Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2021; 13(12): 2203-2215
Published online Dec 15, 2021. doi: 10.4251/wjgo.v13.i12.2203
Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma: A systematic review
Renato Patrone, Francesco Izzo, Raffaele Palaia, Vincenza Granata, Guglielmo Nasti, Alessandro Ottaiano, Gilda Pasta, Andrea Belli
Renato Patrone, PhD ICTH, University of Naples Federico II, Naples 80100, Italy
Francesco Izzo, Raffaele Palaia, Andrea Belli, Department of Abdominal Oncology, Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples 80131, Italy
Vincenza Granata, Division of Radiology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples 80131, Italy
Guglielmo Nasti, Alessandro Ottaiano, SSD-Innovative Therapies for Abdominal Metastases, Clinical and Experimental Abdominal Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples 80131, Italy
Gilda Pasta, Division of Anesthesia, Pain medicine and Supportive Care, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Naples 80131, Italy
Author contributions: All authors contributed significantly to the present research and reviewed the entire manuscript. Patrone R and Belli A participated substantially in the conception, design and execution of the study and in the analysis and interpretation of the data; they also participated substantially in the drafting and editing of the manuscript; Izzo F, Palaia R, Granata V, Nasti G, Ottaiano A and Pasta G participated substantially in the conception, design and execution of the study and in the review of the data.
Conflict-of-interest statement: Authors have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Andrea Belli, MD, Postdoc, Surgeon, Department of Abdominal Oncology, Division of Hepatobiliary Surgical Oncology, Istituto Nazionale Tumori, Fondazione G. Pascale, IRCCS, Via Mariano Semmola, Naples 80131, Italy. a.belli@istitutotumori.na.it
Received: March 23, 2021
Peer-review started: March 23, 2021
First decision: May 3, 2021
Revised: May 30, 2021
Accepted: October 31, 2021
Article in press: October 31, 2021
Published online: December 15, 2021
Processing time: 266 Days and 6 Hours
Abstract
BACKGROUND

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer and is characterized by an aggressive behavior and a dismal prognosis. Radical surgical resection represents the only potentially curative treatment. Despite the increasing acceptance of laparoscopic liver resection for surgical treatment of malignant liver diseases, its use for ICC is not commonly performed. In fact, to achieve surgical free margins a major resection and/or vascular and/or biliary reconstructions is often needed, as well as an associated lymph node dissection.

AIM

To review and summarize the current evidences on the minimally invasive resection of ICC.

METHODS

A systematic review of the literature based on the criteria predetermined by the investigators was performed from the 1st of January 2009 up to the 1st of January 2021 in 4 databases (PubMed, Scopus, Google Scholar, and Cochrane databases). All retrospective and prospective studies reporting on the comparative outcomes of open vs minimally invasive treatment of ICC were included. An evaluation of manuscripts quality was achieved using Methodological Index for Non-Randomized Studies criteria and Newcastle-Ottawa Scale.

RESULTS

After a systematic search 9 studies fulfilled the inclusion criteria. Among the all 3012 included patients, 2450 were operated by an open approach and 562 by a minimally invasive (laparoscopic) approach. Baseline characteristics, tumor characteristics, surgical outcomes and oncological outcomes were collected and analyzed, highlighting values with a statistical significant difference between patients treated with open or laparoscopic approach. Shorter hospital stay and lower intraoperative blood losses were reported by some Authors in minimally invasive surgery, on the contrary, in the open group there was a higher number of lymphadenectomies and a higher percentage of major hepatectomies.

CONCLUSION

Minimally invasive resection of ICC has some short-term benefits and it is safe and feasible only in selected centers with a high experience in laparoscopic approach for liver surgery. Minimally invasive surgery, actually, was considered mainly in patients with a tumor with a diameter < 5 cm, without invasion of main biliary duct or main vessel and no vascular or biliary reconstructions were planned. Further studies are needed to elucidate its impact on long term oncologic outcomes.

Keywords: Cholangiocarcinoma, Minimally invasive, Laparoscopic, Liver resection, Hepatectomy, Biliary neoplasm

Core Tip: Reports on the minimally invasive treatment of intrahepatic cholanciocarcinoma are scanty and no clear evidences on the feasibility, safety and oncological results are currently available. The aim of our study is to review and summarize the current evidences on the topic and to compare the short and long term outcomes to those of open surgical resection.