Cargando…

Comparison of Efficacy and Safety Between Laparoscopic and Open Radical Resection for Hilar Cholangiocarcinoma—A Propensity Score-Matching Analysis

BACKGROUND: Radical resection remains the most effective treatment for hilar cholangiocarcinoma (HCCA). However, due to the complex anatomy of the hilar region, the tumor is prone to invade portal vein and hepatic arteries, making the surgical treatment of HCCA particularly difficult. Successful lap...

Descripción completa

Detalles Bibliográficos
Autores principales: He, Yong-Gang, Huang, Wen, Ren, Qian, Li, Jing, Yang, Feng-Xia, Deng, Chang-Lin, Li, Li-Qi, Peng, Xue-Hui, Tang, Yi-Chen, Zheng, Lu, Huang, Xiao-Bing, Li, Yu-Ming
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9549331/
https://www.ncbi.nlm.nih.gov/pubmed/36226051
http://dx.doi.org/10.3389/fonc.2022.1004974
_version_ 1784805645983154176
author He, Yong-Gang
Huang, Wen
Ren, Qian
Li, Jing
Yang, Feng-Xia
Deng, Chang-Lin
Li, Li-Qi
Peng, Xue-Hui
Tang, Yi-Chen
Zheng, Lu
Huang, Xiao-Bing
Li, Yu-Ming
author_facet He, Yong-Gang
Huang, Wen
Ren, Qian
Li, Jing
Yang, Feng-Xia
Deng, Chang-Lin
Li, Li-Qi
Peng, Xue-Hui
Tang, Yi-Chen
Zheng, Lu
Huang, Xiao-Bing
Li, Yu-Ming
author_sort He, Yong-Gang
collection PubMed
description BACKGROUND: Radical resection remains the most effective treatment for hilar cholangiocarcinoma (HCCA). However, due to the complex anatomy of the hilar region, the tumor is prone to invade portal vein and hepatic arteries, making the surgical treatment of HCCA particularly difficult. Successful laparoscopic radical resection of HCCA(IIIA, IIIB) requires excellent surgical skills and rich experience. Furthermore, the safety and effectiveness of this operation are still controversial. AIM: To retrospectively analyze and compare the efficacy and safety of laparoscopic and open surgery for patients with HCCA. METHODS: Clinical imaging and postoperative pathological data of 89 patients diagnosed with HCCA (IIIA, IIIB) and undergoing radical resection in our center from January 2018 to March 2022 were retrospectively analyzed. Among them, 6 patients (4 were lost to follow-up and 2 were pathologically confirmed to have other diseases after surgery) were ruled out, and clinical data was collected from the remaining 83 patients for statistical analysis. These patients were divided into an open surgery group (n=62) and a laparoscopic surgery group (n=21) according to the surgical methods used, and after 1:2 propensity score matching (PSM), 32 and 16 patients respectively in the open surgery group and laparoscopic surgery group were remained. The demographic data, Bismuth type, perioperative data, intraoperative data, postoperative complications, pathological findings, and long-term survivals were compared between these two groups. RESULTS: After 1:2 PSM, 32 patients in the open surgery group and 16 patients in the laparoscopic surgery group were included for further analysis. Baseline characteristics and pathological outcomes were comparable between the two groups. Statistically significant differences between the two groups were observed in intraoperative blood loss and operative time, as it were 400-800 mL vs 200-400 mL (P=0.012) and (407.97 ± 76.06) min vs (489.69 ± 79.17) min (P=0.001) in the open surgery group and laparoscopic surgery group, respectively. The R0 resection rate of the open group was 28 cases (87.5%), and the R0 resection rate of the laparoscopic group was 15 cases (93.75%). The two groups showed no significant difference in terms of surgical approach, intraoperative blood transfusion, incidence of postoperative complications, and short- and long-term efficacy (P>0.05). CONCLUSIONS: Laparoscopic radical resection of HCCA has comparable perioperative safety compared to open surgery group, as it has less bleeding and shorter operation time. Although it is a promising procedure with the improvement of surgical skills and further accumulation of experience, further investigations are warranted before its wider application.
format Online
Article
Text
id pubmed-9549331
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-95493312022-10-11 Comparison of Efficacy and Safety Between Laparoscopic and Open Radical Resection for Hilar Cholangiocarcinoma—A Propensity Score-Matching Analysis He, Yong-Gang Huang, Wen Ren, Qian Li, Jing Yang, Feng-Xia Deng, Chang-Lin Li, Li-Qi Peng, Xue-Hui Tang, Yi-Chen Zheng, Lu Huang, Xiao-Bing Li, Yu-Ming Front Oncol Oncology BACKGROUND: Radical resection remains the most effective treatment for hilar cholangiocarcinoma (HCCA). However, due to the complex anatomy of the hilar region, the tumor is prone to invade portal vein and hepatic arteries, making the surgical treatment of HCCA particularly difficult. Successful laparoscopic radical resection of HCCA(IIIA, IIIB) requires excellent surgical skills and rich experience. Furthermore, the safety and effectiveness of this operation are