Ann Hepatobiliary Pancreat Surg.  2025 May;29(2):127-139. 10.14701/ahbps.25-012.

Is it time to define the scope of safety for robotic resection in perihilar cholangiocarcinoma surgery? A propensity score matching based analysis of a single center experience

• Efanov M
• Tarakanov P
• Kulezneva Y
• Melekhina O
• Koroleva A
• Vankovich A
• Kovalenko D
• Fisenko D
• Tsvirkun V
• Khatkov I

• KMID: 2568261
• DOI: http://doi.org/10.14701/ahbps.25-012

Abstract

Backgrounds/Aims
Robotic surgery for perihilar cholangiocarcinoma is in the developmental and exploratory phase. The objective of this study was to compare the short-term outcomes and survival rates of robotic versus open resection for perihilar cholangiocarcinoma in a single center, and to determine the reliable scope of robotic interventions.
Methods
A comparative analysis of outcomes from open and robotic resections at a single center was conducted using propensity score matching (PSM). The balance of covariates was assessed using standardized mean differences, and the robotic resection procedures adhered to the standards of open surgery.
Results
PSM was effectively applied between 41 robotic and 82 open resections. No differences were observed in blood loss, overall and severe morbidity, 90-day mortality, or length of hospital stay. Robotic resections were longer but resulted in better immediate oncological outcomes. Median overall survival for the robotic and open groups was 44 and 30 months (p = 0.259) before PSM and 44 and 29 months (p = 0.164) after PSM respectively. Conversion was required in 8 cases. A subgroup analysis excluding conversions revealed no differences in immediate and long-term outcomes. All patients undergoing robotic resection for Bismuth types I and II were alive at a mean follow-up of 37 months.
Conclusions
The robotic approach is comparable to open resection regarding immediate outcomes and survival in select patients with perihilar cholangiocarcinoma. For patients with Bismuth type I and II tumors and early (stages I and II) TNM stages, robotic resection is a reliable treatment option when aligned with the principles of open surgery.

Keyword

Perihilar cholangiocarcinoma; Klatskin tumor; Robot surgery; Minimally invasive surgery

Figure

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  Fig. 1 ALPPS for perihilar cholangiocarcinoma (operation photo). (A) Final view of the resection field after the first stage: (1) portal vein trunk; (2) clipped right portal vein; (3) right hepatic artery; (4) ligated stump of the right hepatic duct; and (5) clipped by hem-o-lok stump of the left hepatic duct. (B–D) Final view of the resection field following right hepatectomy with caudate lobectomy. (B) Three orifices of transected bile ducts to segments 2, 3, and 4 (6); (C) completed hepaticojejunostomy (7); (D) inferior vena cava (8) and middle hepatic vein (9).

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  Fig. 2 Flowchart depicting patient selection for comparative analysis.

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  Fig. 3 (A) Group overall survival prior to PSM; (B) group overall survival after PSM with inclusion of converted cases. (C) Group overall survival after PSM excluding conversion cases. PSM, propensity score matching.

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  Fig. 4 (A) Overall survival following robotic and open resection in patients with Bismuth types I and II tumors before PSM. (B) Overall survival following robotic and open resection in patients with Bismuth types I and II tumors after PSM. PSM, propensity score matching.

Reference

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