Li Hongxin, Kong Junjie, Si Wei, Wang Tao, Ji Min, Li Guangbing, Liu Jun
Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China.
Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Ji'nan, Shandong, China.
Biosci Trends. 2025 Jan 14;18(6):584-598. doi: 10.5582/bst.2024.01277. Epub 2024 Dec 12.
The role of laparoscopic liver resection (LLR) for intrahepatic cholangiocarcinoma (ICC) remains debated. This study aimed to evaluate the short- and long-term outcomes of LLR vs. open liver resection (OLR) in ICC stratified by tumor burden score (TBS). ICC patients who underwent LLR or OLR were included from a multicenter database between July 2009 and October 2022. Patients were stratified into two cohorts based on whether the TBS was > 5.3. A 1:3 propensity score matching (PSM) analysis was performed between LLR and OLR in each cohort. Cox regression analysis was used to identify prognostic factors for ICC. A total of 626 patients were included in this study, 304 and 322 patients were classified into the low- and high-TBS groups, respectively. In the low-TBS group, after PSM, LLR was associated with less blood loss, lower CCI, fewer complications and shorter hospital stay (all p < 0.05). Kaplan-Meier curves revealed that LLR had better OS (p = 0.032). Multivariate Cox regression analysis showed that surgical procedure was an independent prognostic factor for ICC (HR: 0.445; 95% CI: 0.235-0.843; p = 0.013). In the high-TBS group, after PSM, LLR were associated with reduced blood loss, lower CCI, fewer complications and shorter hospital stay (all p < 0.05), while OS (p = 0.98) and DFS (p = 0.24) were similar between the two groups. TBS is an important prognostic factor for ICC. LLR is a safe and feasible option for ICC and leads to faster postoperative recovery. LLR can offer ICC a comparable and even better long-term prognosis than OLR.
腹腔镜肝切除术（LLR）治疗肝内胆管癌（ICC）的作用仍存在争议。本研究旨在评估按肿瘤负荷评分（TBS）分层的ICC患者中LLR与开腹肝切除术（OLR）的短期和长期结局。2009年7月至2022年10月期间，从一个多中心数据库中纳入接受LLR或OLR的ICC患者。根据TBS是否>5.3将患者分为两个队列。在每个队列的LLR和OLR之间进行1:3倾向评分匹配（PSM）分析。采用Cox回归分析确定ICC的预后因素。本研究共纳入626例患者，304例和322例患者分别被分类为低TBS组和高TBS组。在低TBS组中，PSM后，LLR与更少的失血、更低的CCI、更少的并发症和更短的住院时间相关（所有p<0.05）。Kaplan-Meier曲线显示LLR有更好的总生存期（p = 0.032）。多变量Cox回归分析表明手术方式是ICC的独立预后因素（HR：0.445；95%CI：0.235 - 0.843；p = 0.013）。在高TBS组中，PSM后，LLR与失血减少、CCI降低、并发症减少和住院时间缩短相关（所有p<0.05），而两组之间的总生存期（p = 0.98）和无病生存期（p = 0.24）相似。TBS是ICC的重要预后因素。LLR是ICC的一种安全可行的选择，可导致术后更快恢复。与OLR相比，LLR可为ICC提供相当甚至更好的长期预后。
