Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: a multicenter propensity score-matched study

Figures & data

Table 1. Perioperative results and characteristics of patients undergoing liver resection for intrahepatic cholangiocarcinoma.

Parameters		Unmatched cohort			Matched cohort
	All (n = 136)	Laparoscopic (n = 50)	Open (n = 86)	p Value	Laparoscopic (n = 50)	Open (n = 50)	p Value
Age, years, mean (SD)	64.2 (9.8)	65.5 (9.2)	63.4 (10.2)	0.22	65.5 (9.2)	65.4 (10.6)	0.94
Male gender, n (%)	60 (44.1%)	23 (46%)	37 (43%)	0.74	23 (46%)	22 (44%)	0.84
Body mass index, kg/m^2, mean (SD)	27.5 (5.1)	28.3 (4.2)	27 (5.4)	0.17	28.3 (4.2)	27.2 (4.8)	0.26
Underlying liver disease, n (%)	50 (36.8%)	22 (44%)	28 (32.6%)	0.18	22 (44%)	20 (40%)	0.69
CEA, ng/mL, median (range)	2.9 (0.4–183)	3 (0.4–21)	2 (0.4–183)	0.59	3 (0.5–21)	2.6 (0.9–183)	0.85
CA 19–9, U/mL, median (range)	32 (0.1–12000)	24 (0.1–325)	33.5 (2–12000)	0.15	24 (0.1–325)	43 (2–12000)	0.037
AFP, ng/mL, median (range)	4 (4–890)	4 (0.6–890)	4 (0.4–172)	0.67	4 (0.6–890)	4 (0.4–172)	0.67
ASA grade ≥ III, n (%)	75 (55.1%)	28 (56%)	47 (54.7%)	0.88	28 (56%)	28 (56%)	1.0
Number of tumors ≥ 3, n (%)	19 (14%)	6 (12%)	13 (15.1%)	0.61	6 (12%)	6 (12%)	1.0
Bi–lobar tumor location, n (%)	34 (25%)	3 (6%)	31 (36%)	<0.01	3 (6%)	3 (6%)	1.0
Previous liver surgery, n (%)	12 (8.8%)	3 (6%)	9 (10.5%)	0.54	3 (6%)	4 (8%)	1.0
Preoperative chemotherapy, n^a	12	3	9	0.37	3	5	0.47
Southampton difficulty score, median (SD)	34.9 (16.6)	27.7 (15.7)	39.4 (15.6)	<0.01	27.7 (15.7)	35.2 (16.2)	0.022
Major resection, n (%)	88 (64.7%)	19 (38%)	69 (80.2%)	<0.01	19 (38%)	37 (74%)	<0.01
Lymph node dissection, n (%)	67 (49.3%)	10 (20%)	57 (66.3%)	<0.01	10 (20%)	30 (60%)	<0.01
Operative time, min, mean (SD)	268 (53–795)	209 (122)	302 (160)	0.02	209 (122)	294 (156)	<0.01
Red blood cell transfusion, n (%)	26 (19.1%)	4 (8%)	22 (25.6%)	0.01	4 (8.2%)	10 (20%)	0.09
Conversion, n (%)	5 (10%)	5 (10%)	–	–	5 (10%)	–	–
Postoperative complications, n (%)	65 (47.8%)	15 (30%)	50 (58.1%)	<0.01	15 (30%)	26 (52%)	0.025
Severe complications, n (%)	47 (34.6%)	12 (24%)	35 (40.7%)	0.048	12 (24%)	19 (38%)	0.13
CCI^b, median (range)	33.7 (8.7–100)	37.1 (20.9–100)	33.6 (8.7–100)	0.27	37.1 (20.9–100)	33.7 (8.7–100)	0.44
Reoperation, n (%)	16 (11.8%)	2 (4%)	14 (16.3%)	0.03	2 (4%)	8 (16%)	0.046
Readmission, n (%)	18 (13.2%)	5 (10%)	13 (15.1%)	0.39	5 (10%)	7 (14%)	0.54
90–day mortality, n (%)	10 (7.4%)	2 (4%)	8 (9.3%)	0.32	2 (4%)	5 (10%)	0.44
Intensive care unit stay, days, median (range)	1 (1–16)	0 (0–13)	1 (0–16)	<0.01	0 (0–13)	1 (0–16)	<0.01
Length of hospital stay, days, median (range)	7 (1–60)	5 (1–29)	9 (2–60)	<0.01	5 (1–29)	8 (2–60)	<0.01

^aIncomplete data.

^bComprehensive complication index.

Table 2. Type of postoperative complications and incidence of reoperations after open and laparoscopic surgery for intrahepatic cholangiocarcinoma.

