Does Surgical Approach Influence Benchmark Attainment in Intrahepatic Cholangiocarcinoma?

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Intrahepatic cholangiocarcinoma (ICC) is a rare cancer with increasing incidence and poor prognosis.
• Surgical resection is the only curative treatment, with outcomes dependent on achieving R0 margins and lymphadenectomy (LND).
• Open liver resection (OLR) is standard, but laparoscopic (LLR) and robotic liver resection (RLR) are gaining traction, raising questions about their oncologic adequacy.

Purpose of the Study:

• To evaluate the association between achieving composite surgical benchmarks (R0 resection + LND) and short-term/long-term outcomes in ICC resection.
• To stratify these outcomes based on the surgical approach: OLR, LLR, and RLR.

Main Methods:

• A retrospective analysis of 240 patients undergoing ICC resection between 2010 and 2024.
• Primary endpoint: achievement of both R0 resection and LND.
• Secondary endpoints: 90-day mortality, overall survival (OS), and disease-free survival (DFS).

Main Results:

• 38.8% of patients met the R0 + LND benchmark, with significant variation by approach (OLR: 51.1%, RLR: 44.4%, LLR: 14.5%; p < 0.001).
• 90-day mortality was 5.0% overall, with no significant difference between approaches (p = 0.219).
• One- and 3-year OS rates were 79%/30% (OLR), 95%/89% (LLR), and 90%/81% (RLR) (p < 0.001). LLR was independently protective (HR=0.15, p<0.001).

Conclusions:

• While OLR and RLR more frequently achieved oncological benchmarks, LLR demonstrated independent association with improved overall survival.
• This suggests a potential disconnect between adherence to surgical benchmarks and actual long-term oncologic outcomes in ICC.
• Further research is needed to reconcile benchmark attainment with survival benefits across different surgical modalities for ICC.