title: Robotic radical resection for hilar cholangiocarcinoma: perioperative and long-term outcomes of an initial series.
abstract: Radical resection for hilar cholangiocarcinoma (HCa) is one of the most challenging abdominal procedures. Robotic-assisted approach is gaining popularity in hepatobiliary surgery but scarcely tried in the management of HCa. We herein report our initial experience of robotic radical resection for HCa.
  
  
  
  Between May 2009 and October 2012, 10 patients underwent fully robotic-assisted radical resection for HCa in a single institute. The perioperative and long-term outcomes were analyzed and compared with a contemporaneous 32 patients undergoing traditional open surgery.
  
  
  
  The 10 patients presented one of Bismuth-Corlette type II, four of IIIa, one of IIIb and four of IV. There was no significant clinicopathological disparity between the robotic and open groups. The robotic radical resection involves hemihepatectomy plus caudate lobectomy or trisectionectomy, extrahepatic bile duct resection, radical lymphadenectomy and Roux-en-Y hepaticojejunostomy. No conversion to laparotomy occurred. Robotic resection compared unfavorably to traditional open resection in operative time (703 ± 62 vs. 475 ± 121 min, p < 0.001) and morbidity [90 (9/10) vs. 50 %, p = 0.031]. No significant difference was found in blood loss, mortality and postoperative hospital stay. Major complications (≥Clavien-Dindo III) occurred in three patients of robotic group. One patient died of posthepatectomy liver failure on postoperative day 18. The hospital expenditure was much higher in robotic group (USD 27,427 ± 21,316 vs. 15,282 ± 5957, p = 0.018). The tumor recurrence-free survival was inferior in robotic group (p = 0.029).
  
  
  
  Fully robotic-assisted radical resection for HCa is technically achievable in experienced hands and should be limited to highly selective patients. Our current results do not support continued practice of robotic surgery for HCa, until significant technical and instrumental refinements are demonstrated.
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China.
authors.forename: Yinzhe
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China.
authors.forename: Hongguang
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China.
authors.forename: Webin
authors.initials: W
authors.lastname: Ji
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China.
authors.forename: Maosheng
authors.initials: M
authors.lastname: Tang
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Leng
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Meng
authors.affiliation: Department of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian, Beijing, 100853, China. dongjh301@163.com.|Center for Hepatopancreatobiliary Diseases, Beijing Tsinghua Changgung Hospital, Tsinghua University Medical Center, 168 Litang Road, Changping, Beijing, 102218, China. dongjh301@163.com.
authors.forename: Jiahong
authors.initials: J
authors.lastname: Dong
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D018281:Cholangiocarcinoma / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*
keywords: Biliary reconstruction; Caudate lobectomy; Hilar cholangiocarcinoma; Liver resection; Lymphadenectomy; Robotic surgery