The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Scand J Gastroenterol. 2023 May;58(5):489-496. doi: 10.1080/00365521.2022.2143724. Epub 2022 Nov 14.
The role of laparoscopy in the treatment of intrahepatic cholangiocarcinoma (ICC) remains unclear. This multicenter study examined the outcomes of laparoscopic liver resection for ICC.
Patients with ICC who had undergone laparoscopic or open liver resection between 2012 and 2019 at four European expert centers were included in the study. Laparoscopic and open approaches were compared in terms of surgical and oncological outcomes. Propensity score matching was used for minimizing treatment selection bias and adjusting for confounders (age, ASA grade, tumor size, location, number of tumors and underlying liver disease).
Of 136 patients, 50 (36.7%) underwent laparoscopic resection, whereas 86 (63.3%) had open surgery. Median tumor size was larger (73.6 vs 55.1 mm, = 0.01) and the incidence of bi-lobar tumors was higher (36.6 vs 6%, < 0.01) in patients undergoing open surgery. After propensity score matching baseline characteristics were comparable although open surgery was associated with a larger fraction of major liver resections (74 vs 38%, < 0.01), lymphadenectomy (60 vs 20%, < 0.01) and longer operative time (294 vs 209 min, < 0.01). Tumor characteristics were similar. Laparoscopic resection resulted in less complications (30 vs 52%, = 0.025), fewer reoperations (4 vs 16%, = 0.046) and shorter hospital stay (5 vs 8 days, < 0.01). No differences were found in terms of recurrence, recurrence-free and overall survival.
Laparoscopic resection seems to be associated with improved short-term and with similar long-term outcomes compared with open surgery in patients with ICC. However, possible selection criteria for laparoscopic surgery are yet to be defined.
腹腔镜在肝内胆管癌（ICC）治疗中的作用仍不明确。本多中心研究旨在探讨腹腔镜肝切除术治疗 ICC 的疗效。
本研究纳入了 2012 年至 2019 年期间在欧洲 4 个专家中心接受腹腔镜或开腹肝切除术的 ICC 患者。比较了腹腔镜和开腹手术在手术和肿瘤学结果方面的差异。采用倾向评分匹配法最小化治疗选择偏倚，并调整混杂因素（年龄、ASA 分级、肿瘤大小、位置、肿瘤数量和基础肝病）。
共纳入 136 例患者，其中 50 例（36.7%）接受了腹腔镜切除术，86 例（63.3%）接受了开腹手术。开腹组患者的肿瘤中位直径较大（73.6 比 55.1mm， = 0.01），双叶肿瘤发生率较高（36.6%比 6%， < 0.01）。虽然在倾向评分匹配后两组患者的基线特征相当，但开腹组手术中肝切除术比例更大（74%比 38%， < 0.01）、淋巴结清扫术更多（60%比 20%， < 0.01），手术时间更长（294 比 209min， < 0.01）。肿瘤特征相似。腹腔镜组的并发症更少（30%比 52%， = 0.025）、再次手术更少（4%比 16%， = 0.046），住院时间更短（5 比 8 天， < 0.01）。两组患者的复发率、无复发生存率和总生存率无差异。
与开腹手术相比，腹腔镜切除术治疗 ICC 患者似乎具有更好的短期疗效，且长期疗效相当。但是，腹腔镜手术的选择标准仍有待确定。
