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Perioperative and oncologic outcomes of laparoscopic versus open liver resection for combined hepatocellular-cholangiocarcinoma: a propensity score matching analysis

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Abstract

Background

Laparoscopic liver resection (LLR) has now been established as a safe and minimally invasive technique that is deemed feasible for treating hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). However, the role of LLR in treating combined hepatocellular-cholangiocarcinoma (cHCC-CC) patients has been rarely reported. This study aimed to assess the efficacy of LLR when compared with open liver resection (OLR) procedure for patients with cHCC-CC.

Methods

A total of 229 cHCC-CC patients who underwent hepatic resection (34 LLR and 195 OLR patients) from January 2014 to December 2018 in Zhongshan Hospital, Fudan University were enrolled and underwent a 1:2 propensity score matching (PSM) analysis between the LLR and OLR groups to compare perioperative and oncologic outcomes. Overall survival (OS) and recurrence-free survival (RFS) parameters were assessed by the log-rank test and the sensitivity analysis.

Results

A total of 34 LLR and 68 OLR patients were included after PSM analysis. The LLR group displayed a shorter postoperative hospital stay (6.61 vs. 8.26 days; p value < 0.001) when compared with the OLR group. No significant differences were observed in the postoperative complications’ incidence or a negative surgical margin rate between the two groups (p value = 0.409 and p value = 1.000, respectively). The aspartate aminotransferase (AST), alanine aminotransferase (ALT), and inflammatory indicators in the LLR group were significantly lower than those in the OLR group on the first and third postoperative days. Additionally, OS and RFS were comparable in both the LLR and OLR groups (p value = 0.700 and p value = 0.780, respectively), and similar results were obtained by conducting a sensitivity analysis.

Conclusion

LLR can impart less liver function damage, better inflammatory response attenuation contributing to a faster recovery, and parallel oncologic outcomes when compared with OLR. Therefore, LLR can be recommended as a safe and effective therapeutic modality for treating selected cHCC-CC patients, especially for those with small tumors in favorable location.

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Acknowledgements

We acknowledged Dr. Yining Wang for his assistance of patient collection. This work was supported by the Major Program of National Natural Science Foundation of China (No. 82090054), National Natural Science Foundation of China (No. 81772566), Clinical Research Plan of Shanghai Hospital Development Center (No. 2020CR3004A), and Natural Science Funds of Shanghai (No. 21ZR1413800).

Funding

Major Program of National Natural Science Foundation of China, No. 82090054, Xiaoying Wang, National Natural Science Foundation of China, No. 81772566, Xiaoying Wang, Clinical Research Plan of Shanghai Hospital Development Center, No. 2020CR3004A, Xiaoying Wang, Natural Science Funds of Shanghai, No. 21ZR1413800, Kai Zhu.

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Author notes

  1. Dan-Jun Song and Kai Zhu have contributed equally to this work.

Authors and Affiliations

  1. Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Dan-Jun Song, Kai Zhu, Jin-peng Tan, Jia-Bin Cai, Jie Hu, Zhen-Bin Ding, Guo-Ming Shi, Ning Ren, Xiao-Wu Huang, Ying-Hong Shi, Shuang-Jian Qiu, Qing-Hai Ye, Hui-Chuan Sun, Qiang Gao, Jian Zhou, Jia Fan & Xiao-Ying Wang

  2. Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Min-Zhi Lv

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Correspondence to Xiao-Ying Wang.

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Dan-Jun Song, Kai Zhu, Jin-peng Tan, Jia-Bin Cai, Min-Zhi Lv, Jie Hu, Zhen-Bin Ding, Guo-Ming Shi, Ning Ren, Xiao-Wu Huang, Ying-Hong Shi, Shuang-Jian Qiu, Qing-Hai Ye, Hui-Chuan Sun, Qiang Gao, Jian Zhou, Jia Fan, and Xiao-Ying Wang have no conflicts of interest or financial ties to disclose.

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Song, DJ., Zhu, K., Tan, Jp. et al. Perioperative and oncologic outcomes of laparoscopic versus open liver resection for combined hepatocellular-cholangiocarcinoma: a propensity score matching analysis. Surg Endosc 37, 967–976 (2023). https://doi.org/10.1007/s00464-022-09579-y

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