Robotic Surgery for Biliary Tract Cancer

Abstract

Biliary tract cancer consists of cholangiocarcinoma (CC) and gallbladder cancer (GBC). When resectable, surgery provides the best chance at long-term survival. Unfortunately, surgery for these tumors is associated with long operative times, high morbidities, and prolonged hospital stays. Minimally invasive surgery has been shown to impact selected outcomes, including length of stay, in other diseases, and robotic surgery may offer additional advantages compared to laparoscopic surgery in treating bile duct cancers. This is a systematic review of robotic surgery for biliary tract cancer. Predetermined selection criteria were used to appraise the literature. The PRISMA guidelines were followed. In total, 20 unique articles with a total of 259 patients with biliary tract cancer undergoing robotic surgery met the inclusion criteria. For CC and GBC, respectively, the weighted average operative time was 401 and 277 min, the estimated blood loss was 348 and 260 mL, the conversion rate to open was 7 and 3.5%, the all-cause morbidity was 52 and 9.7%, the major morbidity was 12 and 4.4%, the perioperative mortality was 1.4 and 0%, the length of stay was 15 and 4.8 days, the positive margin rate was 27 and 9%, and the number of lymph nodes retrieved was 4.2 and 8. Robotic surgery for biliary tract cancer appears non-inferior to open surgery when compared to the published contemporary data. However, the current literature on the topic is of low quality, and future prospective/randomized studies are needed.

Is HPB robotic-assisted surgery an evolution or a revolution in laparoscopy?

“…Although some laparoscopic surgeries such as laparoscopic pancreaticoduodenectomy can be almost perfectly performed by specialized hepatobiliary and pancreatic centers, robotic-assisted surgery has pronounced advantages in small space operations when performing pancreaticojejunostomy, bile duct reconstruction and blood vessel reconstruction, etc. (14)(15)(16). Meanwhile, it is undeniable that robotic surgery has a relatively higher cost, which should be taken into reasonable consideration because the paid price also covers the cost of the development of medical science and technological equipment.…”

Prognostic role of the systemic immune-inflammation index in biliary tract cancers: a meta-analysis of 3,515 patients

“…Author details 1 Department of Oncology, Changxing People's Hospital, Huzhou 313100, Zhejiang, China. 2 Department of Hepatobiliary Surgery, Changxing People's Hospital, Huzhou 313100, Zhejiang, China. Zhang and Yao World Journal of Surgical Oncology (2022) 20:320…”

“…Biliary tract cancers (BTCs) comprise a heterogeneous group of aggressive malignancies involving the bile ducts and gallbladder [1]. BTC accounts for approximately 3% of all gastrointestinal malignancies and is the second most common primary hepatic malignancy after hepatocellular carcinoma [2]. BTC comprises intrahepatic cholangiocarcinoma (ICC), extrahepatic cholangiocarcinoma (ECC), and gallbladder cancer (GBC) [3].…”

“…The incidence of cholangiocarcinoma has been increasing worldwide, whereas that of GBC has been decreasing in recent years [4]. Surgical resection is the only method for the long-term survival of patients with resectable BTC [2]. However, approximately 80% of BTC cases are unresectable with clear margins or metastatic when diagnosed [5].…”

Insights on liver-directed surgical innovations, targeted therapies, and immunotherapy for biliary tract cancer: navigating the new European Society for Medical Oncology (ESMO) Clinical Practice Guidelines

“…Needless to say, biology trumps technique, and for surgeries that can be done minimally invasively there is a future. Certainly, an ever-increasing number of gallbladder cancers are being addressed minimally invasively, and our recent review has concluded that robotic surgery for biliary tract cancer appears non-inferior to open surgery when compared to published contemporary data ( 4 ).…”