Bismuth Ⅲ、Ⅳ Type Of Hilar Cholangiocarcinoma:A Comparative Study Of Laparoscopic And Open Radical Surgery

【Objective】: To explore the safety and feasibility of laparoscopic radical resection for Bismuth III and IV type of hilar cholangiocarcinoma,and to provide objective basis for its clinical application.【 Methods 】 : According to the inclusion and exclusion criteria,clinical data of 50 patients with bismuth III and IV type of hilar cholangiocarcinoma who underwent radical resection in Hunan Provincial People’s Hospital(the First Affiliated Hospital of Hunan Normal University)from January 2017 to January 2020 were collected.There were 15 cases in the endoscopic group,35 cases in the open group.The preoperative general information(gender,age,BMI,ASA grade,ALB,TBi L,CA19-9),intraoperative situation(operation time,blood loss,blood transfusion rate,hepatectomy scope),surgical margin,number of lymph node dissection,tumor size,postoperative hospital stay,postoperative complications were compared between the two groups Recent complications(bile leakage,bleeding,liver failure,abdominal infection,intestinal fistula),perioperative mortality and the incidence of severe complications(severe complications according to Clavien Dindo classification ≥ 3),and 1-year survival rate were followed up.Analyze and discuss the safety and short-term efficacy of laparoscopic radical surgery.【Results】: All the 50 patients successfully completed radical operation,(laparoscopic vs laparotomy): long operation time [(394.00±35.82min)vs(339.71±33.39min),P=0.001],less intraoperative blood loss[(239.33±116.77ml)vs(403.43±140.29ml),P=0.001],short postoperative hospital stay [(12.10 ±4.05d)vs(16.70 ±5.06d),P=0.003],tumor diameter [(3.33 ±1.20cm)vs(3.044± 0.71 cm),P=0.391].The number of intraoperative lymph node dissection[(9.20±1.97)vs(9.46±1.52),P=0.619],the number of positive lymph nodes[(0.60±0.83)vs(0.49±0.85),P=0.663].Comparison between laparoscopy group and laparotomy group: the intraoperative blood transfusion rate was 13.3% and 11.4%(P = 0.851).The postoperative bile leakage rates were 13.3% and 11.4%(P = 0.849).Postoperative bleeding was 13.3% and 8.6%(P = 0.615).The abdominal infection rates were13.3% and 14.3%(P = 0.929).The complications of Clavien grade ≥ III grade were 2 cases(13.3%)and 3 cases(8.6%)respectively(P = 0.615).There were no intestinal fistula,liver failure,reoperation during hospitalization and perioperative death in the two groups.There was no significant difference in postoperative 1-year survival rate(86.7% vs85.7%).【Conclusion】:1.Total laparoscopic radical surgery for Bismuth III and IV HCCA has the advantages of less intraoperative blood loss and shorter postoperative hospital stay,there is no significant difference in lymph node dissection,postoperative complications,radical resection and short-term efficacy compared with open surgery.2.Under the premise of reasonable select patients and adequate preoperative evaluation,following the principle of radical resection for hilar cholangiocarcinoma,laparoscopic radical resection for Bismuth III and IV type of hilar cholangiocarcinoma in the center with rich laparoscopic experience is safe and feasible,which is worthy of further exploration and development.