title: The role of minimally invasive surgery in the treatment of cholangiocarcinoma.
abstract: Cholangiocarcinoma (CC) is the second most common type of primary liver cancer after hepatocellular carcinoma. Surgical resection is considered the only curative treatment for CC. In general, laparoscopic liver surgery (LLS) is associated with improved short-term outcomes without compromising the long-term oncological outcome. However, the role of LLS in the treatment of CC is not yet well established. In addition, CC may arise in any tract of the biliary tree, thus requiring different types of treatment, including pancreatectomies and extrahepatic bile duct resections. This review presents and discusses the state of the art in the laparoscopic and robotic surgical treatment of all types of CC. An electronic search was performed to identify all studies dealing with laparoscopic or robotic surgery and cholangiocarcinoma. Laparoscopic resection in patients with intrahepatic CC (ICC) is feasible and safe. Regarding oncologic adequacy, as R0 resections, depth of margins, and long-term overall and disease-free survival, laparoscopy is comparable to open procedures for ICC. An adequate patient selection is required to obtain optimal results. Use of laparoscopy in perihilar CC (PHC) has not gained popularity. Further studies are still needed to confirm the benefit of this approach over conventional surgery for PHC. Laparoscopic pancreaticoduodenectomy for distal CC (DCC) represents one of the most advanced abdominal operations owing to the necessity of a complex dissection and reconstruction and has also had small widespread so far. Minimally invasive surgery seems feasible and safe especially for ICC. Laparoscopy for PHC is technically challenging notably for the caudate lobectomy. Not least as for the LLR, the robotic approach for DCC appears technically achievable in selected patients.
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy; Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy. Electronic address: gblevisandri@gmail.com.
authors.forename: G B
authors.initials: GB
authors.lastname: Levi Sandri
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, The Freeman Hospital, Newcastle upon Tyne, Tyne and Wear, United Kingdom.
authors.forename: G
authors.initials: G
authors.lastname: Spoletini
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mascianà
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Colasanti
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Lepiane
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Vennarecci
authors.affiliation: Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: D'Andrea
authors.affiliation: Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy.
authors.forename: G M
authors.initials: GM
authors.lastname: Ettorre
mesh_terms: D001650:Bile Duct Neoplasms / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic; D018281:Cholangiocarcinoma / Q000601:surgery*; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D000072662:Margins of Excision; D018365:Neoplasm, Residual; D016577:Pancreaticoduodenectomy / Q000379:methods; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D015996:Survival Rate
keywords: Cholangiocarcinoma; Laparoscopy; Liver; Robotic; Surgery