| Background and purpose:Hilar Cholangiocarcinoma(HCCA),also known as Klatskin tumor,is the most common malignant tumor of the biliary system.Radical resection is the main treatment for patients to achieve long-term survival.It has been reported that the 5-year survival rate of HCCA patients who have received R0 resection(no tumor residue under the microscope)is 10-40%,which is significantly higher than that of patients who have not received R0 resection.In recent years,with the continuous progress of endoscopic technology,hepatobiliary surgeons began to try to apply laparoscopic technology in the radical resection of HCCA,in order to reduce the pain of patients,speed up the recovery of patients without reducing the safety and effectiveness of the operation and shorten the postoperative hospital stay.Because of laparoscopic radical resection of hilar cholangiocarcinoma is extremely difficult,now only a few large minimally invasive center are exploring this operation and the reports are few.This study aims to explore the safety and feasibility of laparoscopic radical resection for hilar cholangiocarcinoma in order to guide clinical practice.Methods:The method of this study is retrospective analysis statistics.Adopt 92 patients who diagnoses of HCCA between April 2018 and December 2021 in our hospital.According to the operation method divided the patients into two groups: laparoscopy group(A group)and laparotomy group(B group).Compared the age,sex,basic diseases,CA19-9,international standard ratio(INR),leukocyte,albumin,total bilirubin,whether percutaneous biliary drainage,operation time,intraoperative blood loss,bilioenteroanastomosis time,complication rate,feeding time,out of bed time and analgesia time of A and laparotomy group.Data follow-up methods: telephone or outpatient follow-up,the deadline of follow-up was January 2022.SPSS21.0 was used for statistical analysis.Results:A total of 92 patients were included in this study.There were 33 patients in the A group,including20 males and 13 females,the mean age was 60.8±6.9 years old.There were 59 patients in the B group,including 31 males and 28 females,the mean age was 63.0±7.1 years old.The difference were not statistically significant(all P>0.05).Among the 33 patients in the A group,11 were Bismuth Ⅰ type,7 were Bismuth Ⅱ type,11 were Bismuth Ⅲ type and 4 were Bismuth Ⅳ type.Among the 59 patients in the B group,there were 10 cases of Bismuth Ⅰ type,17 cases of Bismuth Ⅱ type,23 cases of Bismuth Ⅲ type and9 cases of Bismuth Ⅳ type.There was no statistical significance between the two groups(P=0.349).There was no significant difference in preoperative general data,such as leukocyte,albumin,total bilirubin and whether percutaneous biliary drainage,et all(all P>0.05).The comparison of intraoperative data between the two groups showed that the operation time of the A group was 355.0(117.5)min longer than that of the B group 300.0(110.0)min,the difference was statistically significant(P<0.0001).The bilioenteroanastomosis time of the A group was 18.1±2.7 min longer than that of the B group(15.1±2.2 min),the difference was statistically significant(P<0.0001).The intraoperative blood loss in the A group was 300.0(150.0)ml and 6 patients received intraoperative blood transfusion,and the intraoperative blood loss in the B group was 400.0(400.0)ml and 16 patients received intraoperative blood transfusion,the difference was not statistically significant(all P>0.05).Postoperative pathology indicated that there were 11,16 and 6 cases of well-differentiated,medium-differentiated and poorly differentiated tumors in the A group,respectively;in the B group,there were 17,27 and 15 cases of well-differentiated,medium-differentiated tumors,and poorly differentiated tumors,respectively.The difference was not statistically significant(P=0.718).In the A group,there were 8,12,11 and 2 patients with TNM stage Ⅰ,Ⅱ,Ⅲ and Ⅳ state,respectively;in the B group,there were 13,27,15 and 4 patients with TNM Ⅰ,Ⅱ,Ⅲ and Ⅳ stage respectively,the difference was not statistically significant(P=0.797).The number of lymph nodes removed during operation was 10(2)in the A group and9(1)in the B group,with no statistically significant difference between the two groups(P=0.264).In the A group,R0 incisional margin was obtained immediately after primary resection in 28 patients,and R0 incisional margin was obtained after secondary resection in 3 patients.In the B group,45 patients received R0 incisional margin immediately after primary resection,and 7 patients received R0 incisional margin after secondary resection.There was no statistical significance between the two groups(all P>0.05).The incidence of total complications in the A group was 24.2%,which showed no statistical significance compared with 25.4% in the B group(P=0.900).In the A group,biliary fistula was found in 2patients,postoperative hepatic insufficiency occurred in 1 patient,postoperative abdominal bleeding occurred in 1 patient,postoperative abdominal infection occurred in 2 patients,2 patients had pulmonary infection;In the B group,4 patients had postoperative incision infection,biliary fistula was found in 3patients,postoperative hepatic insufficiency occurred in 1 patient,postoperative abdominal bleeding occurred in 2 patients,postoperative abdominal infection occurred in 4 patients,1 patient with pulmonary infection.There are no significant difference in the incidence of complications between the two groups(all P>0.05).The time of postoperative hospital stay was 12.0(3.0)d in the A group and 15.0(4.0)d in the B group,the difference was statistically significant(P<0.0001).The duration of postoperative analgesia time,postoperative bed time and intake time in the A group was [4.0(1.0)d,3.0(1.0)d,and 4(2.0)d].The duration of postoperative analgesia time,postoperative bed time and intake time in the B group was[6.0(2.0)d,5.0(1.0)d and 5.0(1.0)d],the difference was statistically significant(all P<0.05).The deadline for follow-up was January 2022.The 1-year and 2-year cumulative survival rates in group A were 85% and 70% respectively,and those in group B were 86% and 61% respectively.There was no significant difference between the groups(P=0.344).Conclusion:For patients who meet the indications,laparoscopic radical resection of hilar cholangiocarcinoma is safe and feasible,which can advance the postoperative feeding time,analgesia time,and time to get out of bed,shorten the postoperative hospitalization time of patients,and has certain advantages in speeding up the recovery speed of patients. |
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