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      Minimally invasive surgery for perihilar cholangiocarcinoma: a systematic review

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          Abstract

          Minimally invasive surgery (MIS) is quickly becoming mainstream in hepato-pancreato-biliary surgery because of presumed advantages. Surgery for perihilar cholangiocarcinoma (PHC) is highly demanding which may hamper the feasibility and safety of MIS in this setting. This study aimed to systematically review the existing literature on MIS for PHC. A systematic literature review was performed according to the PRISMA statement. The PubMed and EMBASE databases were searched and all studies describing MIS in patients with PHC were included. Data extraction and risk of bias were assessed by two independent researchers. Overall, 21 studies reporting on a total of 142 MIS procedures for PHC were included. These included 82 laparoscopic, 59 robot-assisted and 1 hybrid procedure(s). Risk of bias was deemed substantial. Pooled conversion rate was 7/142 (4.9%), pooled morbidity 30/126 (23.8%), and pooled mortality rate 4/126 (3.2%). The only comparative study, comparing 10 robot-assisted procedures to 32 open procedures, reported a significant increased operative time and higher morbidity rate with MIS. The available evidence on MIS for PHC is limited and generally of poor quality. This systematic review shows that the implementation of MIS for patients with PHC is still in its infancy.

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          Evolution of surgical treatment for perihilar cholangiocarcinoma: a single-center 34-year review of 574 consecutive resections.

          Tsuyoshi Igami, Tomoki Ebata, Yuji Nimura … (2013)
          To review our 34-year experience with 574 consecutive resections for perihilar cholangiocarcinoma and to evaluate the progress made in surgical treatment of this disease. Few studies have reported improved surgical outcomes for perihilar cholangiocarcinoma; therefore, it is still unclear whether surgical treatment of this intractable disease has progressed. Between April 1977 and December 2010, a total of 754 consecutive patients with perihilar cholangiocarcinoma were treated, of whom 574 (76.1%) underwent resection. The medical records of these resected patients were retrospectively reviewed. The incidence of major hepatectomies has increased, and limited resections, including central hepatectomies and bile duct resections, were rarely performed. Combined vascular resection was being used more often. Operative time has become shorter, and intraoperative blood loss has also decreased significantly. Because of refinements in surgical techniques and perioperative management, morbidity decreased significantly but was still high, with a rate of 43.1% in the last 5 years. Mortality rate has also decreased significantly (P < 0.001) from 11.1% (8/72) before 1990 to 1.4% (3/218) in the last 5 years. The ratio of advanced disease defined as pStage IVA and IVB has increased significantly from 49.4% before 2000 to 61.4% after 2001. The disease-specific survival for the 574 study patients (including all deaths) was 44.3% at year 3, 32.5% at year 5, and 19.9% at year 10. The survival was significantly better in the later period of 2001 to 2010 than in the earlier period of 1977 to 2000 (38.1% vs 23.1% at year 5, P < 0.001). For pM0, R0, and pN0 patients (n = 243), the survival in the later period was good with 67.1% at year 5, which was significantly better than that of the earlier period (P < 0.001). For pM0, R0, and pN1 patients (n = 142), however, the survival in the later period was similar to that of the earlier period (22.1% vs 14.6% at year 5, P = 0.647). Multivariate analysis revealed that lymph node metastasis was the strongest prognostic indicator. Surgical treatment of perihilar cholangiocarcinoma has been evolving steadily, with expanded surgical indication, decreased mortality, and increased survival. Survival for R0 and pN0 patients was satisfactory, whereas survival for pN1 patients was still poor, suggesting that establishment of effective adjuvant chemotherapy is needed.
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            A nationwide study of conversion from laparoscopic to open cholecystectomy.

            Edward Livingston, R Rege (2004)
            To determine the national incidence and risk factors for conversion from laparoscopic to open cholecystectomy. Most series reporting the rates at which laparoscopic cholecystectomies are performed, relative to the open procedure, have come from centers specializing in laparoscopic surgery. The rates at which conversions occur from these centers may not reflect those in community practice. We sought to determine the actual, and therefore acceptable, conversion rate by examining nationally representative discharge data. The National Hospital Discharge database for 1998 to 2001 was acquired from the Centers for Disease Control. All gallbladder disease related admissions were extracted, and the cholecystectomies (ICD-9-CM codes 51.2X) were analyzed using the SAS package. Stepwise logistic regression was used to determine what factors were associated with the risk of conversion from laparoscopic to open cholecystectomy. Approximately 25% of all cholecystectomies are performed by the open technique. Of the remaining 75%, there is an approximately 5% to 10% conversion rate. The major risk factors for conversion included male sex, obesity, and cholecystitis. Concurrent choledocholithiasis, cholelithiasis, and cholecystitis were associated with a conversion rate of 25%. Length of stay (LOS) was reduced for laparoscopic operations and although conversion added 2 to 3 days to the LOS, for most cases the LOS was still less than for primary open operations. Three quarters of all cholecystectomies are performed laparoscopically, and the national conversion rate is 5% to 10%. Cholecystitis, choledocholithiasis, male sex, and obesity are major predictors for conversion. The data presented in terms of conversion rates and LOS were derived from population-adjusted hospital discharge data and represent the current U.S. experience for cholecystectomy. From these data the community experience for conversion rates, risk factors, and LOS can be derived. Copyright 2004 Excerpta Medica, Inc.
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              Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data

              Takeo Nomi, John Primrose, Luca Antonio Aldrighetti … (2018)
              Article 0 comments Cited 57 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                L. C. Franken:
                ORCID: http://orcid.org/0000-0002-2154-4571
                l.c.franken@amc.nl
                T. M. van Gulik: t.m.vangulik@amc.nl
                Journal
                Journal ID (nlm-ta): J Robot Surg
                Journal ID (iso-abbrev): J Robot Surg
                Title: Journal of Robotic Surgery
                Publisher: Springer London (London )
                ISSN (Print): 1863-2483
                ISSN (Electronic): 1863-2491
                Publication date (Electronic): 2 May 2019
                Publication date PMC-release: 2 May 2019
                Publication date (Print): 2019
                Volume: 13
                Issue: 6
                Pages: 717-727
                Affiliations
                GRID grid.7177.6, ISNI 0000000084992262, Department of Surgery, , Cancer Center Amsterdam, Amsterdam, UMC, University of Amsterdam, ; Amsterdam, The Netherlands
                Author information
                http://orcid.org/0000-0002-2154-4571
                Article
                Publisher ID: 964
                DOI: 10.1007/s11701-019-00964-9
                PMC ID: 6842355
                PubMed ID: 31049774
                SO-VID: 069f2c0e-475c-4b5c-b23a-3929beaf3671
                Copyright © © The Author(s) 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 3 January 2019
                Date accepted : 13 April 2019
                Categories
                Subject: Review Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag London Ltd., part of Springer Nature 2019

                ScienceOpen disciplines: Surgery
                Keywords: perihilar cholangiocarcinoma,minimally invasive surgery,systematic review
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: perihilar cholangiocarcinoma, minimally invasive surgery, systematic review

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