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Total laparoscopic versus open radical resection for hilar cholangiocarcinoma

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Abstract

Background

Radical resection is the only curative option for patients with hilar cholangiocarcinoma (HCCA) to achieve long-term survival. However, due to the fact that radical resection of HCCA has high technical requirements, the safety and efficacy of laparoscopic resection for HCCA remains controversial.

Method

From January 2015 to December 2018, 23 cases of HCCA underwent radical resection in our center. Clinical data of those patients were collected and analyzed retrospectively.

Results

14 patients underwent laparoscopic resection and 9 cases received open resection. 2 patients in laparoscopic group were converted to laparotomy. Operation time in laparoscopic group was significantly longer than that in open group (519.4 ± 155.4 min vs 366.7 ± 93.1 min). Estimated blood loss (620.0 ± 681.2 ml vs 821.4 ± 713.8 ml) and incidence of intraoperative blood transfusion (5/9 vs 8/14) did not differ significantly between two groups. Pathological outcomes were comparable between two groups. Length of postoperative hospital stay (23.4 ± 13.4 days vs 17.8 ± 7.1 days), severe postoperative morbidity (3/9 vs 5/14), bile leakage of Grade A or B (5/9 vs 5/14), intra-abdominal bleeding (0/9 vs 1/14), intra-abdominal abscess (1/9 vs 0/14), wound infection (0/9 vs 1/14), pulmonary infection (2/9 vs 0/14), and liver failure (0/9 vs 0/14) did not differ significantly between two groups. One patient in laparoscopic group died (1/14) at 21 postoperative days due to intra-abdominal bleeding, while no 30-day mortality was observed in open group.

Conclusion

Our results demonstrate that laparoscopic radical resection of HCCA is safe and feasible in experienced hands. Although laparoscopic resection for HCCA, which is still in initial and exploratory stage, fails to show any advantage over open resection in this study, we are optimistic with its wide application in future with the improvement of surgical techniques and experience.

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Authors and Affiliations

  1. Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Shangtang Road 158#, Hangzhou, Zhejiang, China

    Yuhua Zhang, Changwei Dou, Weiding Wu, Jie Liu, Liming Jin, Zhiming Hu & Chengwu Zhang

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  1. Yuhua Zhang
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  2. Changwei Dou
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  3. Weiding Wu
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  4. Jie Liu
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  6. Zhiming Hu
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  7. Chengwu Zhang
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Correspondence to Chengwu Zhang.

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All authors including Yuhua Zhang, Changwei Dou, Weiding Wu, Jie Liu, Liming Jin, Zhiming Hu, and Chengwu Zhang have no conflicts of interest or financial ties to disclose.

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Zhang, Y., Dou, C., Wu, W. et al. Total laparoscopic versus open radical resection for hilar cholangiocarcinoma. Surg Endosc 34, 4382–4387 (2020). https://doi.org/10.1007/s00464-019-07211-0

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