Long-term outcomes after open surgery (OS) for hilar cholangiocarcinoma (CCA) resection were significantly better than those following laparoscopic surgery (LS), in a study recently published in Surgical Endoscopy.
Physicians from the Cheeloo College of Medicine at Shandong University in China compared short- and long-term outcomes of each type of surgery. The results showed no significant difference between the 2 groups in terms of short-term outcomes, except that the incisions were larger for OS than LS (21.0 cm vs 13.2 cm, P <.001). However, the long-term outcomes of overall survival rate and disease-free survival rate were significantly higher in the OS group (P =.0057 and P =.0043, respectively).
The authors stated, “Our results show that LS for [hilar CCA] is technically achievable and has acceptable short-term outcomes; however, LS fails to show any advantage over OS in terms of long-term outcomes.” The authors added, “In the future, as more surgeons become experienced in LS and the technique and related instrumentation undergo further refinement, we believe that more favorable postoperative outcomes will be achieved.”
The authors did not believe that the difference in long-term outcomes was due to incomplete surgical resection, as the 2 techniques had similar oncologic adequacy and R0 resection rates. The LS group did have a slightly lower R0 surgical margin, but it was not significantly different from that of the OS group.
The authors offered 2 possible reasons for the discrepancy in long-term outcomes between LS and OS, including errors due to the small sample size of the LS group and the possible spread of cancer cells due to the technology used in LS. The authors stated that cancer cells may have been contained in the “smoke or spray produced by the harmonic or other power-equipped devices,” which could have spread the cells to other areas. This spread of cells combined with CO2 pneumoperitoneum may have increased the implantation and growth of new tumors and ultimately led to poorer outcomes in the LS group.
A total of 149 patients underwent surgical resection for hilar CCA between February 2017 and September 2020 at Qilu Hospital of Shandong University. After the application of exclusion criteria and propensity score matching, 47 patients were included in the OS group and 20 were included in the LS group.
There were no significant differences between the groups in terms of pathological findings or baseline characteristics such as age, body mass index (BMI), or sex. The median follow-up after surgery for all patients was 17.9 months, with the OS group median being slightly longer (19.2 months) than the LS group (14.7 months). Disease recurrence occurred in 20 OS patients (42.6%) and 12 LS patients (60%).
Ma D, Wang W, Wang J, et al. Laparoscopic versus open surgery for hilar cholangiocarcinoma: a retrospective cohort study on short-term and long-term outcomes. Surg Endosc. Published online August 16, 2021. doi:10.1007/s00464-021-08686-6