Liver resection for extra-pancreatic biliary cancer: what is the role of laparoscopic approach?
Adult
Aged
Aged, 80 and over
Biliary Tract Neoplasms
/ surgery
Cholangiocarcinoma
/ surgery
Feasibility Studies
Female
Gallbladder Neoplasms
/ surgery
Hepatectomy
/ methods
Humans
Klatskin Tumor
/ surgery
Laparoscopy
/ methods
Male
Middle Aged
Operative Time
Postoperative Complications
/ etiology
Treatment Outcome
Biliary tract malignancy
Complications
Laparoscopy
Liver resection
Short-term outcome
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
22
11
2018
accepted:
17
01
2019
pubmed:
30
1
2019
medline:
23
7
2020
entrez:
30
1
2019
Statut:
ppublish
Résumé
Laparoscopic liver resection (LLR) has evolved over time, yet its role in extra-pancreatic biliary cancer has been limited due to several factors. We aimed to evaluate the short-term outcome of LLR in extra-pancreatic biliary tract cancer. From January 2002 to 2016, all patients who underwent LLR for extra-pancreatic biliary tract cancer including gallbladder cancer (GBC), intra-hepatic cholangiocarcinoma (ICC), and peri-hilar cholangiocarcinoma (PHC) with curative intent (R0 or R1) at Institute Mutualiste Montsouris were identified from prospectively collected databases. Patient characteristics, and perioperative outcomes, were analyzed in all three groups. A total of 35 patients were included: 10 with GBC, 14 with ICC, and 11 with PHC. There were 19 (54%) women and median age was 71 years. Median operative time was 240 min, and estimated blood loss was 200 ml. Conversion to an open procedure was more common in patients with PHC (45% vs. 7% for ICC and 0% for GBC, p = 0.010). R0 resection was achieved in 10 (100%), 12 (86%), and 8 (73%) patients in GBC, ICC, and PHC groups, respectively (p = 0.204). Postoperative morbidity was reported in 19 (54%) patients of whom 12 (34%) had minor complications. Postoperative mortality was reported in 4 (11%) patients; one (7%) in GBC group, one (7%) in ICC group, and two (18%) in PHC, p = 0.681. Median hospital stay was 11 days. The present series suggests that LLR is feasible in GBC, challenging but achievable in ICC but unsuitable for the moment in PHC.
Sections du résumé
BACKGROUND
Laparoscopic liver resection (LLR) has evolved over time, yet its role in extra-pancreatic biliary cancer has been limited due to several factors. We aimed to evaluate the short-term outcome of LLR in extra-pancreatic biliary tract cancer.
METHODS
From January 2002 to 2016, all patients who underwent LLR for extra-pancreatic biliary tract cancer including gallbladder cancer (GBC), intra-hepatic cholangiocarcinoma (ICC), and peri-hilar cholangiocarcinoma (PHC) with curative intent (R0 or R1) at Institute Mutualiste Montsouris were identified from prospectively collected databases. Patient characteristics, and perioperative outcomes, were analyzed in all three groups.
RESULTS
A total of 35 patients were included: 10 with GBC, 14 with ICC, and 11 with PHC. There were 19 (54%) women and median age was 71 years. Median operative time was 240 min, and estimated blood loss was 200 ml. Conversion to an open procedure was more common in patients with PHC (45% vs. 7% for ICC and 0% for GBC, p = 0.010). R0 resection was achieved in 10 (100%), 12 (86%), and 8 (73%) patients in GBC, ICC, and PHC groups, respectively (p = 0.204). Postoperative morbidity was reported in 19 (54%) patients of whom 12 (34%) had minor complications. Postoperative mortality was reported in 4 (11%) patients; one (7%) in GBC group, one (7%) in ICC group, and two (18%) in PHC, p = 0.681. Median hospital stay was 11 days.
CONCLUSIONS
The present series suggests that LLR is feasible in GBC, challenging but achievable in ICC but unsuitable for the moment in PHC.
Identifiants
pubmed: 30693390
doi: 10.1007/s00464-019-06664-7
pii: 10.1007/s00464-019-06664-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3711-3717Références
Updates Surg. 2015 Jun;67(2):129-40
pubmed: 26174194
Surgery. 2011 May;149(5):680-8
pubmed: 21316725
HPB (Oxford). 2015 Jun;17(6):536-41
pubmed: 25727091
Transl Gastroenterol Hepatol. 2018 Sep 18;3:69
pubmed: 30363698
Dig Surg. 2019;36(1):7-12
pubmed: 29339658
Surg Endosc. 2016 Nov;30(11):4835-4840
pubmed: 26902611
World J Surg. 2018 Aug;42(8):2592-2598
pubmed: 29520484
Dig Surg. 2011;28(1):44-9
pubmed: 21293131
Arch Surg. 2009 Jan;144(1):46-51
pubmed: 19153324
HPB (Oxford). 2015 Aug;17(8):691-9
pubmed: 26172136
World J Gastrointest Pathophysiol. 2014 Aug 15;5(3):344-54
pubmed: 25133034
Surg Endosc. 2010 Jul;24(7):1766-8
pubmed: 20054570
Ann Surg. 2005 Dec;242(6):824-8, discussion 828-9
pubmed: 16327492
Dig Surg. 2019;36(1):1-6
pubmed: 29339660
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
ANZ J Surg. 2019 May;89(5):476-480
pubmed: 30136376
Surg Endosc. 2013 Feb;27(2):406-14
pubmed: 22926892
Oncologist. 2008 Apr;13(4):415-23
pubmed: 18448556
Ann Surg. 1999 Aug;230(2):266-75
pubmed: 10450742
Surg Endosc. 2016 May;30(5):1999-2010
pubmed: 26194257
Br J Surg. 2015 Feb;102(3):254-60
pubmed: 25522176
Ann Surg. 2001 Oct;234(4):507-17; discussion 517-9
pubmed: 11573044
J Hepatobiliary Pancreat Sci. 2014 Oct;21(10):732-6
pubmed: 25098667
Br J Surg. 2015 Jun;102(7):796-804
pubmed: 25873161
Ann Surg. 2012 Dec;256(6):959-64
pubmed: 22968066