Digestive Health Institute, Tampa, FL, USA.
Hepato-Biliary-Pancreatic and Transplantation Center, Lisbon Central Hospitals and University Center/NOVA Medical School, Lisbon, Portugal.
Ann Surg Oncol. 2024 Jan;31(1):81-89. doi: 10.1245/s10434-023-14307-4. Epub 2023 Sep 18.
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.
Between 2016 and 2023, we prospectively followed patients undergoing robotic resection for perihilar cholangiocarcinoma at three, high-volume, robotic, liver-surgery centers.
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.
Application of the robotic platform for perihilar cholangiocarcinoma is safe and feasible with acceptable short-term clinical and oncological outcomes.
肝门部胆管癌的治疗难度较大，常伴有血管侵犯、局部复发和预后不良。由于需要胆道吻合和潜在的血管切除，标准的治疗方法是开腹手术。高容量中心也偶尔报告腹腔镜切除术后的结果不理想。在这项首次跨大西洋的多中心研究中，我们报告了机器人辅助肝门部胆管癌切除术的结果。这是西半球此类研究中规模最大的研究。
在 2016 年至 2023 年期间，我们前瞻性地随访了在三个高容量机器人肝外科中心接受机器人辅助肝门部胆管癌切除术的患者。
38 例患者接受了机器人辅助肝门部胆管癌切除术；最常见的是 Klatskin 3 型。中位年龄为 72 岁，82%的患者术前接受了胆道引流。中位手术时间为 481 分钟，中位估计出血量为 200 毫升。采集的淋巴结数为 7 个，11 例（28%）患者的淋巴结呈阳性。3 例患者需要血管重建；18%的患者有>1 个胆道吻合口。82%的患者获得了 R0 切除边缘。16%的患者发生了 Clavien-Dindo 分级≥3 的并发症。住院时间为 6 天。5 例患者在 30 天内计划外再次入院。1 例患者在 30 天内死亡。中位随访 15 个月时，68%的患者无病生存，13%的患者复发，19%的患者死亡。
机器人平台在肝门部胆管癌中的应用是安全可行的，具有可接受的短期临床和肿瘤学结果。
