Laparoscopic hepatectomy (LH) for patients with intrahepatic cholangiocarcinoma (CCA) leads to better surgical outcomes with similar oncological and survival outcomes when compared to open hepatectomy (OH), according to a systematic review and meta-analysis published in the European Journal of Surgical Oncology.

The meta-analysis found that patients with intrahepatic CCA who received LH had better surgical outcomes, including lower complication rates (risk ratio .57; P =.01) and a shorter length of hospital stay (mean difference -2.44 days; P =.006) than those who received OH. The 90-day postoperative mortality rates were not significantly different between the 2 groups (P =.28).

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No significant differences were found between the 2 groups regarding oncological outcomes, including R0 resection rate (P =.08) and lymph node dissection rate (P =.23).

No differences were observed in survival outcomes, as well, including 1-year, 3-year, and 5-year overall survival rates (P =.77, P =.93, and P =.74, respectively). The 1-year, 3-year, and 5-year disease-free survival rates were also not significantly different between the 2 groups (P =.60, P =.14, P =.22, respectively).

“This systematic review and meta-analysis of propensity score-matched studies for laparoscopic and open hepatectomy for intrahepatic cholangiocarcinoma found laparoscopic resection to have better surgical outcomes and identical oncological outcomes and survival outcomes,” the authors wrote.

“From a conservative viewpoint, these results can be interpreted to indicate that laparoscopy is at least not inferior to open surgery for intrahepatic cholangiocarcinoma,” the authors concluded.

The literature review used in the analysis initially identified 96 studies after the removal of duplicates. Of these, 78 were excluded based on titles and abstracts. The remaining 18 studies were fully reviewed to see if they met the inclusion criteria of the meta-analysis.

Ultimately, 6 studies were selected for inclusion in the overall meta-analysis resulting in a total of 518 patients with CCA who received LH and 536 who received OH. No significant differences were found in the gender, American Society of Anesthesiologists scores, proportion of patients with liver cirrhosis, tumor stages, number of patients with multiple tumors, and the proportion of patients who underwent major hepatectomy between the 2 patient groups across the studies.


Li HJ, Wang Q, Yang ZL, et al. Laparoscopic versus open hepatectomy for intrahepatic cholangiocarcinoma: Systematic review and meta-analysis of propensity score-matched studies. Eur J Surg Oncol. Published online February 20, 2023. doi:10.1016/j.ejso.2023.02.010