Portal de Periódicos da CAPES

Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: Report of an international multicenter cohort study with propensity score matching

2021; Elsevier BV; Volume: 171; Issue: 5 Linguagem: Inglês

10.1016/j.surg.2021.08.015

1532-7361

Raffaele Brustia, Alexis Laurent, Claire Goumard, Serena Langella, Daniel Cherqui, Takayuki Kawai, Olivier Soubrane, François Cauchy, Olivier Farges, Benjamin Menahem, Christian Hobeika, Rami Rhaiem, Danièle Sommacale, Shinya Okumura, Stefan Hofmeyr, Alessandro Ferrero, François‐René Pruvot, Jean‐Marc Regimbeau, David Fuks, Éric Vibert, Olivier Scatton, J. Abba, René Adam, Mustapha Adham, Marc‐Antoine Allard, Ahmet Ayav, Daniel Azoulay, Philippe Bachellier, Pierre Balladur, Louise Barbier, J. Barbieux, Emmanuel Boleslawski, Karim Boudjéma, M. Bougard, Emmanuel Buc, Petru Bucur, Antoine Carmelo, Denis Chatelain, Jean Chauvat, Zineb Cherkaoui, L. Chiche, Mircea Chirica, Oriana Ciacio, Tatiana Codjia, Fabio Colli, Luciano De Carlis, Jean‐Robert Delpéro, Nicolas Demartines, Olivier Detry, Marcelo Dias Sanches, Momar Diouf, Alexandre Doussot, Christian Ducerf, Mehdi El Amrani, Jacques Ewald, Jean-Marc Fabre, H. Fagot, Simone Famularo, Léo Ferre, Francesco Fleres, Gilton Marques Fonseca, Brice Gayet, Alessandro Giacomoni, Jean‐François Gigot, Édouard Girard, Nicolas Golse, Émilie Grégoire, Jean Hardwigsen, Paulo Herman, Thevi Hor, François Jehaes, Ali-Reza Kianmanesh, Shohei Komatsu, Sophie Laroche, Christophe Laurent, Yves-Patrice Le Treut, Katia Lécolle, Philippe Leourier, Émilie Lermite, Mikael Lesurtel, Christian Létoublon, Paul Leyman, Jean Lubrano, Jean‐Yves Mabrut, Georges Mantion, Ugo Marchèse, Riccardo Memeo, Guillaume Y. Millet, Kayvan Mohkam, André Mulliri, Fabrice Muscari, Françis Navarro, Francisco Nolasco, Takeo Nomi, Jean Nunoz, Gennaro Nuzzo, Nassima Oudafal, Gérard Pascal, Guillaume Passot, D Patrice, Damiano Patrono, François Paye, Fabiano Perdigão, Patrick Pessaux, Niccolò Petrucciani, Gabriella Pittau, C. Ratajczak, Artigas Raventós, Lionel Rebibo, Vívian Resende, Michel Rivoire, Renato Romagnoli, Didier Roulin, António Sá Cunha, Ephrem Salamé, Astrid Schielke, Lilian Schwarz, Michel Scotté, Régis Souche, Bertrand Suc, Michele Tedeschi, Alexandre Thobie, B. Tréchot, Stéphanie Truant, Olivier Turini, Shinji Üemoto, Xavier Unterteiner, Charles Vanbrugghe, Jean Zemour,

Gastric Cancer Management and Outcomes

Intrahepatic cholangiocarcinoma is a rare disease with a poor prognosis. In patients where surgical resection is possible, outcome is influenced by perioperative morbidity and lymph node status. Laparoscopic liver resection is associated with improved clinical and oncological outcomes in primary and metastatic liver cancer compared with open liver resection, but evidence on intrahepatic cholangiocarcinoma is still insufficient. The primary aim of this study was to compare overall survival for a large series of patients treated for intrahepatic cholangiocarcinoma by open or laparoscopic approach. Secondary objectives were to compare disease-free survival, predictors of death, and recurrence.Patients treated with laparoscopic or open liver resection for intrahepatic cholangiocarcinoma from 2000 to 2018 from 3 large international databases were analyzed retrospectively. Each patient in the laparoscopic resection group (case) was matched with 1 open resection control (1:1 ratio), through a propensity score calculated on clinically relevant preoperative covariates. Overall and disease-free survival were compared between the matched groups. Predictors of mortality and recurrence were analyzed with Cox regression, and the Textbook Outcomes were described.During the study period, 855 patients met the inclusion criteria (open liver resection = 709, 82.9%; laparoscopic liver resection = 146, 17.1%). Two groups of 89 patients each were analyzed after propensity score matching, with no significant difference regarding pre- and postoperative variables. Overall survival at 1, 3, and 5 years was 92%, 75%, and 63% in the laparoscopic liver resection group versus 92%, 58%, and 49% in the open liver resection group (P = .0043). Adjusted Cox regression revealed severe postoperative complications (hazard ratio: 10.5, 95% confidence interval [1.01-109] P = .049) and steatosis (hazard ratio: 13.8, 95% confidence interval [1.23-154] P = .033) as predictors of death, and transfusion (hazard ratio: 19.2, 95% confidence interval [4.04-91.4] P < .001) and severe postoperative complications (hazard ratio: 4.07, 95% confidence interval [1.15-14.4] P = .030) as predictors of recurrence.The survival advantage of laparoscopic liver resection over open liver resection for intrahepatic cholangiocarcinoma is equivocal, given historical bias and missing data.