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Liver resection for extra-pancreatic biliary cancer: what is the role of laparoscopic approach?

  • Walid ElmoghazyEmail author
  • Jane Cowan
  • Nicolas Tabchouri
  • Pascale Tinguely
  • Mostefa Bennamoun
  • Candice Tubbax
  • Anthony Sarran
  • Marine Lefevre
  • Christian Lamer
  • Brice Gayet
  • David Fuks
Article

Abstract

Background

Laparoscopic liver resection (LLR) has evolved over time, yet its role in extra-pancreatic biliary cancer has been limited due to several factors. We aimed to evaluate the short-term outcome of LLR in extra-pancreatic biliary tract cancer.

Methods

From January 2002 to 2016, all patients who underwent LLR for extra-pancreatic biliary tract cancer including gallbladder cancer (GBC), intra-hepatic cholangiocarcinoma (ICC), and peri-hilar cholangiocarcinoma (PHC) with curative intent (R0 or R1) at Institute Mutualiste Montsouris were identified from prospectively collected databases. Patient characteristics, and perioperative outcomes, were analyzed in all three groups.

Results

A total of 35 patients were included: 10 with GBC, 14 with ICC, and 11 with PHC. There were 19 (54%) women and median age was 71 years. Median operative time was 240 min, and estimated blood loss was 200 ml. Conversion to an open procedure was more common in patients with PHC (45% vs. 7% for ICC and 0% for GBC, p = 0.010). R0 resection was achieved in 10 (100%), 12 (86%), and 8 (73%) patients in GBC, ICC, and PHC groups, respectively (p = 0.204). Postoperative morbidity was reported in 19 (54%) patients of whom 12 (34%) had minor complications. Postoperative mortality was reported in 4 (11%) patients; one (7%) in GBC group, one (7%) in ICC group, and two (18%) in PHC, p = 0.681. Median hospital stay was 11 days.

Conclusions

The present series suggests that LLR is feasible in GBC, challenging but achievable in ICC but unsuitable for the moment in PHC.

Keywords

Laparoscopy Liver resection Biliary tract malignancy Short-term outcome Complications 

Abbreviations

LLR

Laparoscopic liver resection

ASA

American Society of Anesthesiologists

BMI

Body mass index

CT

Computed tomography

Notes

Compliance with ethical standards

Disclosure

Walid Elmoghazy, Jane Cowan, Nicolas Tabchouri, Pascale Tinguely, Mostefa Bennamoun, Candice Tubbax, Anthony Sarran, Marine Lefevre, Christian Lamer, Brice Gayet, and David Fuks have no conflict of interests or financial ties to disclose.

