To evaluate the clinical application value of modified three-step technique in laparoscopic radical resection of intrahepatic cholangiocarcinoma (ICC) of the left lobe.

Clinical data of 114 patients with advanced ICC of the left lobe who underwent laparoscopic radical resection in Fujian Provincial Hospital from January, 2013 to March, 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 51 patients were male and 63 female, aged from 37 to 79 years, with a median age of 63 years. Patients undergoing laparoscopic radical surgery with traditional process of "lymph node dissection-left hepatectomy" from January, 2013 to December, 2017 were assigned into the traditional group (n=86), and their counterparts receiving modified three-step technique in laparoscopic radical surgery of "pre-dissection of hilar vessels-left hepatectomy-lymph node dissection" from January, 2018 to March, 2020 were allocated into the modified group (n=28). Clinical data between 2 groups were compared by 1∶2 propensity score matching (PSM). Perioperative conditions were compared by Mann-Whitney U test. The incidence of complications was compared by Chi-square test.

After 1∶2 PSM, 28 cases were allocated in the modified group and56 cases in the traditional group. In the modified group, the median operation time, liver resection time, waiting time, lymph node dissection time and intraoperative blood loss were 225(140) min, 107(124) min, 30(6) min, 76(15) min and 200(175) ml, significantly less than 270(115) min,150(99) min, 112(15) min,92(15) min and 300(300) ml in the traditional group (Z=-2.616, -2.676, -7.442, -4.876, -2.008; P<0.05), respectively. In the modified group, the number of lymph node dissection was 10(5), and the number of positive dissected lymph node was 4(3), significantly higher than 7(5) and 3(1) in the traditional group (Z=2.441, 3.044; P<0.05). The hospitalization expense in the modified group was 4.2(0.2)×10⁴ Yuan, significantly less compared with 4.4(0.6)×10⁴ Yuan in the traditional group (Z=-3.150, P<0.05). 3 cases developed postoperative complications in the modified group and 10 in the traditional group. No significant difference was observed in the total incidence of complications between two groups (χ²=0.284, P>0.05).

Modified three-step technique in laparoscopic radical resection of ICC of the left lobe can improve the quality of liver resection and lymph node dissection, reduce the intraoperative bleeding, shorten the operation time and accelerate postoperative recovery.