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Minimally Invasive Approach Provides Oncological Benefit in Patients with High Risk of Very Early Recurrence (VER) After Surgery for Intrahepatic Cholangiocarcinoma (iCCA)

  • Hepatobiliary Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Surgery for intrahepatic cholangiocarcinoma (iCCA) is jeopardized by significant risk of early recurrence (≤ 6 months). The aim of the present study is to analyze the oncological benefit provided by laparoscopic over open approach for iCCA in patients with high risk of very early recurrence (VER).

Materials and Methods

A total of 532 liver resections (LR) were performed for iCCA [265 by minimally invasive surgery (MIS) and 267 with open approach, matched through a 1:1 propensity score] and stratified using the postoperative prediction model of VER. Outcomes were compared between open and laparoscopic approaches, specifically evaluating oncological benefit.

Results

The percentage of patients with high risk of VER was similar (32.7% in the laparoscopic group and 35.3% in the open group, pNS). The number of retrieved nodes as well as the rate and depth of negative resection margins were comparable between laparoscopic and open. The surgery-adjuvant treatment interval was shorter in laparoscopic patients in the overall series, as well in the subgroup of high risk of VER. The rate of patients starting adjuvant treatments within 2 months from surgery was higher in laparoscopic group compared with open group. In VER high-risk group both disease-free survival (DFS) and overall survival (OS) were significantly improved in MIS compared with open group (p = 0.032 and p = 0.026, respectively).

Conclusions

In patients with high risk of VER, laparoscopy translates into an advantage in terms of recurrence-free survival, likely related to lower biological impact of surgery, together with a shorter interval between surgery and start of adjuvant treatments, even allowing for a higher number of patients to start adjuvant therapies within 2 months from resection.

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Authors and Affiliations

  1. Hepatobiliary Surgery Division, IRCCS San Raffaele, Milan, Italy

    Francesca Ratti MD, Cecilia Maina MD, Lucrezia Clocchiatti MD, Rebecca Marino MD & Luca Antonio Maria Aldrighetti MD, PhD

  2. Vita-Salute San Raffaele University, Milan, Italy

    Francesca Ratti MD, Andrea Casadei Gardini MD, Francesco De Cobelli MD & Luca Antonio Maria Aldrighetti MD, PhD

  3. Department of Experimental Oncology, Pathology Unit, San Raffaele Hospital, Milan, Italy

    Federica Pedica MD

  4. Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy

    Andrea Casadei Gardini MD

  5. Department of Radiology, IRCCS San Raffaele Hospital, Milan, Italy

    Francesco De Cobelli MD

  6. Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Francesco De Cobelli MD

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  1. Francesca Ratti MD
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Ratti, F., Maina, C., Clocchiatti, L. et al. Minimally Invasive Approach Provides Oncological Benefit in Patients with High Risk of Very Early Recurrence (VER) After Surgery for Intrahepatic Cholangiocarcinoma (iCCA). Ann Surg Oncol 31, 2557–2567 (2024). https://doi.org/10.1245/s10434-023-14807-3

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