Tingting Qin1, Min Wang1, Hang Zhang1, Jingdong Li2, Xiaxing Deng3, Yuhua Zhang4, Wenxing Zhao5, Ying Fan6, Dewei Li7, Xuemin Chen8, Yechen Feng1, Siwei Zhu9, Zhongqiang Xing10, Guangsheng Yu11, Jian Xu2, Junjie Xie3, Changwei Dou4, Hongqin Ma5, Gangshan Liu6, Yue Shao7, Weibo Chen8, Simiao Xu12, Jun Liu13, Jianhua Liu14, Xinmin Yin15, Renyi Qin16. 1. Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. 2. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Hepatobiliary, Pancreatic and Intestinal Diseases Research Institute of North Sichuan Medical College, Nanchong, China. 3. Department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. 4. Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310003, China. 5. Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University Xuzhou, Jiangsu, China. 6. Department of the Second General Surgery, Sheng Jing Hospital of China Medical University, Liaoning, China. 7. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China. 8. Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Suzhou, China. 9. Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China. 10. Department of Hepato-Pancreato-Biliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China. 11. Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shangdong, China. 12. Department of Endocrinology, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 13. Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shangdong, China. dr_liujun1967@126.com. 14. Department of Hepato-Pancreato-Biliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China. ljh@medmail.com.cn. 15. Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China. 13319587618@163.com. 16. Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. ryqin@tjh.tjmu.edu.cn.
Abstract
OBJECTIVE: The aim of this study was to compare the short- and long-term outcomes of laparoscopic surgery (LS) and open surgery (OP) for perihilar cholangiocarcinoma (PHC) using a large real-world dataset in China. METHODS: Data of patients with PHC who underwent LS and OP from January 2013 to October 2018, across 10 centers in China, were extracted from medical records. A comparative analysis was performed before and after propensity score matching (PSM) in the LS and OP groups and within the study subgroups. The Cox proportional hazards mixed-effects model was applied to estimate the risk factors for mortality, with center and year of operation as random effects. RESULTS: A total of 467 patients with PHC were included, of whom 161 underwent LS and 306 underwent OP. Postoperative morbidity, such as hemorrhage, biliary fistula, abdominal abscess, and hepatic insufficiency, was similar between the LS and OP groups. The median overall survival (OS) was longer in the LS group than in the OP group (NA vs. 22 months; hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.02-1.39, p = 0.024). Among the matched datasets, OS was comparable between the LS and OP groups (NA vs. 35 months; HR 0.99, 95% CI 0.77-1.26, p = 0.915). The mixed-effect model identified that the surgical method was not associated with long-term outcomes and that LS and OP provided similar oncological outcomes. CONCLUSIONS: Considering the comparable long-term prognosis and short-term outcomes of LS and OP, LS could be a technically feasible surgical method for PHC patients with all Bismuth-Corlett types of PHC.
OBJECTIVE: The aim of this study was to compare the short- and long-term outcomes of laparoscopic surgery (LS) and open surgery (OP) for perihilar cholangiocarcinoma (PHC) using a large real-world dataset in China. METHODS: Data of patients with PHC who underwent LS and OP from January 2013 to October 2018, across 10 centers in China, were extracted from medical records. A comparative analysis was performed before and after propensity score matching (PSM) in the LS and OP groups and within the study subgroups. The Cox proportional hazards mixed-effects model was applied to estimate the risk factors for mortality, with center and year of operation as random effects. RESULTS: A total of 467 patients with PHC were included, of whom 161 underwent LS and 306 underwent OP. Postoperative morbidity, such as hemorrhage, biliary fistula, abdominal abscess, and hepatic insufficiency, was similar between the LS and OP groups. The median overall survival (OS) was longer in the LS group than in the OP group (NA vs. 22 months; hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.02-1.39, p = 0.024). Among the matched datasets, OS was comparable between the LS and OP groups (NA vs. 35 months; HR 0.99, 95% CI 0.77-1.26, p = 0.915). The mixed-effect model identified that the surgical method was not associated with long-term outcomes and that LS and OP provided similar oncological outcomes. CONCLUSIONS: Considering the comparable long-term prognosis and short-term outcomes of LS and OP, LS could be a technically feasible surgical method for PHC patients with all Bismuth-Corlett types of PHC.
Authors: P Neuhaus; S Jonas; W O Bechstein; R Lohmann; C Radke; N Kling; C Wex; H Lobeck; R Hintze Journal: Ann Surg Date: 1999-12 Impact factor: 12.969
Authors: Cecilia G Ethun; Alexandra G Lopez-Aguiar; Douglas J Anderson; Andrew B Adams; Ryan C Fields; Maria B Doyle; William C Chapman; Bradley A Krasnick; Sharon M Weber; Joshua D Mezrich; Ahmed Salem; Timothy M Pawlik; George Poultsides; Thuy B Tran; Kamran Idrees; Chelsea A Isom; Robert C G Martin; Charles R Scoggins; Perry Shen; Harveshp D Mogal; Carl Schmidt; Eliza Beal; Ioannis Hatzaras; Rivfka Shenoy; Kenneth Cardona; Shishir K Maithel Journal: Ann Surg Date: 2018-05 Impact factor: 12.969
Authors: Bas Groot Koerkamp; Jimme K Wiggers; Peter J Allen; Marc G Besselink; Leslie H Blumgart; Olivier R C Busch; Robert J Coelen; Michael I D'Angelica; Ronald P DeMatteo; Dirk J Gouma; T Peter Kingham; William R Jarnagin; Thomas M van Gulik Journal: J Am Coll Surg Date: 2015-09-15 Impact factor: 6.113