Department of Digestive, Oncological and Metabolic Surgery - Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
Department of Surgery, Sohag University, Sohag, Egypt.
Surg Endosc. 2019 Nov;33(11):3711-3717. doi: 10.1007/s00464-019-06664-7. Epub 2019 Jan 28.
Laparoscopic liver resection (LLR) has evolved over time, yet its role in extra-pancreatic biliary cancer has been limited due to several factors. We aimed to evaluate the short-term outcome of LLR in extra-pancreatic biliary tract cancer.
From January 2002 to 2016, all patients who underwent LLR for extra-pancreatic biliary tract cancer including gallbladder cancer (GBC), intra-hepatic cholangiocarcinoma (ICC), and peri-hilar cholangiocarcinoma (PHC) with curative intent (R0 or R1) at Institute Mutualiste Montsouris were identified from prospectively collected databases. Patient characteristics, and perioperative outcomes, were analyzed in all three groups.
A total of 35 patients were included: 10 with GBC, 14 with ICC, and 11 with PHC. There were 19 (54%) women and median age was 71 years. Median operative time was 240 min, and estimated blood loss was 200 ml. Conversion to an open procedure was more common in patients with PHC (45% vs. 7% for ICC and 0% for GBC, p = 0.010). R0 resection was achieved in 10 (100%), 12 (86%), and 8 (73%) patients in GBC, ICC, and PHC groups, respectively (p = 0.204). Postoperative morbidity was reported in 19 (54%) patients of whom 12 (34%) had minor complications. Postoperative mortality was reported in 4 (11%) patients; one (7%) in GBC group, one (7%) in ICC group, and two (18%) in PHC, p = 0.681. Median hospital stay was 11 days.
The present series suggests that LLR is feasible in GBC, challenging but achievable in ICC but unsuitable for the moment in PHC.
腹腔镜肝切除术（LLR）随着时间的推移而发展，但由于多种因素的限制，其在胰外胆管癌中的作用有限。我们旨在评估 LLR 在胰外胆管癌中的短期疗效。
从 2002 年 1 月至 2016 年，所有在 Institut Mutualiste Montsouris 接受腹腔镜治疗的胰外胆管癌（包括胆囊癌[GBC]、肝内胆管癌[ICC]和肝门部胆管癌[PHC]）患者均有治愈意向（R0 或 R1），均从前瞻性收集的数据库中确定。分析所有三组患者的一般资料、围手术期结果。
共纳入 35 例患者：10 例 GBC、14 例 ICC 和 11 例 PHC。其中 19 例（54%）为女性，中位年龄为 71 岁。中位手术时间为 240 分钟，估计出血量为 200ml。PHC 患者中转开腹的比例较高（45%比 ICC 组的 7%和 GBC 组的 0%，p=0.010）。GBC、ICC 和 PHC 组患者的 R0 切除率分别为 100%、86%和 73%（p=0.204）。19 例（54%）患者术后发生并发症，其中 12 例（34%）为轻度并发症。4 例（11%）患者术后死亡，GBC 组 1 例（7%）、ICC 组 1 例（7%）、PHC 组 2 例（18%），p=0.681。中位住院时间为 11 天。
本研究表明，LLR 对于 GBC 是可行的，对于 ICC 具有挑战性但可实现，但目前对于 PHC 不适用。
