Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: Report of an international multicenter cohort study with propensity score matching.
Journal
Surgery
ISSN: 1532-7361
Titre abrégé: Surgery
Pays: United States
ID NLM: 0417347
Informations de publication
Date de publication:
05 2022
05 2022
Historique:
received:
31
03
2021
revised:
09
08
2021
accepted:
12
08
2021
pubmed:
19
9
2021
medline:
3
5
2022
entrez:
18
9
2021
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
The survival advantage of laparoscopic liver resection over open liver resection for intrahepatic cholangiocarcinoma is equivocal, given historical bias and missing data.
Identifiants
pubmed: 34535270
pii: S0039-6060(21)00785-6
doi: 10.1016/j.surg.2021.08.015
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1290-1302Investigateurs
Julio Abba
(J)
René Adam
(R)
Mustapha Adham
(M)
Marc-Antoine Allard
(MA)
Ahmet Ayav
(A)
Daniel Azoulay
(D)
Philippe Bachellier
(P)
Pierre Balladur
(P)
Louise Barbier
(L)
Julien Barbieux
(J)
Emmanuel Boleslawski
(E)
Karim Boudjema
(K)
M Bougard
(M)
Emmanuel Buc
(E)
Petru Bucur
(P)
Antoine Carmelo
(A)
Denis Chatelain
(D)
Jean Chauvat
(J)
Zineb Cherkaoui
(Z)
Laurence Chiche
(L)
Mircea Chirica
(M)
Oriana Ciacio
(O)
Tatiana Codjia
(T)
Fabio Colli
(F)
Luciano De Carlis
(L)
Jean-Robert Delpero
(JR)
Nicolas Demartines
(N)
Olivier Detry
(O)
Marcelo Dias Sanches
(MD)
Momar Diouf
(M)
Alexandre Doussot
(A)
Christian Ducerf
(C)
Mehdi El Amrani
(M)
Jacques Ewald
(J)
Jean-Marc Fabre
(JM)
Hervé Fagot
(H)
Simone Famularo
(S)
Léo Ferre
(L)
Francesco Fleres
(F)
Gilton Marques Fonseca
(GM)
Brice Gayet
(B)
Alessandro Giacomoni
(A)
Jean-Francois Gigot
(JF)
E Girard
(E)
Nicolas Golse
(N)
Emilie Gregoire
(E)
Jean Hardwigsen
(J)
Paulo Herman
(P)
Thevi Hor
(T)
François Jehaes
(F)
Ali-Reza Kianmanesh
(AR)
Shohei Komatsu
(S)
Sophie Laroche
(S)
Christophe Laurent
(C)
Yves-Patrice Le Treut
(YP)
K Lecolle
(K)
Philippe Leourier
(P)
Emilie Lermite
(E)
Mikael Lesurtel
(M)
Christian Letoublon
(C)
Paul Leyman
(P)
Jean Lubrano
(J)
Jean-Yves Mabrut
(JY)
Georges Mantion
(G)
Ugo Marchese
(U)
Riccardo Memeo
(R)
Guillaume Millet
(G)
Kayvan Mohkam
(K)
André Mulliri
(A)
Fabrice Muscari
(F)
Francis Navarro
(F)
Francisco Nolasco
(F)
Takeo Nomi
(T)
Jean Nunoz
(J)
Gennaro Nuzzo
(G)
Nassima Oudafal
(N)
Gerard Pascal
(G)
Guillaume Passot
(G)
D Patrice
(D)
Damiano Patrono
(D)
François Paye
(F)
Fabiano Perdigao
(F)
Patrick Pessaux
(P)
Niccolo Petrucciani
(N)
Gabriella Pittau
(G)
C Ratajczak
(C)
Artigas Raventos
(A)
Lionel Rebibo
(L)
Vivian Resende
(V)
Michel Rivoire
(M)
Renato Romagnoli
(R)
Didier Roulin
(D)
Antonio Sa-Cunha
(A)
Ephrem Salame
(E)
Astrid Schielke
(A)
Lilian Schwarz
(L)
Michel Scotte
(M)
François-Regis Souche
(FR)
Bertrand Suc
(B)
Michele Tedeschi
(M)
Alexandre Thobie
(A)
Boris Trechot
(B)
Stéphanie Truant
(S)
Olivier Turini
(O)
Shinji Uemoto
(S)
Xavier Unterteiner
(X)
Charles Vanbrugghe
(C)
Jean Zemour
(J)
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.