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Meta-analysis of laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma

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Abstract

Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive hepatic malignancy. An up-to-date systematic review and meta-analysis was conducted aiming to compare outcomes between laparoscopic (LLR) and open liver resection (OLR) for patients with iCCA. A systematic literature search of Medline, Scopus, Google Scholar, and Cochrane databases was performed. A total of 8 studies comprising 2872 patients, who underwent LLR or OLR for iCCA, were included in our meta-analysis. LLR patients had smaller tumors [mean difference (MD): − 1.17 cm, 95% confidence intervals (CI) − 1.77 to − 0.57, p = 0.0001], underwent major resections less frequently [risk ratio (RR): 0.75, 95% CI 0.67–0.83, p < 0.00001] and R0 resections more frequently (RR: 1.05, 95% CI 1.01–1.09, p = 0.01), while lymphadenectomy was less common in the laparoscopic group (RR: 0.73, 95% CI 0.58–0.92, p = 0.007). The LLR group presented reduced blood loss (MD: − 270.16 ml, 95% CI − 381.53 to − 32.79, p = 0.002), need for transfusion (RR: 0.39, 95% CI 0.21–0.73, p = 0.003), overall morbidity (RR: 0.58, 95% CI 0.4–0.83, p = 0.003) and hospital stay (MD: − 3.48 days, 95% CI: − 6.94 to − 0.02, p = 0.05) compared to the OLR group. No differences were shown in operative time (MD: 1.6 min, 95% CI − 34.17–37.37, p = 0.93), major morbidity (RR: 0.65, 95% CI 0.38–1.11, p = 0.12), mortality (RR: 1.42, 95% CI 0.13–15.07, p = 0.77), overall (HR: 0.9, 95% CI 0.59–1.38, p = 0.63) and relapse-free survival (HR: 0.77, 95% CI 0.5–1.16, p = 0.21) between the two groups. LLR seems to benefit patients with iCCA in terms of short-term outcomes, whilst long-term outcomes are comparable among the two approaches.

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References

  1. Khan SA, Tavolari S, Brandi G (2019) Cholangiocarcinoma: epidemiology and risk factors. Liver Int 39(Suppl 1):19–31. https://doi.org/10.1111/liv.14095

    Article  PubMed  Google Scholar 

  2. de Jong MC, Nathan H, Sotiropoulos GC, Paul A, Alexandrescu S, Marques H et al (2011) Intrahepatic cholangiocarcinoma: an international multi-institutional analysis of prognostic factors and lymph node assessment. J Clin Oncol 29(23):3140–3145. https://doi.org/10.1200/JCO.2011.35.6519

    Article  PubMed  Google Scholar 

  3. Saha SK, Zhu AX, Fuchs CS, Brooks GA (2016) Forty-year trends in cholangiocarcinoma incidence in the US: intrahepatic disease on the rise. Oncologist 21(5):594–599. https://doi.org/10.1634/theoncologist.2015-0446

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wu L, Tsilimigras DI, Paredes AZ, Mehta R, Hyer JM, Merath K et al (2019) Trends in the incidence, treatment and outcomes of patients with intrahepatic cholangiocarcinoma in the USA: facility type is associated with margin status, use of lymphadenectomy and overall survival. World J Surg 43(7):1777–1787. https://doi.org/10.1007/s00268-019-04966-4

    Article  PubMed  Google Scholar 

  5. Rahnemai-Azar AA, Weisbrod AB, Dillhoff M, Schmidt C, Pawlik TM (2017) Intrahepatic cholangiocarcinoma: current management and emerging therapies. Expert Rev Gastroenterol Hepatol 11(5):439–449. https://doi.org/10.1080/17474124.2017.1309290

    Article  CAS  PubMed  Google Scholar 

  6. Machairas N, Lang H, Jayant K, Raptis DA, Sotiropoulos GC (2020) Intrahepatic cholangiocarcinoma: limitations for resectability, current surgical concepts and future perspectives. Eur J Surg Oncol. https://doi.org/10.1016/j.ejso.2020.01.028

