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01-12-2021 | Cholangiocarcinoma

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

Authors: 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, Tang Zhao-hui

Published in: Surgical Endoscopy | Issue 12/2021

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.

Mizuno T, Ebata T, Nagino M (2019) Advanced hilar cholangiocarcinoma: An aggressive surgical approach for the treatment of advanced hilar cholangiocarcinoma: Perioperative management, extended procedures, and multidisciplinary approaches. Surgical oncology undefined:undefined

Cillo U, Fondevila C, Donadon M, Gringeri E, Mocchegiani F, Schlitt H, Ijzermans J, Vivarelli M, Zieniewicz K, Olde Damink S, Groot Koerkamp B (2019) Surgery for cholangiocarcinoma. Liver international : official journal of the International Association for the Study of the Liver null:143–155

Lidsky ME, Jarnagin WR (2018) Surgical management of hilar cholangiocarcinoma at Memorial Sloan Kettering Cancer Center. Ann Gastroenterol Surg 2:304–312PubMedPubMedCentral

Burke EC, Jarnagin WR, Hochwald SN, Pisters PW, Fong Y, Blumgart LH (1998) Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg 228:385–394PubMedPubMedCentral

Parikh A, Abdalla E, Vauthey J (2005) Operative considerations in resection of hilar cholangiocarcinoma. HPB : the official journal of the International Hepato Pancreato Biliary Association 7:254–258

Dinant S, Gerhards M, Busch O, Obertop H, Gouma D, Van Gulik T (2005) The importance of complete excision of the caudate lobe in resection of hilar cholangiocarcinoma. HPB : the official journal of the International Hepato Pancreato Biliary Association 7:263–267

Nagino M, Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nimura Y (2013) Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections. Ann Surg 258:129–140PubMed

Song SC, Choi DW, Kow AW, Choi SH, Heo JS, Kim WS, Kim MJ (2013) Surgical outcomes of 230 resected hilar cholangiocarcinoma in a single centre. ANZ J Surg 83:268–274PubMed

Giulianotti PC, Sbrana F, Bianco FM, Addeo P (2010) Robot-assisted laparoscopic extended right hepatectomy with biliary reconstruction. J Laparoendosc Adv Surg Tech A 20:159–163PubMed

10.

Klatskin G (1965) Adenocarcinoma of the Hepatic Duct at Its Bifurcation within the Porta Hepatis. An Unusual Tumor with Distinctive Clinical and Pathological Features. The American journal of medicine 38:241–256PubMed

11.

Ito F, Cho CS, Rikkers LF, Weber SM (2009) Hilar Cholangiocarcinoma: Current Management. Ann Surg 250:210–218PubMed

12.

Labib PL, Goodchild G, Pereira SP (2019) Molecular Pathogenesis of Cholangiocarcinoma BMC cancer 19:185PubMed

13.

Krasinskas AM (2018) Cholangiocarcinoma Surgical pathology clinics 11:403–429PubMed

14.

Razumilava N, Gores GJ (2014) Cholangiocarcinoma. Lancet (London, England) 383:2168–2179

15.

Fisher AV, Ronnekleiv-Kelly SM (2018) Surgical Management of Hilar Cholangiocarcinoma. Current Surgery Reports 6

16.

Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BJ, Youssef BM, Klimstra D, Blumgart LH (2001) Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 234:507–517PubMedPubMedCentral

17.

Cho MS, Kim SH, Park SW, Lim JH, Choi GH, Park JS, Chung JB, Kim KS (2012) Surgical outcomes and predicting factors of curative resection in patients with hilar cholangiocarcinoma: 10-year single-institution experience. J Gastrointest Surg 16:1672–1679PubMed

18.

Ruys AT, Busch OR, Gouma DJ, van Gulik TM (2012) Staging Laparoscopy for Hilar Cholangiocarcinoma: Is it Still Worthwhile? Indian journal of surgical oncology 3:147–153PubMedPubMedCentral

19.

Li H, Wei Y (2019) Laparoscopic Extended Left Hemi-Hepatectomy plus Caudate Lobectomy for Caudate Lobe Hepatocellular Carcinoma. J Gastrointest Surg 23:617PubMed

20.

Kim JH (2017) Laparoscopy-specific ventral approach in laparoscopic hemihepatectomy. J Surg Oncol 116:159–163PubMed

21.

