Open Versus Laparoscopic and Robotic Approach in Hilar Cholangiocarcinoma: A Network Meta-Analysis With Trial...

Area of Science:

• Surgical Oncology
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Minimally invasive (MI) techniques for hilar cholangiocarcinoma (HCCA) are increasingly used, but high-quality evidence is scarce.
• Assessing the safety of laparoscopic (LPS) and robotic (ROB) approaches versus open surgery for HCCA is crucial.

Purpose of the Study:

• To evaluate the safety and efficacy of laparoscopic (LPS) and robotic (ROB) surgery compared to open surgery for hilar cholangiocarcinoma (HCCA).

Main Methods:

• A systematic search was conducted, followed by a frequentist network meta-analysis and trial sequential analysis.
• Primary outcomes included major complications and R0 resection rates.

Main Results:

• Fourteen studies with 1169 patients (403 LPS, 137 ROB) were analyzed.
• Laparoscopic and robotic approaches demonstrated similar major complication rates.
• Robotic surgery was linked to a higher rate of negative resection margins (OR: 2.856, 95% CI: 1.585-5.144).
• Operative time was longer in MI approaches, while length of stay was shorter in the ROB group.

Conclusions:

• Minimally invasive surgery for HCCA, though limited globally, appears safe and viable for select patients.
• Laparoscopic and robotic approaches are feasible options when performed by experienced surgeons in high-volume centers.