Biliary-enteric reconstruction in laparoscopic radical resection of hilar cholangiocarcinoma: a single-center retrospective cohort study

Abstract

Objective To evaluate the feasibility and quality of biliary-enteric reconstruction (BER) in laparoscopic radical resection of hilar cholangiocarcinoma (LsRRH) versus open surgery and propose technical recommendations. Methods Data of 38 LsRRH and 54 radical laparotomy resections of hilar cholangiocarcinoma (LtRRH) cases were collected from our institution. BER was evaluated via biliary residuals numbers, number of anastomoses, anastomosis manner, suture method, time consumption, and postoperative complication. Results In the LsRRH group, patients were relatively younger; Bismuth type I had a higher proportion while type IIIa and IV were less and required no revascularization. In LsRRH and LtRRH groups, respectively, the biliary residuals number was 2.54 ± 1.62 and 2.47 ± 1.46 (p > 0.05); the number of anastomoses was 2.04 ± 1.27 and 2.57 ± 1.33 (p > 0.05); the time of BER was 65.67 ± 21.53 and 42.5 ± 19.77 min (p < 0.05), 15.08 ± 3.64% and 11.76 ± 2.54% of the total operation time (p < 0.05); postoperative bile leakage incidence was 15.79% and 16.67% (p > 0.05); 14 ± 10.28 and 17 ± 9.73 days for healing (p < 0.05); anastomosis stenosis rate was 2.63% and 1.85% (p > 0.05). Neither group had a biliary hemorrhage or bile leakage-related death. Conclusion The selection bias in LsRRH mainly affects tumor resection than BER. Our cohort study indicates that BER in LsRRH is technically feasible and equals anastomotic quality to open surgery. However, its longer and a more significant proportion of total operation time represent that BER has higher technical requirements and is one of the critical rate-limiting steps affecting the minimal invasiveness of LsRRH.

Evaluation of the outcomes of biliary-enteric reconstruction in robotic radical resection of hilar cholangiocarcinoma: a single-center propensity score matching analysis

“…This difficulty may result in postoperative biliary fistula, anastomotic stenosis, and other serious complications. Liu 28 compared BER between laparoscopic and open radical resection for HCCA and found a significant difference in the anastomosis time (65.67 ± 21.53 vs 42.5 ± 19.77 min, P < 0.05) and BER time ratio (15.08 ± 3.64% vs 11.76 ± 2.54%, P < 0 0.05), with longer times observed in the laparoscopic group mainly owing to the complexity of laparoscopic BER procedures. However, in a systematic review, Guerra 29 suggested that robotic surgery has become a treatment option for biliary tract surgery in large clinical centers.…”

“…Limited research exists on robot-assisted Roux-en-Y hepaticojejunostomy. 28 , 30 , 31 . In this study, a mesentery with fewer blood vessels was selected for appropriate cutting to ensure that the raised intestinal loop had sufficient length.…”