Robotic Surgery for Biliary Tract Cancer.

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Biliary tract cancers (cholangiocarcinoma and gallbladder cancer) require surgical resection for best long-term survival.
• Traditional open surgery for these cancers involves significant morbidity and prolonged recovery.
• Minimally invasive approaches, particularly robotic surgery, are being explored to improve surgical outcomes.

Purpose of the Study:

• To systematically review the existing literature on robotic surgery for biliary tract cancer.
• To evaluate the safety and efficacy of robotic surgery compared to open surgery for cholangiocarcinoma and gallbladder cancer.

Main Methods:

• A systematic review following PRISMA guidelines was conducted.
• Literature search identified 20 unique articles involving 259 patients who underwent robotic surgery for biliary tract cancer.
• Data on operative time, blood loss, conversion rates, morbidity, mortality, length of stay, margin status, and lymph node retrieval were analyzed.

Main Results:

• Robotic surgery for cholangiocarcinoma (CC) showed an average operative time of 401 min, 52% all-cause morbidity, and 15-day length of stay.
• Robotic surgery for gallbladder cancer (GBC) demonstrated an average operative time of 277 min, 9.7% all-cause morbidity, and 4.8-day length of stay.
• Overall, robotic surgery appeared non-inferior to open surgery, with lower major morbidity and mortality rates in GBC.

Conclusions:

• Robotic surgery for biliary tract cancer is a viable option, potentially offering advantages in specific patient groups like GBC.
• Current evidence is largely based on low-quality studies.
• High-quality prospective and randomized controlled trials are necessary to definitively establish the role and superiority of robotic surgery.