Skip to main content

Advertisement

SpringerLink
Log in

Clinical Outcomes of Robotic Resection for Perihilar Cholangiocarcinoma: A First, Multicenter, Trans-Atlantic, Expert-Center, Collaborative Study

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Perihilar cholangiocarcinoma is a difficult cancer to treat with frequent vascular invasion, local recurrence, and poor survival. Due to the need for biliary anastomosis and potential vascular resection, the standard approach is an open operation. Suboptimal outcomes after laparoscopic resection had been sporadically reported by high-volume centers. In this first, Trans-Atlantic, multicenter study, we report our outcomes of robotic resection for perihilar cholangiocarcinoma. This is the largest study of its kind in the Western hemisphere.

Methods

Between 2016 and 2023, we prospectively followed patients undergoing robotic resection for perihilar cholangiocarcinoma at three, high-volume, robotic, liver-surgery centers.

Results

Thirty-eight patients underwent perihilar cholangiocarcinoma utilizing the robotic technique; Klatskin type-3 was the most common. The median age was 72 years, and 82% of the patients underwent preoperative biliary drainage. Median operative time was 481 minutes with a median estimated blood loss of 200 mL. The number of harvested lymph nodes was seven, and 11 (28%) patients yielded positive lymph nodes. Three patients required vascular reconstruction; 18% of patients had >1 biliary anastomosis. R0 resection margins were achieved in 82% of patients. Clavien-Dindo Grade ≥3 complications were seen in 16% of patients. The length of stay was 6 days. Five patients had an unplanned readmission within 30 days. One patient died within 30 days. With a median follow-up of 15 months, 68% of patients are alive without disease, 13% recurred, and 19% died.

Conclusions

Application of the robotic platform for perihilar cholangiocarcinoma is safe and feasible with acceptable short-term clinical and oncological outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Valle JW, Kelley RK, Nervi B, Oh DY, Zhu AX. Biliary tract cancer. Lancet. 2021;397(10272):428–44. https://doi.org/10.1016/S0140-6736(21)00153-7.

    Article  CAS  PubMed  Google Scholar 

  2. Halder R, Amaraneni A, Shroff RT. Cholangiocarcinoma: a review of the literature and future directions in therapy. Hepatobiliary Surg Nutr. 2022;11(4):555–66. https://doi.org/10.21037/hbsn-20-396.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Burke EC, Jarnagin WR, Hochwald SN, Pisters PW, Fong Y, Blumgart LH. Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg. 1998;228(3):385–94. https://doi.org/10.1097/00000658-199809000-00011.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Mueller M, Breuer E, Mizuno T, et al. Perihilar cholangiocarcinoma—Novel benchmark values for surgical and oncological outcomes from 24 expert centers. Ann Surg. 2021;274(5):780–8. https://doi.org/10.1097/SLA.0000000000005103.

    Article  PubMed  Google Scholar 

  5. Serrablo A, Serrablo L, Alikhanov R, Tejedor L. Vascular resection in perihilar cholangiocarcinoma. Cancers (Basel). 2021;13(21). https://doi.org/10.3390/cancers13215278

  6. Zaydfudim VM. Increasing aggressiveness of resection in patients with perihilar cholangiocarcinoma. Surgery. 2021;169(6):1279. https://doi.org/10.1016/j.surg.2020.10.013.

    Article  PubMed  Google Scholar 

  7. Fong Y, Wong J. Evolution in surgery: influence of minimally invasive approaches on the hepatobiliary surgeon. Surg Infect (Larchmt). 2009;10(5):399–406. https://doi.org/10.1089/sur.2009.9936.

    Article  PubMed  Google Scholar 

  8. Spiegelberg J, Iken T, Diener MK, Fichtner-Feigl S. Robotic-assisted surgery for primary hepatobiliary tumors-possibilities and limitations. Cancers (Basel). 2022;14(2). https://doi.org/10.3390/cancers14020265

  9. Qin T, Wang M, Zhang H, et al. The long-term outcome of laparoscopic resection for perihilar cholangiocarcinoma compared with the open approach: a real-world multicentric analysis. Ann Surg Oncol. 2023;30(3):1366–78. https://doi.org/10.1245/s10434-022-12647-1.