Ho KM, Han HS, Yoon YS, Cho JY, Choi YR, Jang JS, Kwon SU, Kim S, Choi JK (2017) Laparoscopic Total Caudate Lobectomy for Hepatocellular Carcinoma. J Laparoendosc Adv Surg Tech A 27:1074–1078PubMed

22.

Oh D, Kwon CH, Na BG, Lee KW, Cho WT, Lee SH, Choi JY, Choi GS, Kim JM, Joh JW (2016) Surgical Techniques for Totally Laparoscopic Caudate Lobectomy. J Laparoendosc Adv Surg Tech A 26:689–692PubMed

23.

Wang M, Peng B, Liu J, Yin X, Tan Z, Liu R, Hong D, Zhao W, Wu H, Chen R, Li D, Huang H, Miao Y, Liu Y, Liang T, Wang W, Cai Y, Xing Z, Cheng W, Zhong X, Zhao Z, Zhang J, Yang Z, Li G, Shao Y, Lin G, Jiang K, Wu P, Jia B, Ma T, Jiang C, Peng S, Qin R (2019) Practice Patterns and Perioperative Outcomes of Laparoscopic Pancreaticoduodenectomy in China: A Retrospective Multicenter Analysis of 1029 Patients. Ann Surg

24.

Song KB, Kim SC, Lee W, Hwang DW, Lee JH, Kwon J, Park Y, Lee SJ, Park G (2019) Laparoscopic pancreaticoduodenectomy for periampullary tumors: lessons learned from 500 consecutive patients in a single center. Surg Endosc

25.

Franken LC, van der Poel MJ, Latenstein AEJ, Zwart MJ, Roos E, Busch OR, Besselink MG, van Gulik TM (2019) Minimally invasive surgery for perihilar cholangiocarcinoma: a systematic review. J Robot Surg

26.

Kasai M, Cipriani F, Gayet B, Aldrighetti L, Ratti F, Sarmiento JM, Scatton O, Kim KH, Dagher I, Topal B, Primrose J, Nomi T, Fuks D, Abu Hilal M (2018) Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data. Surgery 163:985–995PubMed

27.

Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188:205–211PubMed

28.

Dumitrascu T, Chirita D, Ionescu M, Popescu I (2013) Resection for hilar cholangiocarcinoma: analysis of prognostic factors and the impact of systemic inflammation on long-term outcome. J Gastrointest Surg 17:913–924PubMed

29.

Tamoto E, Hirano S, Tsuchikawa T, Tanaka E, Miyamoto M, Matsumoto J, Kato K, Shichinohe T (2014) Portal vein resection using the no-touch technique with a hepatectomy for hilar cholangiocarcinoma. HPB (Oxford) 16:56–61

30.

Kondo S, Hirano S, Ambo Y, Tanaka E, Okushiba S, Morikawa T, Katoh H (2004) Forty consecutive resections of hilar cholangiocarcinoma with no postoperative mortality and no positive ductal margins: results of a prospective study. Ann Surg 240:95–101PubMedPubMedCentral

31.

Launois B, Terblanche J, Lakehal M, Catheline JM, Bardaxoglou E, Landen S, Campion JP, Sutherland F, Meunier B (1999) Proximal bile duct cancer: high resectability rate and 5-year survival. Ann Surg 230:266–275PubMedPubMedCentral

32.

Ramesh H, Kuruvilla K, Venugopal A, Lekha V, Jacob G (2004) Surgery for hilar cholangiocarcinoma: feasibility and results of parenchyma-conserving liver resection. Dig Surg 21:114–122PubMed

33.

Saxena A, Chua TC, Chu FC, Morris DL (2011) Improved outcomes after aggressive surgical resection of hilar cholangiocarcinoma: a critical analysis of recurrence and survival. Am J Surg 202:310–320PubMed

34.

Hirano S, Kondo S, Tanaka E, Shichinohe T, Tsuchikawa T, Kato K, Matsumoto J, Kawasaki R (2010) Outcome of surgical treatment of hilar cholangiocarcinoma: a special reference to postoperative morbidity and mortality. J Hepatobiliary Pancreat Sci 17:455–462PubMed

35.

Hemming AW, Mekeel K, Khanna A, Baquerizo A, Kim RD (2011) Portal vein resection in management of hilar cholangiocarcinoma. J Am Coll Surg 212:604–613PubMed

36.

