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

Abstract

Abstract Background Although robotic radical resection for hilar cholangiocarcinoma(HCCA) has been reported in few cases in some large hepatobiliary centers, biliary-enteric reconstruction (BER) is still a critical step which restricts the success of the operation. This study aimed to evaluate the feasibility and quality of BER in robotic and laparoscopic radical resection of HCCA and propose technical recommendations. Methods A retrospective study was conducted on patients with HCCA who underwent minimally invasive radical resection at Zhejiang Provincial People’s Hospital from January 2016 to July 2023. A 1:2 propensity score matching (PSM), which is widely used to reduce selection bias, was performed to evaluate the surgical outcomes, especially BER-related data between robotic and laparoscopic surgery. Results 46 HCCA patients were enrolled. After PSM at a ratio of 1:2, 10 and 20 patients were assigned to the robotic-assisted and laparoscopic groups, respectively. And the baseline characteristics of two groups were generally well balanced. The average time of liver resection in the robotic group was longer than that in the laparoscopic group( 139.5 ± 38.8 vs 108.1 ± 35.8, P = 0.036), but the former had less intraoperative blood loss(200(50–500) vs 310(100–850)), even though there was no statistical difference(P = 0.109). The biliary residuals number was 2.6 ± 1.3 and 2.7 ± 1.2(P = 0.795); the number of anastomoses were both 1.6 ± 0.7 in two groups(P = 0.965); the time of BER was 38.4 ± 13.6 and 59.1 ± 25.5 min(P = 0.024), 9.9 ± 2.8% and 15.4 ± 4.8% of the total operation time(P = 0.001). Although postoperative bile leakage incidence in laparoscopic group(40.0%)was higher than that in robotic group(10.0%), there was no significant difference between two groups(P = 0.204); 6.7 ± 4.4 and 12.1 ± 11.7 days for tube drawing(P = 0.019); anastomosis stenosis and calculus rate was 10.0% and 30.0% (P = 0.372), 0.0% and 15%(P = 0.532), respectively. Neither group had a hemorrhage or bile leakage-related death. Conclusion Robotic radical resection for HCCA may offer the comparable perioperative outcomes as conventional laparoscopic procedure, and tend to be associated with more advantages in terms of anastomosis time and quality, we are optimistic with its wide application in future with the improvement of surgical techniques and experience.