A recent study published in Annals of Surgical Oncology has revealed that laparoscopic liver resection (LLR) is associated with improved perioperative outcomes and similar overall survival (OS) compared to open liver resection (OLR) for patients with resectable intrahepatic cholangiocarcinoma (iCC).
The study systematically reviewed databases, including PubMed, EMBASE, and Web of Science, to search studies comparing OS and perioperative outcomes for resectable iCC patients. For the investigation of differences in OS between LLR and OLR, a frequentist patient-level, 1-stage meta-analysis was performed. Moreover, the 2 approaches were compared for postoperative, intraoperative, and oncological outcomes.
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The study includes 6 PSM studies with 1,042 patients, including 530 patients undergoing OLR and 512 undergoing LLR. LLR was found to significantly decrease the death hazard compared with OLR.
Furthermore, LLR was reportedly associated with shorter hospital stays, decreased intraoperative bleeding and transfusion, and a lower rate of major complications. “The results of this meta-analysis show benefits not only in terms of survival but also in terms of intraoperative parameters and postoperative outcomes,” the authors highlighted.
In addition, the reconstructed patient-level survival data showed that the restricted mean survival time was 3.6 months, higher among patients undergoing LLR (P =.027), with an increase in relative life expectancy of 7.7% at 5 years. “These findings are both promising and provocative, because liver surgery for iCC is extremely demanding,” the authors wrote.
The authors acknowledged several limitations in the study, including the lack of randomized controlled trials and the small number of studies analyzed. Despite these limitations, the study indicates the benefits of LLR in patients with resectable iCC. It highlights some actionable insights for healthcare providers deciding on an appropriate surgical approach for these patients.
Cholangiocarcinoma is a rare malignancy; however, its incidence and mortality rate have increased worldwide over the past few decades. Intrahepatic cholangiocarcinoma accounts for approximately 10% to 20% of all CCAs, usually presenting as large tumors and associated with modest survival rates, despite adequate oncological resection.
Reference
Aliseda D, Sapisochin G, Martí-Cruchaga P, et al. Association of laparoscopic surgery with improved perioperative and survival outcomes in patients with resectable intrahepatic cholangiocarcinoma: a systematic review and meta-analysis from propensity-score matched studies. Ann Surg Oncol. Published online April 28, 2023. doi: 10.1245/s10434-023-13498-0
