Laparoscopic Approach to Intrahepatic Cholangiocarcinoma is Associated with an Exacerbation of Inadequate Nodal Staging

Sean P. Martin, Justin Drake, Michael M. Wach, Samantha Ruff, Laurence P. Diggs, Jim Wan, Zachary J. Brown, Reed I. Ayabe, Evan Glazer, Paxton V. Dickson, Jeremy L. Davis, Jeremiah Deneve, Jonathan M. Hernandez

Research output: Contribution to journalArticle

Abstract

Introduction: Laparoscopic approach to liver resection is feasible and safe, though its utilization with intrahepatic cholangiocarcinoma (ICC) remains poorly documented. We sought to evaluate the use laparoscopy for ICC, and to examine adherence to oncologic standards. Methods: The National Cancer Database was queried for patients who underwent resection for ICC. Patients were stratified by laparoscopic (LLR) versus open liver resection (OLR). Clinicopathologic parameters and hospital volumes were recorded. Results: In total, 2309 patients with ICC underwent hepatic resection (1997 OLR, 312 LLR) between 2010 and 2015. LLR increased from 12 to 16% during the study period and was utilized more commonly than OLR for wedge and segmental resections (56% vs. 33%, p < 0.001). Nodal evaluation was performed in 58% of all patients with ICC and was significantly more common in patients undergoing OLR (61%, n = 1210) versus LLR (39%, n = 120), p < 0.001. Of the 120 patients undergoing LLR with any nodal evaluation, 31% (n = 37) had a single node evaluated. Patients who underwent LLR were less likely to have ≥ 6 lymph nodes evaluated compared with those who underwent OLR (9% vs. 15%, respectively, p < 0.001). Conclusions: The use of laparoscopy for ICC is associated with an exacerbation of inadequate nodal evaluation compared with open resections.

Original languageEnglish (US)
JournalAnnals of Surgical Oncology
DOIs
StatePublished - Jan 1 2019

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Cholangiocarcinoma
Liver
Laparoscopy
Lymph Nodes
Databases
Neoplasms

All Science Journal Classification (ASJC) codes

  • Surgery
  • Oncology

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Laparoscopic Approach to Intrahepatic Cholangiocarcinoma is Associated with an Exacerbation of Inadequate Nodal Staging. / Martin, Sean P.; Drake, Justin; Wach, Michael M.; Ruff, Samantha; Diggs, Laurence P.; Wan, Jim; Brown, Zachary J.; Ayabe, Reed I.; Glazer, Evan; Dickson, Paxton V.; Davis, Jeremy L.; Deneve, Jeremiah; Hernandez, Jonathan M.

In: Annals of Surgical Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Martin, Sean P. ; Drake, Justin ; Wach, Michael M. ; Ruff, Samantha ; Diggs, Laurence P. ; Wan, Jim ; Brown, Zachary J. ; Ayabe, Reed I. ; Glazer, Evan ; Dickson, Paxton V. ; Davis, Jeremy L. ; Deneve, Jeremiah ; Hernandez, Jonathan M. / Laparoscopic Approach to Intrahepatic Cholangiocarcinoma is Associated with an Exacerbation of Inadequate Nodal Staging. In: Annals of Surgical Oncology. 2019.
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title = "Laparoscopic Approach to Intrahepatic Cholangiocarcinoma is Associated with an Exacerbation of Inadequate Nodal Staging",
abstract = "Introduction: Laparoscopic approach to liver resection is feasible and safe, though its utilization with intrahepatic cholangiocarcinoma (ICC) remains poorly documented. We sought to evaluate the use laparoscopy for ICC, and to examine adherence to oncologic standards. Methods: The National Cancer Database was queried for patients who underwent resection for ICC. Patients were stratified by laparoscopic (LLR) versus open liver resection (OLR). Clinicopathologic parameters and hospital volumes were recorded. Results: In total, 2309 patients with ICC underwent hepatic resection (1997 OLR, 312 LLR) between 2010 and 2015. LLR increased from 12 to 16{\%} during the study period and was utilized more commonly than OLR for wedge and segmental resections (56{\%} vs. 33{\%}, p < 0.001). Nodal evaluation was performed in 58{\%} of all patients with ICC and was significantly more common in patients undergoing OLR (61{\%}, n = 1210) versus LLR (39{\%}, n = 120), p < 0.001. Of the 120 patients undergoing LLR with any nodal evaluation, 31{\%} (n = 37) had a single node evaluated. Patients who underwent LLR were less likely to have ≥ 6 lymph nodes evaluated compared with those who underwent OLR (9{\%} vs. 15{\%}, respectively, p < 0.001). Conclusions: The use of laparoscopy for ICC is associated with an exacerbation of inadequate nodal evaluation compared with open resections.",
author = "Martin, {Sean P.} and Justin Drake and Wach, {Michael M.} and Samantha Ruff and Diggs, {Laurence P.} and Jim Wan and Brown, {Zachary J.} and Ayabe, {Reed I.} and Evan Glazer and Dickson, {Paxton V.} and Davis, {Jeremy L.} and Jeremiah Deneve and Hernandez, {Jonathan M.}",
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AU - Martin, Sean P.

AU - Drake, Justin

AU - Wach, Michael M.

AU - Ruff, Samantha

AU - Diggs, Laurence P.

AU - Wan, Jim

AU - Brown, Zachary J.

AU - Ayabe, Reed I.

AU - Glazer, Evan

AU - Dickson, Paxton V.

AU - Davis, Jeremy L.

AU - Deneve, Jeremiah

AU - Hernandez, Jonathan M.

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AB - Introduction: Laparoscopic approach to liver resection is feasible and safe, though its utilization with intrahepatic cholangiocarcinoma (ICC) remains poorly documented. We sought to evaluate the use laparoscopy for ICC, and to examine adherence to oncologic standards. Methods: The National Cancer Database was queried for patients who underwent resection for ICC. Patients were stratified by laparoscopic (LLR) versus open liver resection (OLR). Clinicopathologic parameters and hospital volumes were recorded. Results: In total, 2309 patients with ICC underwent hepatic resection (1997 OLR, 312 LLR) between 2010 and 2015. LLR increased from 12 to 16% during the study period and was utilized more commonly than OLR for wedge and segmental resections (56% vs. 33%, p < 0.001). Nodal evaluation was performed in 58% of all patients with ICC and was significantly more common in patients undergoing OLR (61%, n = 1210) versus LLR (39%, n = 120), p < 0.001. Of the 120 patients undergoing LLR with any nodal evaluation, 31% (n = 37) had a single node evaluated. Patients who underwent LLR were less likely to have ≥ 6 lymph nodes evaluated compared with those who underwent OLR (9% vs. 15%, respectively, p < 0.001). Conclusions: The use of laparoscopy for ICC is associated with an exacerbation of inadequate nodal evaluation compared with open resections.

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