Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma:  Report of an international multicenter cohort study with propensity score matching.

Brustia, Raffaele; Laurent, Alexis; Goumard, Claire; Langella, Serena; Cherqui, Daniel; Kawai, Takayuki; Soubrane, Olivier; Cauchy, Francois; Farges, Olivier; Menahem, Benjamin; Hobeika, Christian; Rhaiem, Rami; Sommacale, Daniele; Okumura, Shinya; Hofmeyr, Stefan; Ferrero, Alessandro; Pruvot, François-René; Regimbeau, Jean-Marc; Fuks, David; Vibert, Eric; Scatton, Olivier; AFC-ICC-2009; AFC-LLR-2018; PRS-2019 Study, group

doi:10.1016/j.surg.2021.08.015

Article (Scientific journals)

Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: Report of an international multicenter cohort study with propensity score matching.

Brustia, Raffaele; Laurent, Alexis; Goumard, Claire et al.

2022 • In Surgery, 171 (5), p. 1290-1302

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/305511

DOI
10.1016/j.surg.2021.08.015

PubMed
34535270

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Keywords :

Bile Duct Neoplasms/pathology; Bile Ducts, Intrahepatic/pathology; Cholangiocarcinoma; Cohort Studies; Hepatectomy; Humans; Laparoscopy/adverse effects; Liver/pathology; Postoperative Complications/etiology; Propensity Score; Retrospective Studies; Treatment Outcome

Abstract :

[en] BACKGROUND: Intrahepatic cholangiocarcinoma is a rare disease with a poor prognosis. In patients where surgical resection is possible, outcome is influenced by perioperative morbidity and lymph node status. Laparoscopic liver resection is associated with improved clinical and oncological outcomes in primary and metastatic liver cancer compared with open liver resection, but evidence on intrahepatic cholangiocarcinoma is still insufficient. The primary aim of this study was to compare overall survival for a large series of patients treated for intrahepatic cholangiocarcinoma by open or laparoscopic approach. Secondary objectives were to compare disease-free survival, predictors of death, and recurrence. METHODS: Patients treated with laparoscopic or open liver resection for intrahepatic cholangiocarcinoma from 2000 to 2018 from 3 large international databases were analyzed retrospectively. Each patient in the laparoscopic resection group (case) was matched with 1 open resection control (1:1 ratio), through a propensity score calculated on clinically relevant preoperative covariates. Overall and disease-free survival were compared between the matched groups. Predictors of mortality and recurrence were analyzed with Cox regression, and the Textbook Outcomes were described. RESULTS: During the study period, 855 patients met the inclusion criteria (open liver resection = 709, 82.9%; laparoscopic liver resection = 146, 17.1%). Two groups of 89 patients each were analyzed after propensity score matching, with no significant difference regarding pre- and postoperative variables. Overall survival at 1, 3, and 5 years was 92%, 75%, and 63% in the laparoscopic liver resection group versus 92%, 58%, and 49% in the open liver resection group (P = .0043). Adjusted Cox regression revealed severe postoperative complications (hazard ratio: 10.5, 95% confidence interval [1.01-109] P = .049) and steatosis (hazard ratio: 13.8, 95% confidence interval [1.23-154] P = .033) as predictors of death, and transfusion (hazard ratio: 19.2, 95% confidence interval [4.04-91.4] P < .001) and severe postoperative complications (hazard ratio: 4.07, 95% confidence interval [1.15-14.4] P = .030) as predictors of recurrence. CONCLUSION: The survival advantage of laparoscopic liver resection over open liver resection for intrahepatic cholangiocarcinoma is equivocal, given historical bias and missing data.

Disciplines :

Surgery
Oncology

Author, co-author :

Brustia, Raffaele; Department of Digestive and Hepato-Pancreatic-Biliary Surgery, DMU CARE,

Laurent, Alexis; Univ Paris Est Creteil, Faculté de Santé, Créteil, France and Department of

Goumard, Claire; Department of Hepatobiliary and Liver Transplantation Surgery, AP-HP, Hôpital

Langella, Serena; Department of General and Oncological Surgery, Ospedale Mauriziano, Torino,

Cherqui, Daniel; Centre Hepato-Biliaire, AP-HP Paul Brousse Hospital, Paris-Saclay University,

Kawai, Takayuki; Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto,

Soubrane, Olivier; Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de

Cauchy, Francois; Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de

Farges, Olivier; Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de

Menahem, Benjamin; Department of Digestive Surgery, University Hospital of Caen, France.

More authors (14 more)

Other collaborator :

Abba, Julio

Adam, René

Adham, Mustapha

Allard, Marc-Antoine

Ayav, Ahmet

Azoulay, Daniel

Bachellier, Philippe

Balladur, Pierre

Barbier, Louise

Barbieux, Julien

More authors (98 more)

Language :

English

Title :

Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: Report of an international multicenter cohort study with propensity score matching.

Publication date :

May 2022

Journal title :

Surgery

ISSN :

0039-6060

eISSN :

1532-7361

Publisher :

Eslevier

Volume :

171

Issue :

Pages :

1290-1302

Peer reviewed :

Peer Reviewed verified by ORBi

Commentary :

Available on ORBi :

since 30 July 2023

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