    Article  PubMed  Google Scholar 

  7. Bridgewater J, Galle PR, Khan SA, Llovet JM, Park JW, Patel T et al (2014) Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma. J Hepatol 60(6):1268–1289. https://doi.org/10.1016/j.jhep.2014.01.021

    Article  PubMed  Google Scholar 

  8. Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R et al (2017) The Southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg. https://doi.org/10.1097/SLA.0000000000002524

    Article  PubMed  Google Scholar 

  9. Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I et al (2009) The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg 250(5):825–830

    Article  PubMed  Google Scholar 

  10. Machairas N, Sotiropoulos GC (2019) Laparoscopic liver surgery: yesterday, today and tomorrow. Hepatobiliary Surg Nutr 8(3):324–326. https://doi.org/10.21037/hbsn.2019.01.12

    Article  PubMed  PubMed Central  Google Scholar 

  11. Machairas N, Papaconstantinou D, Tsilimigras DI, Moris D, Prodromidou A, Paspala A et al (2019) Comparison between robotic and open liver resection: a systematic review and meta-analysis of short-term outcomes. Updates Surg 71(1):39–48. https://doi.org/10.1007/s13304-019-00629-0

    Article  PubMed  Google Scholar 

  12. Aldrighetti L, Ratti F, Cillo U, Ferrero A, Ettorre GM, Guglielmi A et al (2017) Diffusion, outcomes and implementation of minimally invasive liver surgery: a snapshot from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) registry. Updates Surg 69(3):271–283. https://doi.org/10.1007/s13304-017-0489-x

    Article  PubMed  Google Scholar 

  13. Sotiropoulos GC, Prodromidou A, Kostakis ID, Machairas N (2017) Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. Updates Surg 69(3):291–311. https://doi.org/10.1007/s13304-017-0421-4

    Article  PubMed  Google Scholar 

  14. Machairas N, Papaconstantinou D, Stamopoulos P, Prodromidou A, Garoufalia Z, Spartalis E et al (2018) The emerging role of laparoscopic liver resection in the treatment of recurrent hepatocellular carcinoma: a systematic review. Anticancer Res 38(5):3181–3186. https://doi.org/10.21873/anticanres.12582

    Article  PubMed  Google Scholar 

  15. Machairas N, Papaconstantinou D, Gaitanidis A, Hasemaki N, Paspala A, Stamopoulos P et al (2019) Is single-incision laparoscopic liver surgery safe and efficient for the treatment of malignant hepatic tumors? A systematic review. J Gastrointest Cancer. https://doi.org/10.1007/s12029-019-00285-y

    Article  PubMed  Google Scholar 

  16. Moris D, Tsilimigras DI, Machairas N, Merath K, Cerullo M, Hasemaki N et al (2019) Laparoscopic synchronous resection of colorectal cancer and liver metastases: a systematic review. J Surg Oncol 119(1):30–39. https://doi.org/10.1002/jso.25313

    Article  PubMed  Google Scholar 

  17. Ciria R, Ocana S, Gomez-Luque I, Cipriani F, Halls M, Fretland AA et al (2020) A systematic review and meta-analysis comparing the short- and long-term outcomes for laparoscopic and open liver resections for liver metastases from colorectal cancer. Surg Endosc 34(1):349–360. https://doi.org/10.1007/s00464-019-06774-2

    Article  PubMed  Google Scholar 

  18. Wei F, Lu C, Cai L, Yu H, Liang X, Cai X (2017) Can laparoscopic liver resection provide a favorable option for patients with large or multiple intrahepatic cholangiocarcinomas? Surg Endosc 31(9):3646–3655. https://doi.org/10.1007/s00464-016-5399-3

    Article  PubMed  Google Scholar 

  19. Levi Sandri GB, Spoletini G, Masciana G, Colasanti M, Lepiane P, Vennarecci G et al (2017) The role of minimally invasive surgery in the treatment of cholangiocarcinoma. Eur J Surg Oncol 43(9):1617–1621. https://doi.org/10.1016/j.ejso.2017.02.012

