Intrahepatic cholangiocarcinoma as the new field of implementation of laparoscopic liver resection programs. A comparative propensity score based analysis of open and laparoscopic liver resections

Abstract

Objective: Initial restraint to adoption of laparoscopic approach in the treatment of Intrahepatic cholangiocarcinoma has been recently overcome. This is thanks to the great development in surgical techniques, technology and many studies demonstrating the oncological efficiency of the laparoscopic approach. Aim of the present study is to analyze and compare the outcomes of laparoscopic and open liver resections for ICC in the modern era of minimally invasive liver surgery. Methods: Patients undergoing laparoscopic and open liver resections for ICC in two European tertiary referral centers were included. Finally, 104 patients from the open group and 104 patients from the laparoscopic group were compared after propensity scores matching according to seven covariates representative of patients and disease characteristics. Indications to surgery, short- and long- terms outcomes were analyzed and compared. Results: Operative time, median number of retrieved nodes, rate of negative resection margins, and depth of surgical margins were comparable between the two groups. Blood loss was lower in the MILS (150 ± 100 mL, mean ± SD) compared with the Open group (350 ± 250 mL, p=0.030). Postoperative complications occurred in 14.4% of patients in the MILS and in the 24% of patients in the Open group (p=0.02). There was no significant differences in long term outcomes between the two groups. Conclusions: Our results confirm feasibility, safety and oncological efficiency of the laparoscopic approach in the management of ICC. However, this surgery is often complex and should be only considered in centers with large experience in laparoscopic liver surgery.