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Is It Time to Consider Laparoscopic Hepatectomy for Intrahepatic Cholangiocarcinoma? A Meta-Analysis

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Objectives

The role of laparoscopic hepatectomy (LH) for intrahepatic cholangiocarcinoma (ICC) remains indefinite, though the utilization of this minimally invasive approach has been increasing for ICC. We herein performed a meta-analysis to investigate this issue.

Methods

Six retrospective studies including 384 patients who had undergone LH and 2147 patients who had undergone open hepatectomy (OH) for ICC were included. The fixed-effects or random-effects models were utilized for data analysis.

Results

Compared with patients who had undergone OH for ICC, patients who had undergone LH for ICC experienced more R0 resections (81.6 versus 73.8%, risk ratio (RR) = 1.08, 95% confidence interval (CI) 1.02–1.14; P = 0.008) but less major hepatectomies (37.7 versus 54.2%, RR = 0.69, 95% CI 0.60–0.79; P < 0.0001), less lymph node dissections (38.0 versus 61.5%, RR = 0.62, 95% CI 0.54–0.70; P < 0.0001), and smaller tumor size resected (4.14 versus 4.94 cm, weighted mean difference = − 0.80 cm, 95% CI − 1.38 to − 0.22 cm; P = 0.007). No significant difference was observed in other perioperative results (all P > 0.05) or overall survival (hazard ratio (HR) = 1.38, 95% CI 0.63–3.02; P = 0.43).

Conclusions

LH has comparable safety, feasibility, and oncological efficacy to that of OH for ICC and has superiority in R0 resection over OH. It may be time to consider LH for ICC only if a more thorough effort on lymph node dissection is undertaken in selective patients at experienced centers.

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Author information

Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang Province, China

    Fangqiang Wei, Changwei Dou & Chengwu Zhang

  2. Department of Public Health, Hangzhou Medical College, Hangzhou, 310051, Zhejiang Province, China

    Guan Wang

  3. Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China

    Jianyi Ding

  4. Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, Zhejiang Province, China

    Tunan Yu

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  1. Fangqiang Wei
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  3. Jianyi Ding
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  4. Changwei Dou
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  5. Tunan Yu
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  6. Chengwu Zhang
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Contributions

FQ Wei conceived and designed the study. G Wang, JY Ding, and TN Yu acquired and analyzed the data. CW Dou and CW Zhang interpreted the data. FQ Wei wrote the manuscript. G Wang helped to revise the manuscript. All authors read and approved the manuscript.

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Correspondence to Fangqiang Wei.

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Electronic supplementary material

Table S1

Meta-analysis of baseline characteristics. (DOCX 97 kb)

Figure S1

Flowchart of included studies. (PNG 69 kb)

High Resolution Image (TIF 562 kb)

Figure S2

Results of the meta-analysis on perioperative outcomes: (A) The mean difference of operation time in minutes in laparoscopic hepatectomy (LH) in comparison with open hepatectomy (OH); (B) The mean difference of blood loss in milliliter in LH in comparison with OH; (C) The T1 stage tumors rate in LH in comparison with OH; (D)The well differentiation tumors rate in LH in comparison with OH; (E) The morbidity rate in LH in comparison with OH; (F) The mean difference of hospital stay in days in LH in comparison with OH. (PNG 469 kb)

High Resolution Image (TIF 5187 kb)

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Wei, F., Wang, G., Ding, J. et al. Is It Time to Consider Laparoscopic Hepatectomy for Intrahepatic Cholangiocarcinoma? A Meta-Analysis. J Gastrointest Surg 24, 2244–2250 (2020). https://doi.org/10.1007/s11605-019-04404-9

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  • DOI: https://doi.org/10.1007/s11605-019-04404-9

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