Comparison Of Efficacy And Safety Between Laparoscopic And Open Radical Resection For Hilar Cholangiocarcinoma

Objective: The aim of this study was to compare the perioperative results and recent clinical outcomes of laparoscopic radical resection of hilar cholangiocarcinoma and open radical resection of hilar cholangiocarcinoma(LRRHC and ORRHC),to further evaluate the feasibility and safety of LRRHC,and to provide support for promoting the clinical application of LRRHC.Methods: A retrospective study included 103 patients undergoing HCCA radical resection in the People’s Hospital of Henan University from January 2017 to December 2021.Based on the different surgical approaches taken,50 patients were divided into the laparoscopic surgery group and 53 patients in the open surgery group and the differences between the two groups were compared in terms of preoperative general data,intraoperative data,postoperative data,postoperative oncological outcomes,and follow-up survival.Results:(1)Preoperative general data: There were no statistically significant differences between the two groups in age,gender,total bilirubin,tumor markers,bile duct drainage,combined underlying diseases,Bismuth type and Child-Pugh classification(all P > 0.05).(2)Intraoperative data: the operative time was longer in the laparoscopic surgery group 400(144)min than in the open surgery group 325(124)min,with statistically significant differences(P < 0.01).Intraoperative bleeding was 200.00(700.00)ml in the laparoscopic surgery group and 300.00(400.00)ml in the open surgery group,and the difference between the two groups was not yet statistically significant(P > 0.05).The intraoperative blood transfusion rate was 38.00%(19/50)in the laparoscopic surgery group and 49.06%(26/53)in the open surgery group,and the difference between the two groups was not yet statistically significant(P > 0.05).(3)Comparison of postoperative complications: The overall complication rate in the laparoscopic surgery group was36.00%,including 1 cases of biliary fistula,3 cases of postoperative bleeding,13 cases of pulmonary infection,6 cases of abdominal infection and 12 cases of incisional infection.While the overall complication rate in the open surgery group was 30.68%,including 2 cases of upper gastrointestinal bleeding,3 cases of biliary fistula,8 cases of postoperative bleeding,16 cases of pulmonary infection,18 cases of abdominal infection and 18 cases of incisional infection.The difference in the incidence of postoperative complications between the two groups except abdominal infection was not statistically significant.(4)Postoperative recovery: the postoperative first exhaust time was 1(1)d vs.4(2)d,the postoperative oral feeding time was 3(1)d vs.4(2)d,the time to getting out of bed after surgery was 3(1)d vs.4(2)days,laparoscopic surgery were shorter than those in the open group,and the differences were statistically significant(P < 0.01).The hospitalization time was 18(2)d vs.23(2)d in the two groups,and the differences were statistically significant(P > 0.05).(5)Postoperative oncological results: There was no difference in the degrees of pathological differentiation and TNM staging、venous invasion and lymph node metastasis between the remaining two groups(all P >0.05).The deadline for follow-up was June 2022.The 1-year and 2-year cumulative survival rates in the laparoscopic surgery group were 82%and 65% respectively,and those in the open group were 84% and 64% respectively.There was no significant difference between the groups(P>0.05).Conclusion:For patients who meet the indications,Laparoscopic radical resection of HCCA has comparable perioperative safety compared to open surgery group,which can achieve clinical efficacy no less than open surgery.Laparoscopic radical resection of HCCA can advance the postoperative first exhaust time,the postoperative oral feeding time and time to get out of bed,and has certain advantages in promoting rapid recovery of patients.