Author:
Wang Min,Qin Tingting,Zhang Hang,Li Jingdong,Deng Xiaxing,Zhang Yuhua,Zhao Wenxing,Fan Ying,Li Dewei,Chen Xuemin,Feng Yechen,Zhu Siwei,Xing Zhongqiang,Yu Guangsheng,Xu Jian,Xie Junjie,Dou Changwei,Ma Hongqin,Liu Gangshan,Shao Yue,Chen Weibo,Liu Jun,Liu Jianhua,Yin Xinmin,Qin Renyi
Abstract
Abstract
Background
Laparoscopic surgery (LS) has been increasingly applied in perihilar cholangiocarcinoma (pCCA). In this study, we intend to compare the short-term outcomes of LS versus open operation (OP) for pCCA in a multicentric practice in China.
Methods
This real-world analysis included 645 pCCA patients receiving LS and OP at 11 participating centers in China between January 2013 and January 2019. A comparative analysis was performed before and after propensity score matching (PSM) in LS and OP groups, and within Bismuth subgroups. Univariate and multivariate models were performed to identify significant prognostic factors of adverse surgical outcomes and postoperative length of stay (LOS).
Results
Among 645 pCCAs, 256 received LS and 389 received OP. Reduced hepaticojejunostomy (30.89% vs 51.40%, P = 0.006), biliary plasty requirement (19.51% vs 40.16%, P = 0.001), shorter LOS (mean 14.32 vs 17.95 d, P < 0.001), and lower severe complication (CD ≥ III) (12.11% vs. 22.88%, P = 0.006) were observed in the LS group compared with the OP group. Major postoperative complications such as hemorrhage, biliary fistula, abdominal abscess, and hepatic insufficiency were similar between LS and OP (P > 0.05 for all). After PSM, the short-term outcomes of two surgical methods were similar, except for shorter LOS in LS compared with OP (mean 15.19 vs 18.48 d, P = 0.0007). A series subgroup analysis demonstrated that LS was safe and had advantages in shorting LOS.
Conclusion
Although the complex surgical procedures, LS generally seems to be safe and feasible for experienced surgeons.
Trial registration
NCT05402618 (date of first registration: 02/06/2022).
Funder
National Natural Science Foundation of China
Natural Science Foundation of Hubei Province
Tongji Hospital Science Fund for Distinguished Young Scholars
Tongji Hospital Clinical Research Flagship Program
National Key Research and Development Program of China
Publisher
Springer Science and Business Media LLC
Subject
Cancer Research,Genetics,Oncology