Laparoscopic Liver Resection for Small, Solitary, Peripheral-Type Intrahepatic Cholangiocarcinoma, Based on Preoperative Prediction of Lymph Node Metastasis

Aim: Laparoscopic liver resection (LLR) for intrahepatic cholangiocarcinoma (ICC) is not as widespread as LLR for hepatocellular carcinoma or liver metastasis, mainly because ICC may require a lymph node dissection (LND). However, small, solitary, peripheral-type ICC rarely have lymph node metastasis (LNM). The aim of the current study is to examine the usefulness of LLR for ICC and determine whether our criteria for applying LLR without LND to small, solitary, peripheral-type ICC was appropriate. Methods: We retrospectively selected 78 patients that underwent liver resections for ICC at Osaka University Hospital between 2003 and 2020. We compared LLR (n = 13) to open liver resection (OLR, n = 65) for short-term and long-term outcomes. We also analyzed a subgroup (n = 29) with small, solitary, peripheral-type ICC. Results: The LLR group had less blood loss (P < .001), shorter postoperative stays (P < .001), and significantly higher 5-year recurrence-free survival (RFS, 74.0%), compared to the OLR group (29.6%, P = .030). However, the OLR group included a higher proportion of patients with advanced ICC. Among patients with small, solitary, peripheral-type ICC, LLR (n = 10) was associated with less blood loss (P = .004) and shorter postoperative stays (P = .002), compared to OLR (n = 19). These groups had similar pathological findings, similar 5-year RFS (75.0% versus 56.8%; P = .433), and similar 5-year overall survival (75.0% versus 80.4%; P = .530). No patients that underwent LLR without LND for ICC experienced lymph node recurrence. Conclusions: Among patients with ICC, LLR provided better intraoperative and short-term outcomes than OLR, and comparable oncological outcomes. Furthermore, no patients that underwent LLR without LND for ICC experienced lymph node recurrence. LLR without LND for ICC can be performed safely and feasibly by selecting patients with small, solitary, peripheral-type ICC.