Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Hepatobiliary, Pancreatic and Intestinal Diseases Research Institute of North Sichuan Medical College, Nanchong, 637000, China.
BMC Cancer. 2023 May 3;23(1):394. doi: 10.1186/s12885-023-10783-9.
Laparoscopic surgery (LS) has been increasingly applied in perihilar cholangiocarcinoma (pCCA). In this study, we intend to compare the short-term outcomes of LS versus open operation (OP) for pCCA in a multicentric practice in China.
This real-world analysis included 645 pCCA patients receiving LS and OP at 11 participating centers in China between January 2013 and January 2019. A comparative analysis was performed before and after propensity score matching (PSM) in LS and OP groups, and within Bismuth subgroups. Univariate and multivariate models were performed to identify significant prognostic factors of adverse surgical outcomes and postoperative length of stay (LOS).
Among 645 pCCAs, 256 received LS and 389 received OP. Reduced hepaticojejunostomy (30.89% vs 51.40%, P = 0.006), biliary plasty requirement (19.51% vs 40.16%, P = 0.001), shorter LOS (mean 14.32 vs 17.95 d, P < 0.001), and lower severe complication (CD ≥ III) (12.11% vs. 22.88%, P = 0.006) were observed in the LS group compared with the OP group. Major postoperative complications such as hemorrhage, biliary fistula, abdominal abscess, and hepatic insufficiency were similar between LS and OP (P > 0.05 for all). After PSM, the short-term outcomes of two surgical methods were similar, except for shorter LOS in LS compared with OP (mean 15.19 vs 18.48 d, P = 0.0007). A series subgroup analysis demonstrated that LS was safe and had advantages in shorting LOS.
Although the complex surgical procedures, LS generally seems to be safe and feasible for experienced surgeons.
NCT05402618 (date of first registration: 02/06/2022).
腹腔镜手术（LS）已越来越多地应用于肝门部胆管癌（pCCA）。本研究旨在比较中国多中心实践中 LS 与开腹手术（OP）治疗 pCCA 的短期疗效。
本回顾性分析纳入了 2013 年 1 月至 2019 年 1 月期间在中国 11 家参与中心接受 LS 和 OP 治疗的 645 例 pCCA 患者。在 LS 和 OP 组分别进行倾向评分匹配（PSM）前后的对比分析，并在 Bismuth 亚组内进行分析。采用单因素和多因素模型确定不良手术结局和术后住院时间（LOS）的显著预后因素。
645 例 pCCA 患者中，256 例行 LS，389 例行 OP。LS 组肝肠吻合术（30.89%比 51.40%，P=0.006）、胆道成形术需求（19.51%比 40.16%，P=0.001）、LOS 更短（平均 14.32 比 17.95 d，P<0.001）和严重并发症（CD≥III 级）发生率更低（12.11%比 22.88%，P=0.006）。LS 组与 OP 组的主要术后并发症如出血、胆漏、腹腔脓肿和肝功能不全发生率相似（P>0.05）。PSM 后，两种手术方法的短期疗效相似，但 LS 组 LOS 较 OP 组更短（平均 15.19 比 18.48 d，P=0.0007）。一系列亚组分析表明，LS 安全，在缩短 LOS 方面具有优势。
尽管 LS 手术复杂，但对于有经验的外科医生来说，LS 通常是安全可行的。
NCT05402618（首次注册日期：2022 年 2 月 6 日）。
