Abstract
Background
Intrahepatic cholangiocarcinoma is a rare disease with a poor prognosis. In patients
where surgical resection is possible, outcome is influenced by perioperative morbidity
and lymph node status. Laparoscopic liver resection is associated with improved clinical
and oncological outcomes in primary and metastatic liver cancer compared with open
liver resection, but evidence on intrahepatic cholangiocarcinoma is still insufficient.
The primary aim of this study was to compare overall survival for a large series of
patients treated for intrahepatic cholangiocarcinoma by open or laparoscopic approach.
Secondary objectives were to compare disease-free survival, predictors of death, and
recurrence.
Methods
Patients treated with laparoscopic or open liver resection for intrahepatic cholangiocarcinoma
from 2000 to 2018 from 3 large international databases were analyzed retrospectively.
Each patient in the laparoscopic resection group (case) was matched with 1 open resection
control (1:1 ratio), through a propensity score calculated on clinically relevant
preoperative covariates. Overall and disease-free survival were compared between the
matched groups. Predictors of mortality and recurrence were analyzed with Cox regression,
and the Textbook Outcomes were described.
Results
During the study period, 855 patients met the inclusion criteria (open liver resection
= 709, 82.9%; laparoscopic liver resection = 146, 17.1%). Two groups of 89 patients
each were analyzed after propensity score matching, with no significant difference
regarding pre- and postoperative variables. Overall survival at 1, 3, and 5 years
was 92%, 75%, and 63% in the laparoscopic liver resection group versus 92%, 58%, and
49% in the open liver resection group (P = .0043). Adjusted Cox regression revealed severe postoperative complications (hazard
ratio: 10.5, 95% confidence interval [1.01–109] P = .049) and steatosis (hazard ratio: 13.8, 95% confidence interval [1.23–154] P = .033) as predictors of death, and transfusion (hazard ratio: 19.2, 95% confidence
interval [4.04–91.4] P < .001) and severe postoperative complications (hazard ratio: 4.07, 95% confidence
interval [1.15–14.4] P = .030) as predictors of recurrence.
Conclusion
The survival advantage of laparoscopic liver resection over open liver resection for
intrahepatic cholangiocarcinoma is equivocal, given historical bias and missing data.
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Article info
Publication history
Published online: September 14, 2021
Accepted:
August 12,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