    Article  PubMed  Google Scholar 

  10. Sucandy I, Shapera E, Jacob K, et al. Robotic resection of extrahepatic cholangiocarcinoma: institutional outcomes of bile duct cancer surgery using a minimally invasive technique. J Surg Oncol. 2022;125(2):161–7. https://doi.org/10.1002/jso.26674.

    Article  PubMed  Google Scholar 

  11. Di Benedetto F, Magistri P, Di Sandro S. ASO Author Reflections: Robotic perihilar cholangiocarcinoma beyond technical feasibility. Ann Surg Oncol. 2023;30(5):2834–5. https://doi.org/10.1245/s10434-023-13175-2.

    Article  PubMed  Google Scholar 

  12. Liu L, Lewis N, Mhaskar R, Sujka J, DuCoin C. Robotic-assisted foregut surgery is associated with lower rates of complication and shorter post-operative length of stay. Surg Endosc. 2023;37(4):2800–5. https://doi.org/10.1007/s00464-022-09814-6.

    Article  PubMed  Google Scholar 

  13. Sucandy I, Giovannetti A, Ross S, Rosemurgy A. Institutional first 100 case experience and outcomes of robotic hepatectomy for liver tumors. Am Surg. 2020;86(3):200–7.

    Article  PubMed  Google Scholar 

  14. Faraj K, Chang YH, Neville MR, et al. Robotic vs. open cystectomy: How length-of-stay differences relate conditionally to age. Urol Oncol. 2019;37(6):354 e1-354 e8. https://doi.org/10.1016/j.urolonc.2019.01.028

  15. Machado MA, Mattos BV, Lobo Filho MM, Makdissi F. Robotic Resection of hilar cholangiocarcinoma. Ann Surg Oncol. 2020;27(11):4166–70. https://doi.org/10.1245/s10434-020-08514-6.

    Article  PubMed  Google Scholar 

  16. Cillo U, D’Amico FE, Furlanetto A, Perin L, Gringeri E. Robotic hepatectomy and biliary reconstruction for perihilar cholangiocarcinoma: a pioneer western case series. Updates Surg. 2021;73(3):999–1006. https://doi.org/10.1007/s13304-021-01041-3.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Li J, Tan X, Zhang X, et al. Robotic radical surgery for hilar cholangiocarcinoma: a single-centre case series. Int J Med Robot. 2020;16(2):e2076. https://doi.org/10.1002/rcs.2076

  18. Farges O, Regimbeau JM, Fuks D, et al. Multicentre European study of preoperative biliary drainage for hilar cholangiocarcinoma. Br J Surg. 2013;100(2):274–83. https://doi.org/10.1002/bjs.8950.

    Article  CAS  PubMed  Google Scholar 

  19. Tamada K, Ushio J, Sugano K. Endoscopic diagnosis of extrahepatic bile duct carcinoma: advances and current limitations. World J Clin Oncol. 2011;2(5):203–16. https://doi.org/10.5306/wjco.v2.i5.203.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Chong Y, Prieto M, Gastaca M, et al. An international multicentre propensity score matched analysis comparing between robotic versus laparoscopic left lateral sectionectomy. Surg Endosc. 2023;37(5):3439–48. https://doi.org/10.1007/s00464-022-09790-x.