    Article  CAS  PubMed  Google Scholar 

  20. Machairas N, Prodromidou A, Kostakis ID, Spartalis E, Sotiropoulos GC (2018) Safety and efficacy of laparoscopic liver resection for lesions located on posterosuperior segments: a meta-analysis of short-term outcomes. Surg Laparosc Endosc Percutan Tech 28(4):203–208. https://doi.org/10.1097/SLE.0000000000000562

    Article  PubMed  Google Scholar 

  21. Lee W, Park JH, Kim JY, Kwag SJ, Park T, Jeong SH et al (2016) Comparison of perioperative and oncologic outcomes between open and laparoscopic liver resection for intrahepatic cholangiocarcinoma. Surg Endosc 30(11):4835–4840. https://doi.org/10.1007/s00464-016-4817-x

    Article  PubMed  Google Scholar 

  22. Ratti F, Rawashdeh A, Cipriani F, Primrose J, Fiorentini G, Abu Hilal M et al (2020) Intrahepatic cholangiocarcinoma as the new field of implementation of laparoscopic liver resection programs. A comparative propensity score-based analysis of open and laparoscopic liver resections. Surg Endosc. https://doi.org/10.1007/s00464-020-07588-3

    Article  PubMed  PubMed Central  Google Scholar 

  23. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151(4):W65-94

    Article  PubMed  Google Scholar 

  24. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

    Article  PubMed  Google Scholar 

  25. Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5:13. https://doi.org/10.1186/1471-2288-5-13

    Article  PubMed  PubMed Central  Google Scholar 

  26. Parmar MK, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17(24):2815–2834. https://doi.org/10.1002/(sici)1097-0258(19981230)17:24%3c2815::aid-sim110%3e3.0.co;2-8

    Article  CAS  PubMed  Google Scholar 

  27. Martin SP, Drake J, Wach MM, Ruff S, Diggs LP, Wan JY et al (2019) Laparoscopic approach to intrahepatic cholangiocarcinoma is associated with an exacerbation of inadequate nodal staging. Ann Surg Oncol 26(6):1851–1857. https://doi.org/10.1245/s10434-019-07303-0

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zhu Y, Song J, Xu X, Tan Y, Yang J (2019) Safety and feasibility of laparoscopic liver resection for patients with large or multiple intrahepatic cholangiocarcinomas: a propensity score based case-matched analysis from a single institute. Medicine 98(49):e18307. https://doi.org/10.1097/MD.0000000000018307

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kinoshita M, Kanazawa A, Takemura S, Tanaka S, Kodai S, Shinkawa H et al (2020) Indications for laparoscopic liver resection of mass-forming intrahepatic cholangiocarcinoma. Asian J Endosc Surg 13(1):46–58. https://doi.org/10.1111/ases.12703

    Article  PubMed  Google Scholar 

  30. Kang S, Choi Y, Lee W, Ahn S, Cho JS, Yoon YS et al (2020) Laparoscopic liver resection versus open liver resection for intrahepatic cholangiocarcinoma: 3-year outcomes of a cohort study with propensity score matching. Surg Oncol 33:63–69. https://doi.org/10.1016/j.suronc.2020.01.001

    Article  PubMed  Google Scholar 

  31. Uy BJ, Han HS, Yoon YS, Cho JY (2015) Laparoscopic liver resection for intrahepatic cholangiocarcinoma. J Laparoendosc Adv Surg Tech A 25(4):272–277. https://doi.org/10.1089/lap.2014.0233

    Article  PubMed  Google Scholar 

  32. Ratti F, Cipriani F, Ariotti R, Gagliano A, Paganelli M, Catena M et al (2016) Safety and feasibility of laparoscopic liver resection with associated lymphadenectomy for intrahepatic cholangiocarcinoma: a propensity score-based case-matched analysis from a single institution. Surg Endosc 30(5):1999–2010. https://doi.org/10.1007/s00464-015-4430-4

