A new 3-step laparoscopic approach improves the quality of liver resection and lymph node dissection, prolongs survival, and leads to better outcomes both during and after the operation in patients with advanced intrahepatic cholangiocarcinoma (ICC). This is according to a new study published in BMC Cancer

Laparoscopic surgery for ICC can be challenging in patients with advanced disease. 

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In the present study, a team of researchers led by Shi Chen from Shengli Clinical Medical College of Fujian Medical University and the Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital in Fuzhou, China compared a 3-step optimized procedure, consisting of predissection of hepatic hilar vessels, liver resection, and then lymph node dissection, with a traditional laparoscopic procedure.

Forty-two patients underwent optimized laparoscopic hemihepatectomy with lymph node dissection, while 84 underwent traditional laparoscopic hemihepatectomy plus lymph node dissection.

The results showed that the optimized group had lower surgical bleeding scores and higher surgeon satisfaction scores than the traditional group. 

Blood loss during hepatectomy was lower in the optimized group at 190 mL compared to 295 mL in the traditional group. 

Moreover, the optimized group had more harvested lymph nodes than the traditional group (12 vs 8). Of these lymph nodes, more were positive in the optimized group. 

The disease-free and overall survival times of patients treated with the optimized approach were higher than those of patients treated with the traditional method at 9 months vs 7 months for disease-free survival and 15 months vs 13 months for overall survival.

Finally, the total operation time, liver resection time, lymph node dissection time, and hospital stay were all shorter in the optimized group than in the traditional group. The incidence of total morbidities was also lower in the optimized group. 

“Our results indicated the 3-step laparoscopic procedure described here is feasible and effective and should be considered for patients with advanced ICC,” the researchers concluded. 


Liao CY, Wang DF, Jiang BH, et al. Optimization of a laparoscopic procedure for advanced intrahepatic cholangiocarcinoma based on the concept of “waiting time”: a preliminary report. BMC Cancer. Published online November 28, 2022. doi:10.1186/s12885-022-10323-x