Minimally invasive surgery for hilar cholangiocarcinoma: a multicenter retrospective analysis of 158 patients
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Minimally invasive surgery for hilar cholangiocarcinoma: a multicenter retrospective analysis of 158 patients Li Jingdong1 · Xiong Yongfu1 · Gang Yang1 · Xu Jian1 · Huang Xujian1 · Liu Jianhua2 · Zhao Wenxing3 · Qin Renyi4 · Yin Xinming5 · Zheng Shuguo6 · Liang Xiao7 · Peng Bin8 · Zhang Qifan9 · Li Dewei10 · Tang Zhao‑hui11 Received: 15 April 2020 / Accepted: 15 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Curative resection of hilar cholangiocarcinoma (HC) is typically carried out using open surgery. In the present study, we examined the safety (postoperative complication) and effectiveness (resection margin status and patient survival) of minimally invasive surgery (MIS) for HC. Methods This retrospective analysis included 158 patients receiving MIS for HC at 10 participating centers between December 2013 and November 2019. Patient demographics, surgical outcomes, and oncological outcomes were retrospectively analyzed. Results Clinical information obtained from 10 different clinical centers did not show any evident cohort-bias clustering. One hundred and twenty-six (79.7%) patients underwent LRHC, 12 (7.6%) patients underwent RARHC, conversion to an open procedure occurred in 20 (12.7%) patients. The operation time and estimated blood loss were 410.8 ± 128.9 min and 477.8 ± 706.3 mL, respectively. The surgical radicality of the 158 patients was R0, 129 (81.6%); R1, 20 (18.4%) and R2, 9 (5.7%). Grades I–II complications was occurred in 68 (43.0%) patients. Severe morbidity (grade III–V) occurred in 14 (8.7%) patients. The median overall survival in whole cohort was 25.4 months. The overall survival rate was 67.6% at year 1, 28.8% at year 3, and 19.2% at year 5. Comparing the first half of MISHC performed by each center with the following cases, the operation time and postoperative hospital stay does not decrease with the increasing cases. On literature review, MISHC is non-inferior to open surgery at least in perioperative period. Conclusions In this Chinese MIS for HC multicenter study, the largest to date, long-term overall survival rates after MIS appear comparable to those reported in current open series. Further randomized controlled trials are necessary to assess the global impact of MISHC. Keywords Hilar cholangiocarcinoma · Minimally invasive surgery · Multicenter clinical study Hilar cholangiocarcinoma (HC) is a highly aggressive cancer with very poor prognosis. Estimated number of new cases each year is 7000 in the USA and 65,000 in China. In > 50% of the cases, HC is not resectable upon initial diagnosis. In
Li Jingdong, Xiong Yongfu have contributed equally to this work. * Li Jingdong Li‑[email protected] * Xiong Yongfu Xiong‑[email protected] * Tang Zhao‑hui [email protected] Extended author information available on the last page of the article
the remaining cases, curative resection is the only treatment that offers a chance of long-term survival [1–3]. Curative resection of HC is o
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