Perihilar Cholangiocarcimoma: Are We Ready to Step towards Minimally-Invasiveness?

Abstract

Introduction: The primary endpoint of this study is to evaluate the feasibility and safety of the laparoscopic approach in selected types of PeriHilar Cholangiocarcinoma (PHC). Materials and Methods: From January 2004 to June 2019, 261 procedures with curative intent for PHC were performed. From March 2018 a Mils program for PHC was undertaken: 16 patients constituted the study group that was compared with a group of patients operated by open technique (control group) from 2014 to march 2018 through a propensity score matching with a 1: 2 ratio. Intraoperative and postoperative outcomes were evaluated and compared, focusing on blood loss, length of surgery, conversion to open approach and complications. Results: There were no statistically significant differences in terms of preoperative characteristics between the two groups. Laparoscopic resections resulted in statistically significant longer procedures (360 vs 275 minutes, p=0.048). Conversion rate was 18.8%, being oncological concerns the most frequent reason for conversion (3/3 cases). Laparoscopic series resulted in a statistically significant lower blood loss (380 vs 470, p=0.048) and minor intraoperative blood transfusions (12.5% vs 21.9%, p=0.032). Number of retrieved nodes was 9 vs 8 (p=ns) and the rate of R0 resections was similar between the two groups. Patients in the MILS group had a significantly shorter length of postoperative stay (median 10; range: 7-15) compared with the open group (median: 14; range:12-29), p=0.048. Conclusion: The laparoscopic approach in phc demonstrates adequate feasibility and safety standards when conducted in carefully selected patients and in centers with expertise.