancies since 2010. Among the 210 patients identified, 32 developed major complications. Several independent predictors were identified through a multivariate analysis, defining a preoperative model: diabetes, history of previous hepatectomy, surgical approach, alanine aminotransferase levels and lesion entity. The addition of operative time and whether conversion was required significantly improved predictions and were thus incorporated into the postoperative model. Both models were able to identify patients with major complications with acceptable performance (area under the receiver-operating characteristic curve (AUC) for a preoperative model = 0.77 vs. postoperative model = 0.80). Internal validation was performed and confirmed the discriminatory ability of the models. An easily accessible online tool was deployed in order to estimate probabilities of severe complication without the need for manual calculation.
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22
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Machairas N, Kostakis ID, Schizas D, Kykalos S, Nikiteas N, Sotiropoulos GC. Meta-analysis of laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma. Updates Surg 2020; 73:59-68. [PMID: 33219937 DOI: 10.1007/s13304-020-00930-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023]
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive hepatic malignancy. An up-to-date systematic review and meta-analysis was conducted aiming to compare outcomes between laparoscopic (LLR) and open liver resection (OLR) for patients with iCCA. A systematic literature search of Medline, Scopus, Google Scholar, and Cochrane databases was performed. A total of 8 studies comprising 2872 patients, who underwent LLR or OLR for iCCA, were included in our meta-analysis. LLR patients had smaller tumors [mean difference (MD): - 1.17 cm, 95% confidence intervals (CI) - 1.77 to - 0.57, p = 0.0001], underwent major resections less frequently [risk ratio (RR): 0.75, 95% CI 0.67-0.83, p < 0.00001] and R0 resections more frequently (RR: 1.05, 95% CI 1.01-1.09, p = 0.01), while lymphadenectomy was less common in the laparoscopic group (RR: 0.73, 95% CI 0.58-0.92, p = 0.007). The LLR group presented reduced blood loss (MD: - 270.16 ml, 95% CI - 381.53 to - 32.79, p = 0.002), need for transfusion (RR: 0.39, 95% CI 0.21-0.73, p = 0.003), overall morbidity (RR: 0.58, 95% CI 0.4-0.83, p = 0.003) and hospital stay (MD: - 3.48 days, 95% CI: - 6.94 to - 0.02, p = 0.05) compared to the OLR group. No differences were shown in operative time (MD: 1.6 min, 95% CI - 34.17-37.37, p = 0.93), major morbidity (RR: 0.65, 95% CI 0.38-1.11, p = 0.12), mortality (RR: 1.42, 95% CI 0.13-15.07, p = 0.77), overall (HR: 0.9, 95% CI 0.59-1.38, p = 0.63) and relapse-free survival (HR: 0.77, 95% CI 0.5-1.16, p = 0.21) between the two groups. LLR seems to benefit patients with iCCA in terms of short-term outcomes, whilst long-term outcomes are comparable among the two approaches.
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Affiliation(s)
- Nikolaos Machairas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece. .,Department of HPB Surgery and Liver Transplant, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.
| | - Ioannis D Kostakis
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Kykalos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Nikolaos Nikiteas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Georgios C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece
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