Complications	Surgical approach
	Laparoscopic		Open
	Number	Reoperation (n = 2)	Number	Reoperation (n = 14)
Ileus			2	2
Bile leakage	5	1	14	2
Pneumonia	1
Pulmonary embolism	1		5
Pneumothorax			1
Pleural effusion	3		3
Respiratory failure	2		3
Renal failure	1
Liver failure	1		3
Transient liver insufficiency	1		7
Fever			3
Ascites	2		3
Peritonitis			1	1
Intraabdominal bleeding	1	1	2	2
Intraabdominal abscess			3	3
Ulcer perforation			1	1
Wound infection			1
Wound rupture			3	3
Delayed gastric emptying			1
Acute pancreatitis	1		1
Hemodynamic instability (dehydration)			1
Urinary tract infection			1
Multiorgan failure			2
Sepsis			4
Acute coronary syndrome	1
Cardiac tamponade			1

Table 3. Pathology findings in patients undergoing laparoscopic and open resection for intrahepatic cholangiocarcinoma.

Parameters		Unmatched cohort			Matched cohort
	All (n = 136)	Laparoscopic (n = 50)	Open (n = 86)	p Value	Laparoscopic (n = 50)	Open (n = 50)	p Value
Tumor size, mm, mean (SD)	66.8 (40.1)	55.1 (31.5)	73.6 (43.1)	0.01	55.1 (31.5)	58.1 (29.2)	0.63
Specimen weight, gram, median (range)	400 (20–2222)	256 (69–1180)	614 (20–2222)	0.001	256 (69–1180)	480 (20–1512)	0.014
R1, n^b	34	8	26	0.047	8	8	0.93
Tumor stage, n (%)				0.09			0.34
T1	67 (49.3%)	29 (58%)	38 (44.2%)		29 (58%)	25 (50%)
T2	44 (32.4%)	17 (34%)	27 (31.4%)		17 (34%)	14 (28%)
T3	12 (8.8%)	1 (2%)	11 (12.8%)		1 (2%)	6 (12%)
T4	13 (9.5%)	3 (6%)	10 (11.6%)		3 (6%)	5 (10%)
Nodal stage, n^a				0.47			0.69
N0	44	8	36		8	20
N1	23	2	21		2	10
Detected lymph nodes, median (range)	2 (0–20)	1 (0–20)	2 (0–15)	0.001	1 (0–20)	2 (0–15)	0.002
Positive lymph nodes, median (range)	0 (0–4)	0 (0–2)	0 (0–4)	0.06	0 (0–2)	0 (0–4)	0.13
Tumor differentiation (poor), n^c	35	14	21	0.31	14	9	0.24
Vascular invasion, n^d	43	13	30	0.17	13	16	0.31
Perforation of the visceral peritoneum, n^e	17	3	14	0.052	3	8	0.07

^aLymphadenectomy performed in 67 cases.

^bData missing in 6 cases.

^cData missing in 13 cases.

^dData missing in 9 cases.

^eData missing in 10 cases.

Figure 1. Recurrence-free (a) and overall survival (b) following laparoscopic and open liver resection for intrahepatic cholangiocarcinoma (matched cohort).

Table 4. Long-term oncologic outcomes in patients undergoing laparoscopic and open resection for intrahepatic cholangiocarcinoma (patients that had died after surgery were excluded).

Parameters		Unmatched			Matched
	All (n = 126)	Laparoscopic (n = 48)	Open (n = 78)	p Value	Laparoscopic (n = 48)	Open (n = 45)	p Value
Adjuvant chemotherapy, n^a	29	13	16	0.41	13	6	0.11
Recurrence, n^b	68	25	43	0.34	25	22	0.64
Recurrence type, n^b				0.37			0.41
Intrahepatic	34	14	22		14	9
Extrahepatic	15	7	8		7	6
Both	17	4	13		4	7
Survival, months, median (95% CI)
Recurrence-free	14.7 (9.4–20)	15.5 (5.2–25.8)	14 (9.2–18.8)	0.64	15.5 (5.2–25.8)	16.9 (1.2–35)	0.9
1 year	59.9%	59.4%	60.1%		59.4%	62.4%
3 years	36.9%	40%	35.3%		40%	38.3%
Overall	40.7 (29.6–51.7)	47.6 (18.4–76.8)	36.4 (26.2–46.6)	0.29	47.6 (18.4–76.8)	40.7 (26.2–46.6)	0.43
3 years	53.1%	55.8%	51.2%		55.8%	56%
5 years	40.5%	47.2%	37%		47.2%	43.2%

^aData not available in six patients.

^bData not available in 12 patients.