Does Surgical Approach Influence Benchmark Attainment in Intrahepatic Cholangiocarcinoma?
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.
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BibTeX
@article{gastineau2026does,
title = {{Does Surgical Approach Influence Benchmark Attainment in Intrahepatic Cholangiocarcinoma?}},
author = {Delphine Gastineau and Claire Goumard and Alexandre Doussot and Marc‐antoine Allard and Raphael Venezia and Serena Langella and Guillaume Millet and Ruth Bustamante and Christian Hobeika and Rami Rhaiem and Stylianos Tzedakis and Heithem Jeddou and Bastien Le Floch and Alain Valverde and Nicolas Peru and Patrick Pessaux and Fabio Giannone and Jean Yves Mabrut and Kayvan Mohkam and Antonio Sa Cunha and Chady Salloum and Pierre Yves Blanc and Bertrand Le Roy and Takayuki Kawai and Olivier Farges and Stefan Hofmeyr and David Fuks and Stéphanie Truant and Daniel Cherqui and Alessandro Ferrero and Emmanuel Boleslawski and Jean‐marc Regimbeau and Eric Vibert and Daniele Sommacale and Olivier Soubrane and Olivier Scatton and Alexis Laurent and Raffaele Brustia},
journal = {World Journal of Surgery},
year = {2026},
month = jul,
doi = {10.1002/wjs.70491},
url = {https://u-picardie.hal.science/hal-05714445v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Does Surgical Approach Influence Benchmark Attainment in Intrahepatic Cholangiocarcinoma?
AU - Delphine Gastineau
AU - Claire Goumard
AU - Alexandre Doussot
AU - Marc‐antoine Allard
AU - Raphael Venezia
AU - Serena Langella
AU - Guillaume Millet
AU - Ruth Bustamante
AU - Christian Hobeika
AU - Rami Rhaiem
AU - Stylianos Tzedakis
AU - Heithem Jeddou
AU - Bastien Le Floch
AU - Alain Valverde
AU - Nicolas Peru
AU - Patrick Pessaux
AU - Fabio Giannone
AU - Jean Yves Mabrut
AU - Kayvan Mohkam
AU - Antonio Sa Cunha
AU - Chady Salloum
AU - Pierre Yves Blanc
AU - Bertrand Le Roy
AU - Takayuki Kawai
AU - Olivier Farges
AU - Stefan Hofmeyr
AU - David Fuks
AU - Stéphanie Truant
AU - Daniel Cherqui
AU - Alessandro Ferrero
AU - Emmanuel Boleslawski
AU - Jean‐marc Regimbeau
AU - Eric Vibert
AU - Daniele Sommacale
AU - Olivier Soubrane
AU - Olivier Scatton
AU - Alexis Laurent
AU - Raffaele Brustia
PY - 2026
DA - 2026/07/24
JO - World Journal of Surgery
DO - 10.1002/wjs.70491
UR - https://u-picardie.hal.science/hal-05714445v1
AB - 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.
SN - 0364-2313
SN - 1432-2323
ER -