The Contrast Of Laparoscopic And Open Radical Resection Of Intrahepatic Cholangiocarcinoma

BackgroundIntrahepatic cholangiocarcinoma is the second most common primary liver cancer after hepatocellular carcinoma,with high invasiveness and poor prognosis.Early surgical treatment is the only effective treatment.The open surgery for radical resection of intrahepatic cholangiocarcinoma has become very mature,but due to the technical difficulties of laparoscopic surgery such as insufficient resection margin,difficulty in lymph node dissection,and massive intraoperative bleeding,the laparoscopic surgery for intrahepatic cholangiocarcinoma has not yet been widely promoted.Moreover,it is still highly controversial whether routine lymph node dissection should be performed during the radical resection of intrahepatic cholangiocarcinoma.ObjectiveEvaluate the safety of laparoscopic surgery and the necessity of lymph node dissection by comparing clinical data of patients undergoing laparoscopic and open radical resection of intrahepatic cholangiocarcinoma.MethodA retrospective analysis was conducted on the data of patients who underwent laparoscopic or open radical hepatectomy in our hospital from January 2017 to December 2022,with postoperative pathological diagnosis of intrahepatic cholangiocarcinoma.Among them,22 cases underwent laparoscopic radical resection of intrahepatic cholangiocarcinoma and 32 cases underwent open radical resection of intrahepatic cholangiocarcinoma.Collect data from two groups of patients,including:① preoperative age,gender,longest diameter of tumor,liver function grading,etiology,etc.;② During surgery:surgical time,intraoperative bleeding volume,number of intraoperative blood transfusions,whether lymph node dissection has been performed during surgery,etc.;③Postoperative:drainage time,exhaust time,hospital stay,incidence of complications,pathological type,etc.;④Prognosis:lymph node metastasis,postoperative survival status for six months and one year;⑤Laboratory indicators such as white blood cell count,hemoglobin count,platelet count,prothrombin time,and bilirubin level before and after treatment.A repeated measurement analysis of variance was used to compare the changes in experimental values before and after surgery between two groups of patients.Chi-square test,Fisher’s exact probability method,and t-test were used to compare the general and perioperative data of the two groups of patients.Cox regression analysis and Kaplan Meier method were used for postoperative survival analysis at six months and one year.ResultAll patients received surgical treatment smoothly.After propensity matching score,there was no significant difference in preoperative data between the two groups of patients in terms of gender,age,longest tumor diameter,liver function grading,and etiology(P>0.05).Comparison of perioperative data showed that there was no difference in surgical time,number of intraoperative blood transfusions,and lymph node dissection between the two groups of patients,while the intraoperative bleeding volume in the LLR group(313.18±322.599ml)was lower than that in the OLR group(628.13±552.405ml).Comparison of postoperative data showed that there was no difference in postoperative drainage time,postoperative period time,and incidence of complications between the two groups of patients,while the hospitalization time of patients in the LLR group(21.32 ±8.22 days)was shorter than that of patients in the OLR group(29.94±18.25 days).Prognostic data comparison showed that there was no difference in postoperative recurrence or metastasis between the two groups of patients,but the survival rate of the LLR group was better half a year and one year after surgery than that of the OLR group.The follow-up time for half a year(174.00±20.20 days)and one year(330.27±77.39 days)was longer than that of the OLR group.There was no difference in postoperative recurrence or metastasis between patients who underwent lymph node dissection and those who did not(P values>0.05).ConclusionCompared with open radical surgery for intrahepatic cholangiocarcinoma,laparoscopic radical surgery for intrahepatic cholangiocarcinoma reduces intraoperative bleeding and hospital stay,while maintaining a similar incidence of postoperative complications.It is a safe,feasible,and worthy of clinical promotion.Lymph node dissection should be carried out based on preoperative imaging indications for lymph node metastasis and the actual situation of lymph nodes during surgery.