References

  1. 1.
    Aldrighetti L, Belli G, Boni L, Cillo U, Ettorre G, De Carlis L, Pinna A, Casciola L, Calise F, Italian Group of Minimally Invasive Liver S (2015) Italian experience in minimally invasive liver surgery: a national survey. Updates Surg 67:129–140.  https://doi.org/10.1007/s13304-015-0307-2 CrossRefGoogle Scholar
  2. 2.
    Agarwal AK, Javed A, Kalayarasan R, Sakhuja P (2015) Minimally invasive versus the conventional open surgical approach of a radical cholecystectomy for gallbladder cancer: a retrospective comparative study. HPB 17:536–541.  https://doi.org/10.1111/hpb.12406 CrossRefGoogle Scholar
  3. 3.
    Castro CM, Santibanez SP, Rivas TC, Cassis NJ (2018) Totally laparoscopic radical resection of gallbladder cancer: technical aspects and long-term results. World J Surg.  https://doi.org/10.1007/s00268-018-4490-4 Google Scholar
  4. 4.
    Gumbs AA, Jarufe N, Gayet B (2013) Minimally invasive approaches to extrapancreatic cholangiocarcinoma. Surg Endosc 27:406–414.  https://doi.org/10.1007/s00464-012-2489-8 CrossRefGoogle Scholar
  5. 5.
    Gumbs AA, Hoffman JP (2010) Laparoscopic radical cholecystectomy and Roux-en-Y choledochojejunostomy for gallbladder cancer. Surg Endosc 24:1766–1768.  https://doi.org/10.1007/s00464-009-0840-5 CrossRefGoogle Scholar
  6. 6.
    Dagher I, Gayet B, Tzanis D, Tranchart H, Fuks D, Soubrane O, Han HS, Kim KH, Cherqui D, O’Rourke N, Troisi RI, Aldrighetti L, Bjorn E, Abu Hilal M, Belli G, Kaneko H, Jarnagin WR, Lin C, Pekolj J, Buell JF, Wakabayashi G (2014) International experience for laparoscopic major liver resection. J Hepat Biliary Pancreat Sci 21:732–736.  https://doi.org/10.1002/jhbp.140 CrossRefGoogle Scholar
  7. 7.
    Nomi T, Fuks D, Govindasamy M, Mal F, Nakajima Y, Gayet B (2015) Risk factors for complications after laparoscopic major hepatectomy. Br J Surg 102:254–260.  https://doi.org/10.1002/bjs.9726 CrossRefGoogle Scholar
  8. 8.
    Hu HJ, Wu ZR, Jin YW, Ma WJ, Yang Q, Wang JK, Liu F, Li FY (2018) Minimally invasive surgery for hilar cholangiocarcinoma: state of art and future perspectives. ANZ J Surg.  https://doi.org/10.1111/ans.14765 Google Scholar
  9. 9.
    Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BJ, Youssef BM, Klimstra D, Blumgart LH (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507–517 (Discussion 517–509)CrossRefGoogle Scholar
  10. 10.
    Nomi T, Fuks D, Kawaguchi Y, Mal F, Nakajima Y, Gayet B (2015) Learning curve for laparoscopic major hepatectomy. Br J Surg 102:796–804.  https://doi.org/10.1002/bjs.9798 CrossRefGoogle Scholar
  11. 11.
    Ishizawa T, Gumbs AA, Kokudo N, Gayet B (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964.  https://doi.org/10.1097/SLA.0b013e31825ffed3 CrossRefGoogle Scholar
  12. 12.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefGoogle Scholar
  13. 13.
    Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The “50–50 criteria” on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828 (Discussion 828–829)CrossRefGoogle Scholar
  14. 14.
    Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M, Christophi C, Banting S, Brooke-Smith M, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Nimura Y, Figueras J, DeMatteo RP, Buchler MW, Weitz J (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688.  https://doi.org/10.1016/j.surg.2010.12.002 CrossRefGoogle Scholar
  15. 15.
    Ishizawa T, Hasegawa K, Kokudo N, Sano K, Imamura H, Beck Y, Sugawara Y, Makuuchi M (2009) Risk factors and management of ascites after liver resection to treat hepatocellular carcinoma. Arch Surg 144:46–51.  https://doi.org/10.1001/archsurg.2008.511 CrossRefGoogle Scholar
  16. 16.
    Hezel AF, Zhu AX (2008) Systemic therapy for biliary tract cancers. The Oncologist 13:415–423.  https://doi.org/10.1634/theoncologist.2007-0252 CrossRefGoogle Scholar
