A recent study found improved short-term and similar long-term outcomes associated with laparoscopic surgery compared to open surgery in patients with intrahepatic cholangiocarcinoma (iCCA).
The retrospective study, published in the Scandinavian Journal of Gastroenterology, showed that patients who had laparoscopic surgery had fewer complications, fewer reoperations, and shorter hospital stays than those who had open surgery.
The number of laparoscopic liver surgeries to manage colorectal liver metastases and hepatocellular carcinoma is on the rise, especially in specialized treatment centers. Prior evidence suggested that laparoscopic liver surgeries offer significant postoperative benefits to patients compared to open surgeries.
The present study is a multicenter cohort study. It included patients with iCCA who had undergone laparoscopic or open liver resection between 2012 and 2019 at 4 European expert centers in liver surgery: Oslo University Hospital, Norway; Groeninge Hospital, Kortrijk, Belgium; University Medical Centre Maribor, Slovenia; and Moscow Clinical Scientific Center, Russia.
The study team compared surgical and oncological outcomes with laparoscopic and open approaches, including postoperative outcomes and recurrence, recurrence-free and overall survival. To better understand the risk factors for complications after liver resection, the study also conducted a subgroup analysis stratifying for the type of hepatectomy.
The final study sample included 136 patients who underwent liver resection for iCCA within the study period. Of these, 50 patients received laparoscopic procedures and 86 had open resections.
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Patients receiving open liver surgery had a longer mean operative time and a higher incidence of red blood cell transfusion than those who underwent the laparoscopic procedure. Furthermore, a higher rate of postoperative complications and reoperations was found among patients receiving open liver surgery. Laparoscopic surgery was also associated with shorter intensive care units and hospital stays.
Although the study found improved short-term outcomes for patients receiving laparoscopic surgery compared to open surgery, the long-term outcomes were similar. Median recurrence-free and overall survival were similar between the groups. In the subgroup analysis, open major and minor hepatectomies were associated with an increased frequency of regional lymphadenectomy.
“This study demonstrates that oncologic outcomes, especially long-term results, are similar for laparoscopic and open resections, whenever the minimally invasive approach is found feasible. This is mostly in agreement with the meta-analyses published to date,” the authors wrote. “To the best of our knowledge, this is the first report on [iCCA] to include subgroup analyses of minor/major hepatectomy for laparoscopic and open resections.”
Patients with resectable iCCA can be suitable candidates for laparoscopic resection in high-volume surgical centers with sufficient expertise. Future studies could focus on defining the patient selection criteria for laparoscopic surgery among patients with iCCA, the researchers wrote.
Sahakyan MA, Aghayan DL, Edwin B, et al. Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: a multicenter propensity score-matched study. Scandinavian Journal of Gastroenterology. Published online November 14, 2022. doi:10.1080/00365521.2022.2143724