    Article  PubMed  Google Scholar 

  21. Chong CC, Fuks D, Lee KF, et al. Propensity score-matched analysis comparing robotic and laparoscopic right and extended right hepatectomy. JAMA Surg. 2022;157(5):436–44. https://doi.org/10.1001/jamasurg.2022.0161.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Willems E, D’Hondt M, Kingham TP, et al. Comparison between minimally invasive right anterior and right posterior sectionectomy vs right hepatectomy: An international multicenter propensity score-matched and coarsened-exact-matched analysis of 1,100 patients. J Am Coll Surg. 2022;235(6):859–68. https://doi.org/10.1097/XCS.0000000000000394.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Liu Q, Zhang W, Zhao JJ, et al. Propensity-score matched and coarsened-exact matched analysis comparing robotic and laparoscopic major hepatectomies: An international multicenter study of 4822 cases. Ann Surg. https://doi.org/10.1097/SLA.0000000000005855

  24. Lauterio A, De Carlis R, Centonze L, et al. Current surgical management of peri-hilar and intra-hepatic cholangiocarcinoma. Cancers (Basel). 2021. https://doi.org/10.3390/cancers13153657

  25. D'Amico FE, Mescoli C, Caregari S, et al. Impact of positive radial margin on recurrence and survival in perihilar cholangiocarcinoma. Cancers (Basel). 2022. https://doi.org/10.3390/cancers14071680

  26. Lim JH, Choi GH, Choi SH, Kim KS, Choi JS, Lee WJ. Liver resection for Bismuth type I and Type II hilar cholangiocarcinoma. World J Surg. 2013;37(4):829–37. https://doi.org/10.1007/s00268-013-1909-9.

    Article  PubMed  Google Scholar 

  27. Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001;234(4):507-17; discussion 517-9. https://doi.org/10.1097/00000658-200110000-00010

  28. Zimmerman AM, Roye DG, Charpentier KP. A comparison of outcomes between open, laparoscopic and robotic pancreaticoduodenectomy. HPB (Oxford). 2017. https://doi.org/10.1016/j.hpb.2017.10.008

  29. Cortolillo N, Patel C, Parreco J, et al. Nationwide outcomes and costs of laparoscopic and robotic vs. open hepatectomy. J Robot Surg. 2019;13(4):557-65. https://doi.org/10.1007/s11701-018-0896-0

  30. van Keulen AM, Olthof PB, Cescon M, et al. Actual 10-year survival after resection of perihilar cholangiocarcinoma: what factors preclude a chance for cure? Cancers (Basel). 2021. https://doi.org/10.3390/cancers13246260

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Digestive Health Institute, Tampa, FL, USA

    Iswanto Sucandy MD & Sharona B. Ross MD

  2. Hepato-Biliary-Pancreatic and Transplantation Center, Lisbon Central Hospitals and University Center/NOVA Medical School, Lisbon, Portugal

    Hugo P. Marques MD, PhD, Joao Santos Coelho MD & Beatriz Chumbinho MD

  3. University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Trenton Lippert BS

  4. Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University Hospital of Modena “Policlinico”, University of Modena and Reggio Emilia, Modena, Italy

    Paolo Magistri MD, Stefano Di Sandro MD, PhD & Fabrizio DiBenedetto MD, PhD

Authors
  1. Iswanto Sucandy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hugo P. Marques MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Trenton Lippert BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paolo Magistri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joao Santos Coelho MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sharona B. Ross MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Beatriz Chumbinho MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stefano Di Sandro MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fabrizio DiBenedetto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Iswanto Sucandy MD.

Ethics declarations

Disclosure

Dr. Sharona B. Ross is a consultant for Intuitive Surgical (Sunnyvale, CA) and Ethicon. Dr. Ross receives educational grants for her Women in Surgery Career Symposium from Intuitive Surgical and Medtronic (Minneapolis, MN).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sucandy, I., Marques, H.P., Lippert, T. et al. Clinical Outcomes of Robotic Resection for Perihilar Cholangiocarcinoma: A First, Multicenter, Trans-Atlantic, Expert-Center, Collaborative Study. Ann Surg Oncol 31, 81–89 (2024). https://doi.org/10.1245/s10434-023-14307-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-023-14307-4

Search

Navigation