    Article  PubMed  Google Scholar 

  33. Haber PK, Wabitsch S, Kastner A, Andreou A, Krenzien F, Schoning W et al (2020) Laparoscopic liver resection for intrahepatic cholangiocarcinoma: a single-center experience. J Laparoendosc Adv Surg Tech A. https://doi.org/10.1089/lap.2020.0215

    Article  PubMed  Google Scholar 

  34. Halls MC, Cipriani F, Berardi G, Barkhatov L, Lainas P, Alzoubi M et al (2018) Conversion for unfavorable intraoperative events results in significantly worse outcomes during laparoscopic liver resection: lessons learned from a multicenter review of 2861 cases. Ann Surg 268(6):1051–1057. https://doi.org/10.1097/SLA.0000000000002332

    Article  PubMed  Google Scholar 

  35. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2

    Article  PubMed  Google Scholar 

  36. Chen K, Pan Y, Zhang B, Liu XL, Maher H, Zheng XY (2018) Laparoscopic versus open surgery for hepatocellular carcinoma: a meta-analysis of high-quality case-matched studies. Can J Gastroenterol Hepatol 2018:1746895. https://doi.org/10.1155/2018/1746895

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sotiropoulos GC, Prodromidou A, Machairas N (2017) Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma: The European experience. J BUON 22(5):1160–1171

    PubMed  Google Scholar 

  38. Zhang XF, Chakedis J, Bagante F, Chen Q, Beal EW, Lv Y et al (2018) Trends in use of lymphadenectomy in surgery with curative intent for intrahepatic cholangiocarcinoma. Br J Surg 105(7):857–866. https://doi.org/10.1002/bjs.10827

    Article  PubMed  Google Scholar 

  39. Zhou R, Lu D, Li W, Tan W, Zhu S, Chen X et al (2019) Is lymph node dissection necessary for resectable intrahepatic cholangiocarcinoma? A systematic review and meta-analysis. HPB. https://doi.org/10.1016/j.hpb.2018.12.011

    Article  PubMed  Google Scholar 

  40. Amin MB (2017) American Joint Committee on cancer staging manual, Eight. Springer, New York

    Book  Google Scholar 

  41. Ratti F, Fiorentini G, Cipriani F, Paganelli M, Catena M, Aldrighetti L (2019) Perioperative and long-term outcomes of laparoscopic versus open lymphadenectomy for biliary tumors: a propensity-score-based, case-matched analysis. Ann Surg Oncol 26(2):564–575. https://doi.org/10.1245/s10434-018-6811-0

    Article  PubMed  Google Scholar 

  42. Khan S, Beard RE, Kingham PT, Fong Y, Boerner T, Martinie JB et al (2018) Long-term oncologic outcomes following robotic liver resections for primary hepatobiliary malignancies: a multicenter study. Ann Surg Oncol 25(9):2652–2660. https://doi.org/10.1245/s10434-018-6629-9

    Article  PubMed  PubMed Central  Google Scholar 

  43. Guerrini GP, Esposito G, Tarantino G, Serra V, Olivieri T, Catellani B et al (2020) Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: the first meta-analysis. Langenbecks Arch Surg. https://doi.org/10.1007/s00423-020-01877-0

    Article  PubMed  Google Scholar 

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Author notes

  1. Nikolaos Machairas and Ioannis D. Kostakis contributed equally and both should be considered as first authors.

Authors and Affiliations

  1. 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece

    Nikolaos Machairas, Stylianos Kykalos, Nikolaos Nikiteas & Georgios C. Sotiropoulos

  2. Department of HPB Surgery and Liver Transplant, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK

    Nikolaos Machairas & Ioannis D. Kostakis

  3. 1st Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece

    Dimitrios Schizas

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  1. Nikolaos Machairas
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Correspondence to Nikolaos Machairas.

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Machairas, N., Kostakis, I.D., Schizas, D. et al. Meta-analysis of laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma. Updates Surg 73, 59–68 (2021). https://doi.org/10.1007/s13304-020-00930-3

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