Short- and long-term outcomes of laparoscopic versus open resection of perihilar cholangiocarcinoma: a propensity score-based analysis

Background: Laparoscopic resection (LR) of perihilar cholangiocarcinoma (pCCA) is still in the exploratory stage due to its exacting technical requirements, and its feasibility remains controversial. The objective of this study was to compare the short- and long-term outcomes of LR and open resection (OR) of pCCA. Methods: This study analyzed the data of pCCA patients who underwent LR or OR from January 2012 to January 2020 at Southwest Hospital. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were used to balance the baseline characteristics between the LR and OR groups. The short- and long-term outcomes were compared between the LR and OR groups. Results: Forty-five patients in the LR group and 243 in the OR group were analyzed. After IPTW and PSM, the amount of intraoperative blood loss, incidence of surgical site infections (SSIs), length of stay (LOS), and number of perioperative blood transfusions (PBTs) were significantly lower in the LR group than in the OR group (after IPTW: P<0.001, P=0.009, P=0.01, P<0.001 respectively; after PSM: P<0.001, P=0.003, P=0.03, P=0.04 respectively). Only after IPTW was the 30-day mortality rate significantly lower in the LR group than in the OR group (P=0.005). There was no significant difference in overall survival (OS) or recurrence-free survival (RFS) between the two groups after IPTW or PSM. Conclusions: LR of pCCA is an achievable procedure whose long-term outcomes are similar to those of OR, and LR outperforms OR in short-term outcomes such as intraoperative blood loss, SSI, LOS, 30-day mortality, and PBTs. It is believed that it is safe and feasible to treat pCCA with LR after rigorous patient selection.