Does Surgical Approach Influence Benchmark Attainment in Intrahepatic Cholangiocarcinoma?

BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) is a rare malignancy with rising incidence and poor prognosis. Surgical resection remains the only curative option, with outcomes driven by R0 margins and lymphadenectomy (LND). While open liver resection (OLR) is standard, laparoscopic (LLR) and robotic liver resection (RLR) are increasingly used, with concerns about their oncologic adequacy. OBJECTIVE: To assess the association between composite surgical benchmark attainment (R0 + LND) and short- and long-term outcomes after ICC resection, stratified per surgical approach. METHODS: A retrospective multicenter analysis was conducted including 240 patients treated from 2010 to 2024. The primary endpoint was achievement of both R0 resection and LND. Secondary endpoints included 90-day mortality, overall (OS), and disease-free survival (DFS). RESULTS: Among the 240 included patients 38.8% met surgical benchmarks (R0 + LND), with rates varying by approach: OLR 51.1%, RLR 44.4%, and LLR 14.5% (p < 0.001). 90-day mortality was 5.0% (12/240) overall, with no significant difference between surgical approaches (p = 0.219). One and 3-year overall survival was 79%/30% for OLR, 95%/89% for LLR, and 90%/81% for RLR (p < 0.001). Multivariable analysis identified tumor multiplicity as an independent predictor of mortality (HR = 2.18, p = 0.003), while LLR was independently protective (HR = 0.15, p < 0.001); RLR showed a non-significant protective trend. CONCLUSION: Although OLR and RLR more frequently met oncological benchmark criteria, only LLR was independently associated with improved overall survival, highlighting a potential disconnect between benchmark adherence and long-term outcomes in ICC.

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Journal
World Journal of Surgery
Published
2026-07-24
DOI
https://doi.org/10.1002/wjs.70491
Primary Topic
Cholangiocarcinoma and Gallbladder Cancer Studies
Type
article
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article

Does Surgical Approach Influence Benchmark Attainment in Intrahepatic Cholangiocarcinoma?

Raffaele Brustia, S. Truant, Alexandre Doussot, Mabrut Jp et al.
World Journal of Surgery
Cholangiocarcinoma and Gallbladder Cancer Studies
article

Does Surgical Approach Influence Benchmark Attainment in Intrahepatic Cholangiocarcinoma?

Raffaele Brustia, S. Truant, Alexandre Doussot, Mabrut Jp, Heithem Jeddou, Serena Langella, Daniel Cherqui, Claire Goumard, S. Hofmeyr, Emmanuel Boleslawski, Marc‐Antoine Allard, N. Péru, B Le Roy, G. Millet, Christian Hobeika, Alexis Laurent, David Fuks, Danièle Sommacale, P. Blanc, Delphine Gastineau, Ruth Bustamante, Raphael Venezia, P Pessaux, AFC‐ICC‐2009, AFC‐LLR‐2018, PRS‐2019 and FRIES‐ACHBPT‐2024 Study group, Chady Salloum, Alessandro Ferrero, Takayuki Kawai, Alain Valverde, Eric Vibert, Bastien Le Floch, Fabio Giannone, Jean‐Marc Regimbeau, Kayvan Mohkam, Olivier Soubrane, Stylianos Tzedakis, Olivier Farges, Antonio Sa Cunha, Rami Rhaiem, Olivier Scatton
article en

Abstract

BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) is a rare malignancy with rising incidence and poor prognosis. Surgical resection remains the only curative option, with outcomes driven by R0 margins and lymphadenectomy (LND). While open liver resection (OLR) is standard, laparoscopic (LLR) and robotic liver resection (RLR) are increasingly used, with concerns about their oncologic adequacy. OBJECTIVE: To assess the association between composite surgical benchmark attainment (R0 + LND) and short- and long-term outcomes after ICC resection, stratified per surgical approach. METHODS: A retrospective multicenter analysis was conducted including 240 patients treated from 2010 to 2024. The primary endpoint was achievement of both R0 resection and LND. Secondary endpoints included 90-day mortality, overall (OS), and disease-free survival (DFS). RESULTS: Among the 240 included patients 38.8% met surgical benchmarks (R0 + LND), with rates varying by approach: OLR 51.1%, RLR 44.4%, and LLR 14.5% (p < 0.001). 90-day mortality was 5.0% (12/240) overall, with no significant difference between surgical approaches (p = 0.219). One and 3-year overall survival was 79%/30% for OLR, 95%/89% for LLR, and 90%/81% for RLR (p < 0.001). Multivariable analysis identified tumor multiplicity as an independent predictor of mortality (HR = 2.18, p = 0.003), while LLR was independently protective (HR = 0.15, p < 0.001); RLR showed a non-significant protective trend. CONCLUSION: Although OLR and RLR more frequently met oncological benchmark criteria, only LLR was independently associated with improved overall survival, highlighting a potential disconnect between benchmark adherence and long-term outcomes in ICC.

World Journal of Surgery
Inserm (FR), Université Paris-Est Créteil (FR), Université Paris Cité (FR), Kyoto University (JP), Université de Lille (FR), Stellenbosch University (ZA), Université Paris-Saclay (FR), Hôpital Beaujon (FR), Tygerberg Hospital (ZA), Sorbonne Université (FR), Centre Hospitalier Universitaire de Besançon (FR), Hôpital de la Croix-Rousse (FR), Institute Mutualiste Montsouris (FR), Hôpital Cochin (FR), Assistance Publique – Hôpitaux de Paris (FR), Groupe Hospitalier Diaconesses Croix Saint-Simon (FR), Pitié-Salpêtrière Hospital (FR), Hôpital Pontchaillou (FR), A. O. Ordine Mauriziano di Torino (IT), Hôpitaux Universitaires Henri-Mondor (FR), Centre Hospitalier Universitaire de Saint-Étienne (FR), Hôpital Paul-Brousse (FR), Université de Picardie Jules Verne (FR), Université de Strasbourg (FR), Université de Reims Champagne-Ardenne (FR)
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Openalex Percentile: Top 7%
Cholangiocarcinoma and Gallbladder Cancer Studies
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