Efanov Mikhail, Tarakanov Pavel, Kulezneva Yuliya, Melekhina Olga, Koroleva Anna, Vankovich Andrey, Kovalenko Dmitry, Fisenko Denis, Tsvirkun Victor, Khatkov Igor
Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia.
Department of Interventional Radiology, Moscow Clinical Scientific Center, Moscow, Russia.
Ann Hepatobiliary Pancreat Surg. 2025 May 31;29(2):127-139. doi: 10.14701/ahbps.25-012. Epub 2025 Apr 15.
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.
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.
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 ( = 0.259) before PSM and 44 and 29 months ( = 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.
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.
背景/目的：肝门部胆管癌的机器人手术尚处于发展和探索阶段。本研究的目的是比较单中心机器人手术与开放手术切除肝门部胆管癌的短期疗效和生存率，并确定机器人手术干预的可靠范围。
采用倾向评分匹配（PSM）对单中心开放手术和机器人手术的结果进行比较分析。使用标准化均值差异评估协变量的平衡性，机器人手术操作遵循开放手术的标准。
41例机器人手术和82例开放手术有效地进行了PSM。在失血量、总体及严重并发症、90天死亡率或住院时间方面未观察到差异。机器人手术时间较长，但近期肿瘤学结局较好。PSM前，机器人手术组和开放手术组的中位总生存期分别为44个月和30个月（P = 0.259），PSM后分别为44个月和29个月（P = 0.164）。8例需要中转手术。排除中转手术的亚组分析显示近期和远期结局无差异。所有接受机器人手术治疗的I型和II型Bismuth患者在平均37个月的随访时均存活。
对于部分肝门部胆管癌患者，机器人手术方法在近期疗效和生存率方面与开放手术相当。对于I型和II型Bismuth肿瘤且处于早期（I期和II期）TNM分期的患者，当遵循开放手术原则时，机器人手术是一种可靠的治疗选择。
