Minimally invasive approach to intrahepatic cholangiocarcinoma: technical notes for a safe hepatectomy and lymphadenectomy

Background: Despite the improvements of laparoscopic (I,PS) technologies and their extensive application to the treatment of liver diseases, minimally invasive approach to intrahepatic cholangiocarcinoma (ICC) is still poorly widespread. The aim of the present study is to investigate the extension and the diffusion of laparoscopy applied to surgical treatment of ICC. Methods: We reviewed studies dealing with the LPS treatment of ICC and LPS lymphadenectomy (LND) for ICC. Data regarding conversion rate, morbidity and LND were extracted, synthesized and analyzed. Additionally, we described technical notes for a safe liver resection and LND. Results: We identified 11 studies encompassing liver resections for ICCs. Among a total of 1,882 cases included, there were 101 (5.5%) patients treated laparoscopically who were affected by ICC. The observed conversion rate was comparable to that of other LPS advanced procedures; laparoscopy was not responsible for increased morbidity and LND was demonstrated being feasible without causing any increasing in the post-operative complications. Furthermore, no differences in disease free survival and on the 3-year overall survival were observed. Conclusions: Few are the cases of ICC that are nowadays tackled laparoscopically. Hepatic resection and LPS LND for ICC are feasible and safe; as more, laparoscopy granted both short and long term results that were comparable to open surgery, extending the applicability of minimally invasive surgery.