Video Abstract
.jpg "Iswanto Sucandy, MD FACS photo")
Iswanto Sucandy, MD FACS
Director, Center for Liver Cancers and Disorders
AdventHealth Tampa
Tampa, Florida, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Resection of cholangiocarcinoma especially the perihilar & extrahepatic types is traditionally performed via open approach. The minimally invasive technique is emerging from few high-volume hepatobiliary centers in Asia, despite its technical challenges and steep learning curve. Only very limited data exist in the literature today in regards to feasibility and outcomes. We demonstrate our techniques and initial experience with robotic resection of perihilar & extrahepatic cholangiocarcinoma requiring biliary reconstruction. To our knowledge, this is the first series in America reporting outcomes after such resections.
Methods: With IRB approval, 19 consecutive patients undergoing robotic resection and reconstruction for perihilar & extrahepatic cholangiocarcinoma were studied. Two patients with gallbladder cancer involving the common bile duct were included in the study. Surgical videos to demonstrate techniques and perioperative variables were collected. Data are presented as Median (Mean±SD).
Results:
Patients were 72 (72±8.8) years old with a BMI of 25 (27±6.0) kg/m2, ASA score of 3, Child-Pugh score of 6 and MELD score of 10. 42% of patients presented with jaundice and subsequently required percutaneous or endoscopic biliary drainage. Operative time was 458 (446±79.7) minutes and estimated blood loss was 100 (161±131.8) mL. Length of stay was 5 (6±2.9) days and there were two patients who experienced postoperative fluid collection/bile leak and required readmission within 30 days (Clavien-Dindo >3). This was resolved with CT-guided percutaneous drain placement. One patient died within 90 days due to cardiopulmonary complications. Average length of follow-up is 19 months with 13 patients are alive without disease and 2 patients are alive with disease (distant metastasis). Our operative techniques for the resection of type II, IIIA, and IIIB Klatskin tumor resections is shown in the video.
Conclusions: Robotic resection of perihilar & extrahepatic cholangiocarcinoma is safe and feasible with excellent short-term outcomes. Further follow-up study is needed to determine its long-term outcomes and oncological results.