Comparison Of Outcomes Between Open And Laparoscopic Liver Resection For Hilar Cholangiocarcinoma

Objective:To explore the feasibility of laparoscopic resection of hilar cholangiocarcinoma and provide clinical reference for clinicians.Methods:In the present study,the patients who underwent radical hepatectomy for hilar cholangiocarcinoma in the Affiliated Hospital of North Sichuan Medical College from 2015 to 2019 were studied,and the patients were grouped according to whether they underwent laparoscopic surgery.Results:A total of 58 patients were included in the final analysis.There were 20 patients(12 men)underwent laparoscopic surgery with an average age of 60,0±11.2 years old;38 patients(26 men)underwent laparotomy with an average age of 58.8±8.8 years old.Compared with the laparotomy group,the rate of pre-operative cholecystitis in the laparoscopic group was lower(0%vs 29.7%,p=0.023),while the incidence of hepatic artery invasion was higher(60.0%vs 27.3%,p=0.057),and the percentage of portal invasion was higher(78.6%vs 32.4%,p=0.003).The preoperative Bismuth-Corlette classification showed that the ratios of Ⅰ-Ⅱ,Ⅲ and Ⅳ in the laparoscopic group were 45%,40%and 15%,respectively,compared with 21.1%,36.8%and 42.1%in the laparotomy group;p=0.065.Regarding the AJCC TNM staging,type Ⅲ-Ⅳ in the laparoscopic group accounted for a higher proportion(80%vs 50%,p=0.028).In terms of degree of differentiation,the laparoscopic group was mainly medium differentiation(73.3%),while the laparotomy group was mainly high differentiation(43.8%);p=0.003.Compared with the laparotomy group,the amount of intraoperative hemorrhage in the laparoscopic group was lower(400ml vs 700ml,p=0.037),and the percentage of intraoperative blood transfusion in the laparoscopic group was also lower(45.0%vs 84.2%,p=0.002).There were no statistically differences in post resection status,blood vessel reconstruction,operation time,blood loss,postoperative blood transfusion,early recovery of motion,early enteral feeding,hospitalization time,and postoperative complications.Conclusion:1.Laparoscopic resection of hilar cholangiocarcinoma has the advantages of less trauma and less intraoperative bleeding than open surgery,yet with no significant difference found in short-term postoperative complications.2.Laparoscopic resection of hilar cholangiocarcinoma is safe and feasible under certain conditions and strictly standardized preoperative evaluation.