still controversial. AIM: To retrospectively analyze and compare the efficacy and safety of laparoscopic and open surgery for patients with HCCA. METHODS: Clinical imaging and postoperative pathological data of 89 patients diagnosed with HCCA (IIIA, IIIB) and undergoing radical resection in our center from January 2018 to March 2022 were retrospectively analyzed. Among them, 6 patients (4 were lost to follow-up and 2 were pathologically confirmed to have other diseases after surgery) were ruled out, and clinical data was collected from the remaining 83 patients for statistical analysis. These patients were divided into an open surgery group (n=62) and a laparoscopic surgery group (n=21) according to the surgical methods used, and after 1:2 propensity score matching (PSM), 32 and 16 patients respectively in the open surgery group and laparoscopic surgery group were remained. The demographic data, Bismuth type, perioperative data, intraoperative data, postoperative complications, pathological findings, and long-term survivals were compared between these two groups. RESULTS: After 1:2 PSM, 32 patients in the open surgery group and 16 patients in the laparoscopic surgery group were included for further analysis. Baseline characteristics and pathological outcomes were comparable between the two groups. Statistically significant differences between the two groups were observed in intraoperative blood loss and operative time, as it were 400-800 mL vs 200-400 mL (P=0.012) and (407.97 ± 76.06) min vs (489.69 ± 79.17) min (P=0.001) in the open surgery group and laparoscopic surgery group, respectively. The R0 resection rate of the open group was 28 cases (87.5%), and the R0 resection rate of the laparoscopic group was 15 cases (93.75%). The two groups showed no significant difference in terms of surgical approach, intraoperative blood transfusion, incidence of postoperative complications, and short- and long-term efficacy (P>0.05). CONCLUSIONS: Laparoscopic radical resection of HCCA has comparable perioperative safety compared to open surgery group, as it has less bleeding and shorter operation time. Although it is a promising procedure with the improvement of surgical skills and further accumulation of experience, further investigations are warranted before its wider application. Frontiers Media S.A. 2022-09-26 /pmc/articles/PMC9549331/ /pubmed/36226051 http://dx.doi.org/10.3389/fonc.2022.1004974 Text en Copyright © 2022 He, Huang, Ren, Li, Yang, Deng, Li, Peng, Tang, Zheng, Huang and Li https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
He, Yong-Gang
Huang, Wen
Ren, Qian
Li, Jing
Yang, Feng-Xia
Deng, Chang-Lin
Li, Li-Qi
Peng, Xue-Hui
Tang, Yi-Chen
Zheng, Lu
Huang, Xiao-Bing
Li, Yu-Ming
Comparison of Efficacy and Safety Between Laparoscopic and Open Radical Resection for Hilar Cholangiocarcinoma—A Propensity Score-Matching Analysis
title Comparison of Efficacy and Safety Between Laparoscopic and Open Radical Resection for Hilar Cholangiocarcinoma—A Propensity Score-Matching Analysis
title_full Comparison of Efficacy and Safety Between Laparoscopic and Open Radical Resection for Hilar Cholangiocarcinoma—A Propensity Score-Matching Analysis
title_fullStr Comparison of Efficacy and Safety Between Laparoscopic and Open Radical Resection for Hilar Cholangiocarcinoma—A Propensity Score-Matching Analysis
title_full_unstemmed Comparison of Efficacy and Safety Between Laparoscopic and Open Radical Resection for Hilar Cholangiocarcinoma—A Propensity Score-Matching Analysis
title_short Comparison of Efficacy and Safety Between Laparoscopic and Open Radical Resection for Hilar Cholangiocarcinoma—A Propensity Score-Matching Analysis
title_sort comparison of efficacy and safety between laparoscopic and open radical resection for hilar cholangiocarcinoma—a propensity score-matching analysis
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9549331/
https://www.ncbi.nlm.nih.gov/pubmed/36226051
http://dx.doi.org/10.3389/fonc.2022.1004974
work_keys_str_mv AT heyonggang comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis
AT huangwen comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis
AT renqian comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis
AT lijing comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis
AT yangfengxia comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis
AT dengchanglin comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis
AT liliqi comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis
AT pengxuehui comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis
AT tangyichen comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis
AT zhenglu comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis
AT huangxiaobing comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis
AT liyuming comparisonofefficacyandsafetybetweenlaparoscopicandopenradicalresectionforhilarcholangiocarcinomaapropensityscorematchinganalysis