Total laparoscopic versus open radical resection for hilar cholangiocarcinoma
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and Other Interventional Techniques
Total laparoscopic versus open radical resection for hilar cholangiocarcinoma Yuhua Zhang1 · Changwei Dou1 · Weiding Wu1 · Jie Liu1 · Liming Jin1 · Zhiming Hu1 · Chengwu Zhang1 Received: 24 May 2019 / Accepted: 9 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Background Radical resection is the only curative option for patients with hilar cholangiocarcinoma (HCCA) to achieve long-term survival. However, due to the fact that radical resection of HCCA has high technical requirements, the safety and efficacy of laparoscopic resection for HCCA remains controversial. Method From January 2015 to December 2018, 23 cases of HCCA underwent radical resection in our center. Clinical data of those patients were collected and analyzed retrospectively. Results 14 patients underwent laparoscopic resection and 9 cases received open resection. 2 patients in laparoscopic group were converted to laparotomy. Operation time in laparoscopic group was significantly longer than that in open group (519.4 ± 155.4 min vs 366.7 ± 93.1 min). Estimated blood loss (620.0 ± 681.2 ml vs 821.4 ± 713.8 ml) and incidence of intraoperative blood transfusion (5/9 vs 8/14) did not differ significantly between two groups. Pathological outcomes were comparable between two groups. Length of postoperative hospital stay (23.4 ± 13.4 days vs 17.8 ± 7.1 days), severe postoperative morbidity (3/9 vs 5/14), bile leakage of Grade A or B (5/9 vs 5/14), intra-abdominal bleeding (0/9 vs 1/14), intraabdominal abscess (1/9 vs 0/14), wound infection (0/9 vs 1/14), pulmonary infection (2/9 vs 0/14), and liver failure (0/9 vs 0/14) did not differ significantly between two groups. One patient in laparoscopic group died (1/14) at 21 postoperative days due to intra-abdominal bleeding, while no 30-day mortality was observed in open group. Conclusion Our results demonstrate that laparoscopic radical resection of HCCA is safe and feasible in experienced hands. Although laparoscopic resection for HCCA, which is still in initial and exploratory stage, fails to show any advantage over open resection in this study, we are optimistic with its wide application in future with the improvement of surgical techniques and experience. Keywords Laparoscopy · Hilar cholangiocarcinoma · Radical resection Surgical resection of HCCA remains one of the greatest challenges for hepatobiliary surgeons [1]. Radical resection of HCCA has high technical requirements that encompass lymph nodes dissection, extended hepatectomy with caudate lobe, cholangiojejunostomy, and vascular reconstruction if necessary. Minimally invasive operations, including laparoscopic and robotic operations, have been commonly performed for the treatment of benign hepatobiliary diseases and result in faster recovery and less postoperative
complication. However, due to the high technical requirements, laparoscopic approach has limited application in radical resection of HCCA. Only limited publications reported this minimally invasive appro
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