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Minimally invasive surgery for hilar cholangiocarcinoma: a multicenter retrospective analysis of 158 patients

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Abstract

Background

Curative resection of hilar cholangiocarcinoma (HC) is typically carried out using open surgery. In the present study, we examined the safety (postoperative complication) and effectiveness (resection margin status and patient survival) of minimally invasive surgery (MIS) for HC.

Methods

This retrospective analysis included 158 patients receiving MIS for HC at 10 participating centers between December 2013 and November 2019. Patient demographics, surgical outcomes, and oncological outcomes were retrospectively analyzed.

Results

Clinical information obtained from 10 different clinical centers did not show any evident cohort-bias clustering. One hundred and twenty-six (79.7%) patients underwent LRHC, 12 (7.6%) patients underwent RARHC, conversion to an open procedure occurred in 20 (12.7%) patients. The operation time and estimated blood loss were 410.8 ± 128.9 min and 477.8 ± 706.3 mL, respectively. The surgical radicality of the 158 patients was R0, 129 (81.6%); R1, 20 (18.4%) and R2, 9 (5.7%). Grades I–II complications was occurred in 68 (43.0%) patients. Severe morbidity (grade III–V) occurred in 14 (8.7%) patients. The median overall survival in whole cohort was 25.4 months. The overall survival rate was 67.6% at year 1, 28.8% at year 3, and 19.2% at year 5. Comparing the first half of MISHC performed by each center with the following cases, the operation time and postoperative hospital stay does not decrease with the increasing cases. On literature review, MISHC is non-inferior to open surgery at least in perioperative period.

Conclusions

In this Chinese MIS for HC multicenter study, the largest to date, long-term overall survival rates after MIS appear comparable to those reported in current open series. Further randomized controlled trials are necessary to assess the global impact of MISHC.

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Data availability

The dataset that supports the findings of this study is available from the corresponding author upon request.

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Funding

This research was funded by the Department of Education, Sichuan Province (16TDD00025, to Jingdong Li), Scientific Research Project of Affiliated Hospital of North Sichuan Medical College (2020ZD001, to Yongfu Xiong; 2020JC035, to Gang Yang), and Pre-research of State-level Project of North Sichuan Medical College (CBY19-YZ17, to Yongfu Xiong); Project of multicentre clinical research of Shanghai Jiaotong University School of Medicine (DLY201807, to Zhaohui Tang).

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Author notes

  1. Li Jingdong, Xiong Yongfu have contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Institute of Hepatobiliary-Pancreatic-Intestinal Diseases, Affiliated Hospital of North Sichuan Medical College, No.63 Wenhua Road, Shunqing District, Nanchong, 637000, China

    Li Jingdong, Xiong Yongfu, Gang Yang, Xu Jian & Huang Xujian

  2. Department of Hepatobiliary Surgery, Second Affiliated Hospital of Hebei Medical University, Hebei, 200092, China

    Liu Jianhua

  3. Department of Hepatobiliary Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221006, China

    Zhao Wenxing

  4. Department of Biliary Pancreatic Surgery, Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Qin Renyi

  5. Department of Hepatobiliary Surgery, Hunan Provincial People’s Hospital, Changsha, 410005, China

    Yin Xinming

  6. Department of Biliary Surgery, The First Hospital Affiliated to Army Medical University, Chongqing, 400038, China

    Zheng Shuguo

  7. Department of Hepatobiliary Surgery, SirRunRunShaw Hospital of Zhejiang University, Hangzhou, 310020, China

    Liang Xiao

  8. Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, China

    Peng Bin

  9. Department of Hepatobiliary Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, 510515, China

    Zhang Qifan

  10. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Li Dewei

  11. Department of General Surgery, Xinhua Hospital Affiliated of Shanghai Jiaotong University School of Medicine, Yangpu District, No.1665 Kong jiang Road, Shanghai, 200000, China

    Tang Zhao-hui

Authors
  1. Li Jingdong
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  2. Xiong Yongfu
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  3. Gang Yang
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  4. Xu Jian
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  5. Huang Xujian
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  6. Liu Jianhua
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  7. Zhao Wenxing
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  8. Qin Renyi
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  9. Yin Xinming
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  10. Zheng Shuguo
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  11. Liang Xiao
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  12. Peng Bin
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  13. Zhang Qifan
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  14. Li Dewei
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  15. Tang Zhao-hui
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Corresponding authors

Correspondence to Li Jingdong, Xiong Yongfu or Tang Zhao-hui.

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Disclosures

Li Jingdong, Xiong Yongfu, Gang Yang, Xu Jian, Huang Xujian, Liu Jianhua, Zhao Wenxing, Qin Renyi, Yin Xinming, Zheng Shuguo, Liang Xiao, Peng Bin, Zhang Qifan, Li Dewei and Tang Zhao-hui have no conflicts of interest or financial ties to disclose.

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Jingdong, L., Yongfu, X., Yang, G. et al. Minimally invasive surgery for hilar cholangiocarcinoma: a multicenter retrospective analysis of 158 patients. Surg Endosc 35, 6612–6622 (2021). https://doi.org/10.1007/s00464-020-08161-8

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