Lee SG, Song GW, Hwang S, Ha TY, Moon DB, Jung DH, Kim KH, Ahn CS, Kim MH, Lee SK, Sung KB, Ko GY (2010) Surgical treatment of hilar cholangiocarcinoma in the new era: the Asan experience. J Hepatobiliary Pancreat Sci 17:476–489PubMed

37.

Nagino M, Nimura Y, Nishio H, Ebata T, Igami T, Matsushita M, Nishikimi N, Kamei Y (2010) Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg 252:115–123PubMed

38.

Tan JW, Hu BS, Chu YJ, Tan YC, Ji X, Chen K, Ding XM, Zhang A, Chen F, Dong JH (2013) One-stage resection for Bismuth type IV hilar cholangiocarcinoma with high hilar resection and parenchyma-preserving strategies: a cohort study. World J Surg 37:614–621PubMed

39.

Li H, Qin Y, Cui Y, Chen H, Hao X, Li Q (2011) Analysis of the surgical outcome and prognostic factors for hilar cholangiocarcinoma: a Chinese experience. Dig Surg 28:226–231PubMed

40.

Cheng QB, Yi B, Wang JH, Jiang XQ, Luo XJ, Liu C, Ran RZ, Yan PN, Zhang BH (2012) Resection with total caudate lobectomy confers survival benefit in hilar cholangiocarcinoma of Bismuth type III and IV. Eur J Surg Oncol 38:1197–1203PubMed

41.

Chen XP, Lau WY, Huang ZY, Zhang ZW, Chen YF, Zhang WG, Qiu FZ (2009) Extent of liver resection for hilar cholangiocarcinoma. Br J Surg 96:1167–1175PubMed

42.

Otto G, Hoppe-Lotichius M, Bittinger F, Schuchmann M, Duber C (2011) Klatskin tumour: meticulous preoperative work-up and resection rate. Z Gastroenterol 49:436–442PubMed

43.

Todoroki T, Kawamoto T, Koike N, Takahashi H, Yoshida S, Kashiwagi H, Takada Y, Otsuka M, Fukao K (2000) Radical resection of hilar bile duct carcinoma and predictors of survival. Br J Surg 87:306–313PubMed

44.

Havlik R, Sbisa E, Tullo A, Kelly MD, Mitry RR, Jiao LR, Mansour MR, Honda K, Habib NA (2000) Results of resection for hilar cholangiocarcinoma with analysis of prognostic factors. Hepatogastroenterology 47:927–931PubMed

45.

Kawasaki S, Imamura H, Kobayashi A, Noike T, Miwa S, Miyagawa S (2003) Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg 238:84–92PubMedPubMedCentral

46.

Konstadoulakis MM, Roayaie S, Gomatos IP, Labow D, Fiel MI, Miller CM, Schwartz ME (2008) Aggressive surgical resection for hilar cholangiocarcinoma: is it justified? Audit of a single center’s experience. Am J Surg 196:160–169PubMed

47.

Seyama Y, Kubota K, Sano K, Noie T, Takayama T, Kosuge T, Makuuchi M (2003) Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 238:73–83PubMedPubMedCentral

48.

Ogura Y, Mizumoto R, Tabata M, Matsuda S, Kusuda T (1993) Surgical treatment of carcinoma of the hepatic duct confluence: analysis of 55 resected carcinomas. World J Surg 17:85–92PubMed

49.

Shimada K, Sano T, Sakamoto Y, Kosuge T (2005) Safety and effectiveness of left hepatic trisegmentectomy for hilar cholangiocarcinoma. World J Surg 29:723–727PubMed

50.

Ercolani G, Zanello M, Grazi GL, Cescon M, Ravaioli M, Del Gaudio M, Vetrone G, Cucchetti A, Brandi G, Ramacciato G, Pinna AD (2010) Changes in the surgical approach to hilar cholangiocarcinoma during an 18-year period in a Western single center. J Hepatobiliary Pancreat Sci 17:329–337PubMed

Title: Minimally invasive surgery for hilar cholangiocarcinoma: a multicenter retrospective analysis of 158 patients
Authors: 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
Tang Zhao-hui
Publication date: 01-12-2021
Publisher: Springer US
Keywords: Cholangiocarcinoma
Cholangiocarcinoma
Minimally Invasive Surgery
Published in: Surgical Endoscopy / Issue 12/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-020-08161-8

At a glance: The STEP trials

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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