Biliary Tract Cancers: Is Laparoscopic Liver Resection Adequate?

2022 Year in Review: Cholangiocarcinoma — January 4, 2023

The safety and adequacy of laparoscopic liver surgery has not been well established in biliary tract cancers. An institutional retrospective matched cohort study identified patients in the Mayo Clinic’s institutional database who underwent laparoscopic versus open surgery and compared clinical operative and postoperative variables. Results from this study were shared at the 2022 International Hepato-Pancreato-Biliary Association World Congress.

A total of 87 patients were identified; 33 underwent laparoscopic surgery and 54 underwent open resection. The patients who underwent laparoscopic resections had significantly less blood loss, higher negative-margin resection rates, shorter length of stay, and lower number of harvested lymph nodes, and these patients were less likely to have major liver resection. There were no between-group differences in procedural time, tumor size, severe postoperative complications, need for adjuvant chemotherapy, or need for readmission.

The researchers concluded that “laparoscopic liver resections for GBC and iCCA are safe and appear to have at least some short-term benefits with appropriate patient selection and when these procedures are done by a high volume, experienced center. They also do not compromise any of the oncologic outcomes.”

Flavio Rocha, MD, FACS, FSSP, Physician-in-Chief of the Knight Cancer Institute, noted that these results were hypothesis-generating: “I do think the shorter operative procedures can certainly help patients get onto adjuvant therapy quicker, which we know ultimately is what they need to control micrometastatic disease after surgery.”

Source: Pery R, Starlinger P, Fiorentini G, et al. Laparoscopic versus open liver resections for gallbladder cancer and intrahepatic cholangiocarcinoma: the Mayo Clinic experience. International Hepato-Pancreato-Biliary Association World Congress 2022. Abstract FP10-5.

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