Robotic-assisted surgery improves short-term outcomes of perihilar cholangiocarcinoma: a referral-center cohort study

Surgical management of perihilar cholangiocarcinoma (pCCA) is one of the most challenging procedures within hepatobiliary surgery. Robotic platform, with its intrinsic advantages, is emerging as a promising tool for these complex procedures. The aim of the study was to compare perioperative outcomes of robotic and open resections of pCCA.

Retrospective, single-referral center, observational study comparing preoperative, intraoperative, and postoperative outcomes between the first 10 consecutive robotic resections and the last 20 consecutive open resections of histologically confirmed pCCA. All cases were potentially candidates for both approaches. Exclusion criteria were palliative resections, unresectable/metastatic disease, associated vascular resections, concomitant malignancies or prior major hepatectomy.

Baseline characteristics were similar between the open and robotic groups, with a median age of 69 years, a predominance of male (73%) and a homogeneous representation of Bismuth type (I-23%; II-13%; IIIa-13%; IIIb-27%; IV-23%). The only preoperative difference was the use of bilateral biliary drains exclusively in the open group (p = 0.029). Intraoperatively, robotic approach required less blood transfusions (p = 0.038) and allowed more extended lymphadenectomies (p = 0.001), with a consequently higher number of retrieved nodes (median 9 [6-16] vs. 4 [2-8], p = 0.022), at cost of longer operative time (660 vs 345 min, p < 0.001). Postoperative complications, 90-days mortality rates and hospital stay were comparable (p = 0.175, p > 0.99 and p = 0.055).

Robotic-assisted resection for pCCA appears to be a feasible and safe approach in selected patients and experienced hands, offering potential advantages over open surgery.