Background and Objective: Intrahepatic cholangiocarcinoma (ICC) is the second most common liver malignancy and represents the 10% of cholangiocarcinoma (CCA). ICC has an aggressive behavior and radical surgical resection represent the only potentially curative treatment. Even though the laparoscopic approach played a key role in the surgical treatment of benign and malignant liver tumors, the role of laparoscopic liver resection (LLR) for ICC is still debated. The scarcity of data of literature, the controversy on adequate lymphadenectomy and the high technical difficulty of surgery for ICC are some of the factors related with the low rate of LLR for ICC. The aim of this study is to review the current literature regarding the role of the LLR in the treatment of ICC focusing on safety, feasibility, and oncological results. Methods: A comprehensive review of the literature regarding the intraoperative and the short-term outcome as well as the oncological safety of the LLR for ICC was undertaken using the following combination of text words “intrahepatic cholangiocarcinoma”, “laparoscopic surgery”, “laparoscopic liver resection”, “laparoscopic hepatectomy”, “laparoscopy”, “minimally invasive surgery”. The inclusion criteria were full text peer review published papers describing a LLR for ICC and focusing on short- and long-term outcome. Among 1,645 manuscripts were selected for initial screening, 10 papers have been deemed eligible for the narrative review. Key Content and Findings: LLR for ICC increased the recent period, since 2015 among studies a total of 573 patients were included in this analysis. The rate of major hepatectomies for ICC ranged between 33% and 75% for lesions with a median size ranging from 3.5 to 6 cm. Data regarding lymph-node dissection rate showed controversial results ranging between 9% and 85%, otherwise the rate of radical resection (R0) was consistently high with values ranging between 81% and 100%. Data coming from centers with a high experience in LLR are encouraging and showed that it is safe and feasible as it is related to similar morbidity and mortality to open liver resection (OLR), 9–30% and 0–7% for LLR and 19–50% and 0–4% for OLR, respectively. Likely, LLR offers adequate long-term outcome in terms of both 3-year disease-free survival (DFS) and 3-year overall survival (OS), 3-year DFS of 35–53% and 3-year OS of 20–78% for OLR compared to 3-year DFS of 38–60% and 3-year OS of 46–85% for LLR. Conclusions: The results regarding the safety and feasibility of LLR for ICC are encouraging but the experience and the follow up of LLR are too preliminary to give conclusive indications especially on long-term outcome and further studies are required to confirm these results
Laparoscopic hepatic resection for intrahepatic cholangiocarcinoma: a narrative review of the current literature
Tripepi, Marzia;Conci, Simone;Campagnaro, Tommaso;De Bellis, Mario;Poletto, Edoardo;Marchitelli, Ivan;Guglielmi, Alfredo;Ruzzenente, Andrea
2022-01-01
Abstract
Background and Objective: Intrahepatic cholangiocarcinoma (ICC) is the second most common liver malignancy and represents the 10% of cholangiocarcinoma (CCA). ICC has an aggressive behavior and radical surgical resection represent the only potentially curative treatment. Even though the laparoscopic approach played a key role in the surgical treatment of benign and malignant liver tumors, the role of laparoscopic liver resection (LLR) for ICC is still debated. The scarcity of data of literature, the controversy on adequate lymphadenectomy and the high technical difficulty of surgery for ICC are some of the factors related with the low rate of LLR for ICC. The aim of this study is to review the current literature regarding the role of the LLR in the treatment of ICC focusing on safety, feasibility, and oncological results. Methods: A comprehensive review of the literature regarding the intraoperative and the short-term outcome as well as the oncological safety of the LLR for ICC was undertaken using the following combination of text words “intrahepatic cholangiocarcinoma”, “laparoscopic surgery”, “laparoscopic liver resection”, “laparoscopic hepatectomy”, “laparoscopy”, “minimally invasive surgery”. The inclusion criteria were full text peer review published papers describing a LLR for ICC and focusing on short- and long-term outcome. Among 1,645 manuscripts were selected for initial screening, 10 papers have been deemed eligible for the narrative review. Key Content and Findings: LLR for ICC increased the recent period, since 2015 among studies a total of 573 patients were included in this analysis. The rate of major hepatectomies for ICC ranged between 33% and 75% for lesions with a median size ranging from 3.5 to 6 cm. Data regarding lymph-node dissection rate showed controversial results ranging between 9% and 85%, otherwise the rate of radical resection (R0) was consistently high with values ranging between 81% and 100%. Data coming from centers with a high experience in LLR are encouraging and showed that it is safe and feasible as it is related to similar morbidity and mortality to open liver resection (OLR), 9–30% and 0–7% for LLR and 19–50% and 0–4% for OLR, respectively. Likely, LLR offers adequate long-term outcome in terms of both 3-year disease-free survival (DFS) and 3-year overall survival (OS), 3-year DFS of 35–53% and 3-year OS of 20–78% for OLR compared to 3-year DFS of 38–60% and 3-year OS of 46–85% for LLR. Conclusions: The results regarding the safety and feasibility of LLR for ICC are encouraging but the experience and the follow up of LLR are too preliminary to give conclusive indications especially on long-term outcome and further studies are required to confirm these results
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