Minimally invasive surgery for perihilar cholangiocarcinoma: a systematic review

L C Franken,O R Busch,T M Van Gulik,E Roos,M G Besselink,M J Van Der Poel,M J Zwart,A E J Latenstein

doi:10.1007/s11701-019-00964-9

Abstract

Minimally invasive surgery (MIS) is quickly becoming mainstream in hepato-pancreato-biliary surgery because of presumed advantages. Surgery for perihilar cholangiocarcinoma (PHC) is highly demanding which may hamper the feasibility and safety of MIS in this setting. This study aimed to systematically review the existing literature on MIS for PHC. A systematic literature review was performed according to the PRISMA statement. The PubMed and EMBASE databases were searched and all studies describing MIS in patients with PHC were included. Data extraction and risk of bias were assessed by two independent researchers. Overall, 21 studies reporting on a total of 142 MIS procedures for PHC were included. These included 82 laparoscopic, 59 robot-assisted and 1 hybrid procedure(s). Risk of bias was deemed substantial. Pooled conversion rate was 7/142 (4.9%), pooled morbidity 30/126 (23.8%), and pooled mortality rate 4/126 (3.2%). The only comparative study, comparing 10 robot-assisted procedures to 32 open procedures, reported a significant increased operative time and higher morbidity rate with MIS. The available evidence on MIS for PHC is limited and generally of poor quality. This systematic review shows that the implementation of MIS for patients with PHC is still in its infancy.

Highlights

Perihilar cholangiocarcinoma (PHC) is an uncommon type of cancer with a bad prognosis
Resection margins were reported in 57 cases, of which 46 R0-resection (79.3%), seven R1-resection, and two R2-resections. In this first systematic review on Minimally invasive surgery (MIS) in patients with PHC, we found that this field is still in its infancy
Case series and case reports included in this study show that laparoscopic and robotic external bile duct resection combined with-hepatectomy is technically feasible in highly selected patients with PHC in experienced hands

Summary

Introduction

Perihilar cholangiocarcinoma (PHC) is an uncommon type of cancer with a bad prognosis. Usually entailing hilar resection with extended hepatectomy, is the only potentially curative treatment. These procedures are considered highly challenging due to the tumors’ proximity to the portal vein and hepatic artery [1]. Severe morbidity (Clavien–Dindo ≥ III) can rise up to 27.5–54% and mortality is high with rates of 1.4–18% [2–6]. The efficiency of surgical treatment of PHC has progressed in recent years with the surgical strategy changing from limited bile duct resections. L.C. Franken and M.J. van der Poel shared first authorship

Methods

Results

Conclusion