Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis

Christian Hobeika (1, 2) , François Cauchy (1, 2) , David Fuks (3, 4) , Louise Barbier (5) , Jean-Michel Fabre (6, 7) , Emmanuel Boleslawski (8) , Jean-Marc Regimbeau (9, 10) , Olivier Farges (2) , François-René Pruvot (11) , Patrick Pessaux (12, 13, 14) , Éphrem Salame (15) , Olivier Soubrane (1, 2) , E. Vibert (16, 17) , Olivier Scatton (18)

1 UPCité - Université Paris Cité
2 Hôpital Beaujon [AP-HP]
3 IMM - Institut Mutualiste de Montsouris
4 UPD5 - Université Paris Descartes - Paris 5
5 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
6 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
7 UM - Université de Montpellier
8 Hôpital Claude Huriez [Lille]
9 Chirurgie digestive [CHU Amiens]
10 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
11 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
12 IHU Strasbourg - L'Institut hospitalo-universitaire de Strasbourg
13 IRCAD/EITS - Institut de Recherche Contre les Cancers de l'Appareil Digestif-European Institute of Telesurgery
14 CHU Strasbourg - Centre Hospitalier Universitaire [Strasbourg]
15 CHU Trousseau [APHP]
16 Physiopathologie et traitement des maladies du foie
17 Hôpital Paul Brousse
18 CRSA - Centre de Recherche Saint-Antoine

Background: The relevance of laparoscopic resection of intrahepatic cholangiocarcinoma (ICC) remains debated. The aim of this study was to compare laparoscopic (LLR) and open (OLR) liver resection for ICC, with specific focus on textbook outcome and lymph node dissection (LND). Methods: Patients undergoing LLR or OLR for ICC were included from two French, nationwide hepatopancreatobiliary surveys undertaken between 2000 and 2017. Patients with negative margins, and without transfusion, severe complications, prolonged hospital stay, readmission or death were considered to have a textbook outcome. Patients who achieved both a textbook outcome and LND were deemed to have an adjusted textbook outcome. OLR and LLR were compared after propensity score matching. Results: In total, 548 patients with ICC (127 LLR, 421 OLR) were included. Textbook-outcome and LND completion rates were 22.1 and 48.2 per cent respectively. LLR was independently associated with a decreased rate of LND (odds ratio 0.37, 95 per cent c.i. 0.20 to 0.69). After matching, 109 patients remained in each group. LLR was associated with a decreased rate of transfusion (7.3 versus 21.1 per cent; P = 0.001) and shorter hospital stay (median 7 versus 14 days; P = 0.001), but lower rate of LND (33.9 versus 73.4 per cent; P = 0.001). Patients who underwent LLR had lower rate of adjusted TO completion than patients who had OLR (6.5 versus 17.4 per cent; P = 0.012). Conclusion: The laparoscopic approach did not substantially improve quality of care of patients with resectable ICC.

Domaines: Sciences du Vivant [q-bio]; Chirurgie

Christian Hobeika, François Cauchy, David Fuks, Louise Barbier, Jean-Michel Fabre, et al.. Laparoscopic versus open resection of intrahepatic cholangiocarcinoma: nationwide analysis. British Journal of Surgery, 2021, 108 (4), pp.419-426. ⟨10.1093/bjs/znaa110⟩. ⟨hal-03595516⟩