Clinical efficacy of laparoscopic hepatectomy for intrahepatic cholangiocarcinoma

Abstract

Objective \nTo investigate the clinical efficacy of laparoscopic hepatectomy for intrahepatic cholangiocarcinoma (ICC). \n \n \nMethods \nThe retrospective cross-sectional study was conducted. The clinicopathological data of 62 patients with ICC who were admitted to Mengchao Hepatobiliary Hospital of Fujian Medical University (32 patients) and the First Hospital Affiliated to Army Medical University (30 patients) between January 2013 and January 2018 were collected; there were 35 males and 27 females, aged from 25 to 77 years, with an average of 60 years. According to the preoperative and intraoperative situations, lymph node dissection was performed, and anatomical or non-anatomical laparoscopic hepatectomy were performed based on tumor size and location. Observation indicators: (1) surgical and postoperative recovery; (2) pathological examination results; (3) follow-up and survival situations. Follow-up was conducted by telephone interview and outpatient examination once every 3 months to detect tumor-free survival and overall survival of patients up to June 2018. Measurement data with normal distribution were represented as Mean±SD. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute number and percentage. The survival curve and rate were drawn and calculated by the Kaplan-Meier method. \n \n \nResults \n(1) Surgical and postoperative recovery: all the 62 patients received successful laparoscopic hepatectomy, without conversion to open surgery or preoperative death, including 40 with anatomical hepatectomy and 22 with non-anatomical hepatectomy. There were 18 patients undergoing regional lymph node dissection. The operation time of 62 patients was (217±86)minutes. Of 62 patients, 12 had hepatic vascular occlusion using the Pringle method with a total occlusion time of (14±7)minutes, 45 received selective hepatic vascular occlusion and 5 did not receive hepatic portal occlusion. The volume of intraoperative blood loss was 282 mL (range, 20-2 500 mL). Four patients had intraoperative infusion of suspended red blood cells. The time for out-of-bed activity, time to initial anal exsufflation, time of abdominal drainage-tube removal, recovery time of liver function to normal level were 1 day (range, 1-3 days), 2.5 days (2.0-4.0 days), (4.4±1.3)days, (6.8±1.6)days. There was no liver failure. Six of 62 patients had postoperative complications, including 5 with thoracic and abdominal effusion, 3 with abdominal infection, 2 with pulmonary infection, 2 with bile leakage, 1 with intraperitoneal hemorrhage, 1 with urinary retention, 1 with postoperative incision infection, multiple complications might occur in the same patient. Two of 6 patients with complications of Clavien-Dindo Ⅲ were improved by symptomatic treatment. The other patients had no clear complications. The duration of postoperative hospital stay was (13±9)days. Thirteen patients received preventive TACE treatment after surgery, 9 received 4-6 courses of chemotherapy, 2 received both TACE and chemotherapy with chemotherapy drug of Tegafur or gemcitabine combined with cisplatin. (2) Pathological examination results: the tumor diameter of 62 patients was (5.4±3.3)cm, including 38 with the diameter ≤ 5 cm and 24 with the diameter >5 cm. There were 56 patients of mass-forming type, 4 of intraductal growth type and 2 of periductal infiltrating type. High-, moderate-, poor-differentiated adenocarcinoma were respectively detected in 10, 37 and 15 of 62 patients. The distance of surgical margins to tumor was > 1.0 cm in 57 patients. There were 60 patients with negative surgical margin, 1 patient of intraductal growth type and 1 of periductal infiltrating type with positive margin. Lymph node dissection was performed in 18 patients, among which 11 were pathologically positive, otherwise, there were 16 patients with microvascular invasion, and 4 patients with peripheral nerve infiltration. TNM stages of 62 patients: stage ⅠA, stage ⅠB, stage Ⅱ and stage ⅢB were respectively detected in 14, 23, 14 and11 patients. (3) Follow-up and survival situations: 62 patients were followed up for (22±12)months. The 1- and 3-year disease-free survival rates were 65.2% and 39.8% respectively. The 1- and 3-year overall survival rates were 89.6% and 52.5% respectively. During the follow-up, 2 of 44 patients without lymph node dissection had liver portal lymph node metastasis, 1 had extensive lymph node metastasis, 2 died of other causes at 6 months and 18 months after operation. \n \n \nConclusion \nRoutine laparoscopic radical resection of intrahepatic cholangiocarcinoma with regional lymph node dissection is safe and effective, however, laparoscopic hepatectomy should be carefully selected for intraductal growth type and periductal infiltration type. \n \n \nKey words: \nBiliary tract neoplasms;\xa0Intrahepatic cholangiocarcinoma;\xa0Hepatectomy;\xa0Lymph node dissection;\xa0Postoperative complications;\xa0Laparoscopy