  17. 17.
    Han HS, Yoon YS, Agarwal AK, Belli G, Itano O, Gumbs AA, Yoon DS, Kang CM, Lee SE, Wakai T, Troisi RI (2019) Laparoscopic surgery for gallbladder cancer: an expert consensus statement. Dig Surg 36:1–6.  https://doi.org/10.1159/000486207 CrossRefGoogle Scholar
  18. 18.
    Yoon YS, Han HS, Agarwal A, Belli G, Itano O, Gumbs AA, Yoon DS, Kang CM, Lee SE, Wakai T, Troisi RI (2019) Survey Results of the expert meeting on laparoscopic surgery for gallbladder cancer and a review of relevant literature. Dig Surg 36:7–12;  https://doi.org/10.1159/000486208 CrossRefGoogle Scholar
  19. 19.
    Fiorentini G, Ratti F, Cipriani F, Palombo D, Catena M, Paganelli M, Aldrighetti L (2017) Minimally invasive approach to intrahepatic cholangiocarcinoma: technical notes for a safe hepatectomy and lymphadenectomy. Ann Laparosc Endosc Surg.  https://doi.org/10.21037/ales.2017.03.05 Google Scholar
  20. 20.
    Ratti F, Cipriani F, Ariotti R, Gagliano A, Paganelli M, Catena M, Aldrighetti L (2016) Safety and feasibility of laparoscopic liver resection with associated lymphadenectomy for intrahepatic cholangiocarcinoma: a propensity score-based case-matched analysis from a single institution. Surg Endosc 30:1999–2010.  https://doi.org/10.1007/s00464-015-4430-4 CrossRefGoogle Scholar
  21. 21.
    Lee W, Park JH, Kim JY, Kwag SJ, Park T, Jeong SH, Ju YT, Jung EJ, Lee YJ, Hong SC, Choi SK, Jeong CY (2016) Comparison of perioperative and oncologic outcomes between open and laparoscopic liver resection for intrahepatic cholangiocarcinoma. Surg Endosc 30:4835–4840.  https://doi.org/10.1007/s00464-016-4817-x CrossRefGoogle Scholar
  22. 22.
    Yu H, Wu SD, Chen DX, Zhu G (2011) Laparoscopic resection of Bismuth type I and II hilar cholangiocarcinoma: an audit of 14 cases from two institutions. Dig Surg 28:44–49.  https://doi.org/10.1159/000322398 CrossRefGoogle Scholar
  23. 23.
    Zhang W, Yan LN (2014) Perihilar cholangiocarcinoma: current therapy. World J Gastrointest Pathophysiol 5:344–354.  https://doi.org/10.4291/wjgp.v5.i3.344 CrossRefGoogle Scholar
  24. 24.
    Launois B, Terblanche J, Lakehal M, Catheline JM, Bardaxoglou E, Landen S, Campion JP, Sutherland F, Meunier B (1999) Proximal bile duct cancer: high resectability rate and 5-year survival. Ann Surg 230:266–275CrossRefGoogle Scholar
  25. 25.
    Capobianco I, Rolinger J, Nadalin S (2018) Resection for Klatskin tumors: technical complexities and results. Transl Gastroenterol Hepatol 3:69  https://doi.org/10.21037/tgh.2018.09.01 CrossRefGoogle Scholar
  26. 26.
    Mansour JC, Aloia TA, Crane CH, Heimbach JK, Nagino M, Vauthey JN (2015) Hilar cholangiocarcinoma: expert consensus statement. HPB 17:691–699.  https://doi.org/10.1111/hpb.12450 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Walid Elmoghazy
    • 1
    • 2
    Email author
  • Jane Cowan
    • 1
  • Nicolas Tabchouri
    • 1
  • Pascale Tinguely
    • 1
  • Mostefa Bennamoun
    • 3
  • Candice Tubbax
    • 1
  • Anthony Sarran
    • 4
  • Marine Lefevre
    • 5
  • Christian Lamer
    • 6
  • Brice Gayet
    • 1
    • 7
  • David Fuks
    • 1
    • 7
  1. 1.Department of Digestive, Oncological and Metabolic Surgery – Institut Mutualiste MontsourisParisFrance
  2. 2.Department of SurgerySohag UniversitySohagEgypt
  3. 3.Department of Oncology – Institut Mutualiste MontsourisParisFrance
  4. 4.Department of Radiology – Institut Mutualiste MontsourisParisFrance
  5. 5.Department of Pathology – Institut Mutualiste MontsourisParisFrance
  6. 6.Department of Intensive Care Unit – Institut Mutualiste MontsourisParisFrance
  7. 7.Université Paris DescartesParisFrance

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