Early outcomes of robotic-assisted resection for perihilar cholangiocarcinoma

Abstract

Introduction: Minimally invasive approach for radical treatment of perihilar cholangiocarcinoma is not validated option and outcomes of robotic procedures are only starting to be evaluated. Method: Data were collected for four years (2014-2016) in a single Russian high-volume centers. All patients underwent surgery with intention to treat for hilar cholangiocarcinoma. The standard procedure included major liver resection with segmentectomy 1, extrahepatic bile duct resection and Roux-en-Y biliary reconstruction with D2 lymphadenectomy. In case of insufficient (<40%) volume of FLR its hypertrophy was induced by modified variant of ALPPS (PRALPPS). Result: Thirteen patients were treated. Major liver resection was performed in 12 patients. Final histological examination confirmed hilar cholangiocarcinoma in 10 patients with exception of 2 patients with benign strictures and gallbladder sarcoma in one patient. In two patients there was conversion to open procedure due to vascular invasion required vascular resection and reconstruction. The mean operation time was 699 (490-980) min for totally laparoscopic cases. After initial period of the first 4 procedures the mean time decreased from 858 (560-980) min to 608 (490-690) min without significant differences. Mean blood loss was 392 (50-950) mL. The rate of R0/R1 resection was 10/1 in patients with malignancy. The mean number of lymph nodes harvested was 8 (4-9). Severe complications (>2, Clavien-Dindo) revealed in 10 patients. In seven of them IIIa,b grade morbidity was observed. One patient died due to liver failure. The mean hospital stay was 22 (11-37) days. The mean follow up time was 8 (1-19) months. One patient died due to tumor progression 18 months after procedure. Conclusion: The initial experience of robot-assisted resection for hilar cholangiocarcinoma suggests that robotic approach may be validated in highly selected patients. Further evaluation is needed to clarify the surgical and oncological safety.