Immediate outcomes of robotic resection for hilar cholangiocarcinoma. Initial experience evaluation

Abstract

Background: Outcomes of robotic resection for perihilar cholangiocarcinoma is still controversial. Aim. Estimation of outcomes after robot-assisted resection for hilar cholangiocarcinoma. Methods. 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. Diagnosis was based on medical history, CT, MRI and PTBD data. 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). Results: Twelve patients were treated. Major liver resection was performed in 11 patients. In one case of papillary tumor type I according to Bismuth-Corlette classification extrahepatic bile ducts were resected without liver resection. Final histological examination confirmed hilar cholangiocarcinoma in 9 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 710 (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 612 (490-690) min without significant differences. Mean blood loss was 420 (50-950) mL. The rate of R0/R1 resection was 9/1 in patients with malignancy. The mean number of lymph nodes harvested was 8 (4-9). Severe complications (>2 according Clavien-Dindo classification) revealed in 9 patients. In six of them IIIa,b grade morbidity was observed. One patient died due to liver failure. The mean hospital stay was 22 (11-37) days. Conclusion: The initial experience of robot-assisted resection for hilar cholangiocarcinoma suggests that robotic approach may be validated in highly selected patients. Evaluation of long-term Results is needed to clarify oncological safety.