Robotic resection of hilar cholangiocarcinoma: a single institution experience

Aim: Hilar cholangiocarcinoma is an aggressive malignancy with a poor prognosis, for which only surgical resection offers potential cure. Because of its complex location in the porta hepatis, the standard surgical approach has been open surgery. With the gradual increase in the use of minimally invasive surgery, we aimed to describe our single institutional experience of robotic resection of hilar cholangiocarcinoma. To the best of our knowledge, this is the largest published series in North America. Methods: Between 2016-2022, we prospectively followed all patients who underwent robotic extrahepatic biliary resection for hilar cholangiocarcinoma. Results: Robotic resection of hilar cholangiocarcinoma was performed on 21 patients of median age 72 years, 16 (76%) of whom underwent concomitant hepatectomy. All patients initially presented with jaundice and underwent preoperative drainage. Median operative time was 458 minutes and the estimated blood loss was 150 mL. There were no intraoperative complications or conversions to open surgery. The length of stay was five days, with one readmission at 30 days. There were three postoperative complications and one postoperative mortality (at 90 days). R0 was attained in 90% (19/21) of cases and R1 in 10% (2/21). Our median follow-up time was 21 months. At the final follow-up, 15 patients were alive with no evidence of disease and six died. Conclusion: Robotic resection of hilar cholangiocarcinoma is safe and feasible and achieves excellent outcomes. We believe that robotic surgery will soon be an accepted approach for complex hepatobiliary resections, such as for hilar cholangiocarcinoma.