Abstract
Background
Radical resection for hilar cholangiocarcinoma (HCa) is one of the most challenging abdominal procedures. Robotic-assisted approach is gaining popularity in hepatobiliary surgery but scarcely tried in the management of HCa. We herein report our initial experience of robotic radical resection for HCa.
Methods
Between May 2009 and October 2012, 10 patients underwent fully robotic-assisted radical resection for HCa in a single institute. The perioperative and long-term outcomes were analyzed and compared with a contemporaneous 32 patients undergoing traditional open surgery.
Results
The 10 patients presented one of Bismuth–Corlette type II, four of IIIa, one of IIIb and four of IV. There was no significant clinicopathological disparity between the robotic and open groups. The robotic radical resection involves hemihepatectomy plus caudate lobectomy or trisectionectomy, extrahepatic bile duct resection, radical lymphadenectomy and Roux-en-Y hepaticojejunostomy. No conversion to laparotomy occurred. Robotic resection compared unfavorably to traditional open resection in operative time (703 ± 62 vs. 475 ± 121 min, p < 0.001) and morbidity [90 (9/10) vs. 50 %, p = 0.031]. No significant difference was found in blood loss, mortality and postoperative hospital stay. Major complications (≥Clavien–Dindo III) occurred in three patients of robotic group. One patient died of posthepatectomy liver failure on postoperative day 18. The hospital expenditure was much higher in robotic group (USD 27,427 ± 21,316 vs. 15,282 ± 5957, p = 0.018). The tumor recurrence-free survival was inferior in robotic group (p = 0.029).
Conclusions
Fully robotic-assisted radical resection for HCa is technically achievable in experienced hands and should be limited to highly selective patients. Our current results do not support continued practice of robotic surgery for HCa, until significant technical and instrumental refinements are demonstrated.
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Abbreviations
- HCa:
-
Hilar cholangiocarcinoma
- PLAGH:
-
People’s Liberation Army General Hospital
- LIOUS:
-
Laparoscopic intraoperative ultrasound
- MHV:
-
Middle hepatic vein
- LN:
-
Lymph node
- SHV:
-
Short hepatic vein
- IVC:
-
Inferior vena cava
- AJCC:
-
American Joint Committee on Cancer
- TBil:
-
Total bilirubin
- PTBD:
-
Percutaneous transhepatic biliary drainage
- sPVE:
-
Selective portal venous embolization
- PHLF:
-
Posthepatectomy liver failure
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Acknowledgments
The authors are grateful to Drs. Daniel Cherqui and Yuman Fong for their efforts in revising this article and English editing.
Grants and financial support
The work is supported by the National Key Technology Research & Development Program of China (No. 2012BAI06B01) and the National Science & Technology Major Project for Infectious Diseases of China (No. 2012ZX10002-017).
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Drs. Yinzhe Xu, Hongguang Wang, Wenbin Ji, Maosheng Tang, Hao Li, Jianjun Leng, Xuan Meng and Jiahong Dong have no conflicts of interest or financial ties to disclose.
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Yinzhe Xu, Hongguang Wang and Webin Ji have contributed equally to this work.
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Xu, Y., Wang, H., Ji, W. et al. Robotic radical resection for hilar cholangiocarcinoma: perioperative and long-term outcomes of an initial series. Surg Endosc 30, 3060–3070 (2016). https://doi.org/10.1007/s00464-016-4925-7
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DOI: https://doi.org/10.1007/s00464-016-4925-7