Biliary-enteric reconstruction in laparoscopic radical resection of hilar cholangiocarcinoma (CCA) is technically feasible and the quality of anastomosis equals that of open surgery.
However, it takes longer and a more significant proportion of the total operation time showing that biliary-enteric reconstruction requires higher technical skill and is one of the critical rate-limiting steps affecting the minimal invasiveness of laparoscopic surgery.
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These are the findings of a study published in BMC Cancer, the aim of which was to propose technical recommendations on CCA surgery.
The team, led by Yongjun Chen from the Huazhong University of Science and Technology in Hubei, China, analyzed data from 38 laparoscopic radical resection and 54 radical laparotomy resections of hilar CCA.
The researchers reported that patients were relatively younger in the laparoscopic resection group and that Bismuth type I had a higher proportion. On the contrary, type 3a and 4 were less and needed no revascularization.
The biliary residuals number was between 0.92 and 4.16 in the laparoscopic group and between 1.01 and 3.93 in the laparotomy group. The number of anastomoses in the laparoscopy group was between 0,77 and 3.31, while in the laparotomy group, it was between 1.24 and 3.9.
The time of biliary-enteric reconstruction ranged between 44.14 minutes and 87.2 minutes in the laparoscopy group and between 22.73 minutes and 62.27 minutes in the laparotomy group. This corresponded to between 11.44% and 18.72% and 9.22% and 14.3% of the total operation time, respectively.
The incidence of bile leakage following the operation was 15.79% in the laparoscopy group and 16.67% in the laparotomy group.
It took those in the laparoscopy group between 3.72 and 24.28 days to heal and those in the laparotomy group between 7.27 and 26.74 days to heal.
The anastomosis stenosis rate was 2.63% in the laparoscopy group and 1.85% in the laparotomy group.
There were no deaths related to biliary hemorrhage or bile leakage in either group.
The researchers concluded that laparoscopic biliary-enteric reconstruction has both advantages and disadvantages.
Reference
Liu W, Xiong F, Wu G, Wang Q, Wang B, Chen Y. Biliary-enteric reconstruction in laparoscopic radical resection of hilar cholangiocarcinoma: a single-center retrospective cohort study. BMC Cancer. Published online May 18, 2023. doi:10.1186/s12885-023-10942-y
