Is It Time to Consider Laparoscopic Hepatectomy for Intrahepatic Cholangiocarcinoma? A Meta-Analysis
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ORIGINAL ARTICLE
Is It Time to Consider Laparoscopic Hepatectomy for Intrahepatic Cholangiocarcinoma? A Meta-Analysis Fangqiang Wei 1
&
Guan Wang 2 & Jianyi Ding 3 & Changwei Dou 1 & Tunan Yu 4 & Chengwu Zhang 1
Received: 5 August 2019 / Accepted: 7 September 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Objectives The role of laparoscopic hepatectomy (LH) for intrahepatic cholangiocarcinoma (ICC) remains indefinite, though the utilization of this minimally invasive approach has been increasing for ICC. We herein performed a meta-analysis to investigate this issue. Methods Six retrospective studies including 384 patients who had undergone LH and 2147 patients who had undergone open hepatectomy (OH) for ICC were included. The fixed-effects or random-effects models were utilized for data analysis. Results Compared with patients who had undergone OH for ICC, patients who had undergone LH for ICC experienced more R0 resections (81.6 versus 73.8%, risk ratio (RR) = 1.08, 95% confidence interval (CI) 1.02–1.14; P = 0.008) but less major hepatectomies (37.7 versus 54.2%, RR = 0.69, 95% CI 0.60–0.79; P < 0.0001), less lymph node dissections (38.0 versus 61.5%, RR = 0.62, 95% CI 0.54–0.70; P < 0.0001), and smaller tumor size resected (4.14 versus 4.94 cm, weighted mean difference = − 0.80 cm, 95% CI − 1.38 to − 0.22 cm; P = 0.007). No significant difference was observed in other perioperative results (all P > 0.05) or overall survival (hazard ratio (HR) = 1.38, 95% CI 0.63–3.02; P = 0.43). Conclusions LH has comparable safety, feasibility, and oncological efficacy to that of OH for ICC and has superiority in R0 resection over OH. It may be time to consider LH for ICC only if a more thorough effort on lymph node dissection is undertaken in selective patients at experienced centers. Keywords Laparoscopic hepatectomy . Intrahepatic cholangiocarcinoma . Lymph node dissection . Survival . Meta-analysis
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-019-04404-9) contains supplementary material, which is available to authorized users. * Fangqiang Wei [email protected] 1
Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
2
Department of Public Health, Hangzhou Medical College, Hangzhou 310051, Zhejiang Province, China
3
Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
4
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
Intrahepatic cholangiocarcinoma (ICC), the second most common primary hepatobiliary cancer, is a refractory malignancy associated with a late diagnosis, highly infiltrative nature, and disappointing outcomes.1,2 The incidence of ICC has been steadily increasing over decades worldwide,3,4 from 0.49 per 100,000 in 1995 to 1.49 per 100,000 in 2014 in the USA.5 Su
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