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Huang J, Li JW, Xu D. Total Laparoscopic Radical Resection of S1 + S4 for Bismuth-Corlette Type IV Hilar Cholangiocarcinoma (With Video). Ann Surg Oncol 2024; 31:5631-5635. [PMID: 38833055 DOI: 10.1245/s10434-024-15531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/13/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND The management of Bismuth-Corlette type IV hilar cholangiocarcinoma typically necessitates extensive hepatectomy, resection of the extrahepatic bile ducts, regional lymph node dissection, and reconstruction of the biliary tract; however, there is a high incidence of postoperative liver dysfunction and failure. METHODS A 64-year-old male patient was admitted to our department after 1 month of escalating jaundice and abdominal discomfort. Upon admission, his total bilirubin was 334 μmol/L and his direct bilirubin was 221 μmol/L. His carbohydrate antigen 19-9 was > 1200.00 U/mL, his carcinoembryonic antigen was 98.90 U/mL, and his α-fetoprotein was normal. Enhanced computed tomography (CT) and magnetic resonance imaging scans revealed a thickened and enlarged biliary tree extending from the common hepatic duct to the orifices of the left and right hepatic ducts. RESULTS The patient underwent total laparoscopic radical resection of S1 + S4, accompanied by radical lymphadenectomy with skeletonization and biliary reconstruction. The surgery was successfully conducted within 450 min, with a minimal blood loss of 200 mL. The histological grading was T2bN1M0 (stage III). CT on postoperative day 5 showed satisfactory postoperative recovery. The patient was discharged from the hospital on postoperative day 10 without complications, following which the patient underwent a regimen of single-agent capecitabine chemotherapy. Over a 20-month follow-up period, no recurrence was observed. CONCLUSIONS Resection of hepatic segments S1 + S4 is a viable surgical option for hilar carcinoma in cases with poor liver function or when the carcinoma is confined to both hepatic ducts without invasion of the hepatic artery and portal vein.
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Affiliation(s)
- Jie Huang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
| | - Jian-Wei Li
- Department of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Dingwei Xu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Hu XS, Wang Y, Pan HT, Zhu C, Chen SL, Zhou S, Liu HC, Pang Q, Jin H. "Hepatic hilum area priority, liver posterior first": An optimized strategy in laparoscopic resection for type III-IV hilar cholangiocarcinoma. World J Gastrointest Surg 2024; 16:2167-2174. [PMID: 39087123 PMCID: PMC11287698 DOI: 10.4240/wjgs.v16.i7.2167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/31/2024] [Accepted: 06/20/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND In recent years, pure laparoscopic radical surgery for Bismuth-Corlette type III and IV hilar cholangiocarcinoma (HCCA) has been preliminarily explored and applied, but the surgical strategy and safety are still worthy of further improvement and attention. AIM To summarize and share the application experience of the emerging strategy of "hepatic hilum area dissection priority, liver posterior separation first" in pure laparoscopic radical resection for patients with HCCA of Bismuth-Corlette types III and IV. METHODS The clinical data and surgical videos of 6 patients with HCCA of Bismuth-Corlette types III and IV who underwent pure laparoscopic radical resection in our department from December 2021 to December 2023 were retrospectively analyzed. RESULTS Among the 6 patients, 4 were males and 2 were females. The average age was 62.2 ± 11.0 years, and the median body mass index was 20.7 (19.2-24.1) kg/m2. The preoperative median total bilirubin was 57.7 (16.0-155.7) μmol/L. One patient had Bismuth-Corlette type IIIa, 4 patients had Bismuth-Corlette type IIIb, and 1 patient had Bismuth-Corlette type IV. All patients successfully underwent pure laparoscopic radical resection following the strategy of "hepatic hilum area dissection priority, liver posterior separation first". The operation time was 358.3 ± 85.0 minutes, and the intraoperative blood loss volume was 195.0 ± 108.4 mL. None of the patients received blood transfusions during the perioperative period. The median length of stay was 8.3 (7.0-10.0) days. Mild bile leakage occurred in 2 patients, and all patients were discharged without serious surgery-related complications. CONCLUSION The emerging strategy of "hepatic hilum area dissection priority, liver posterior separation first" is safe and feasible in pure laparoscopic radical surgery for patients with HCCA of Bismuth-Corlette types III and IV. This strategy is helpful for promoting the modularization and process of pure laparoscopic radical surgery for complicated HCCA, shortens the learning curve, and is worthy of further clinical application.
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Affiliation(s)
- Xiao-Si Hu
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Yong Wang
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Hong-Tao Pan
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Chao Zhu
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Shi-Lei Chen
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Shuai Zhou
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Hui-Chun Liu
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Qing Pang
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
| | - Hao Jin
- Department of Hepatopancreatobiliary Surgery, Anhui No. 2 Provincial People's Hospital, Hefei 230041, Anhui Province, China
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Jiang X, Cai Z, Dai X, Pan L. Surgical effect and gastrointestinal functional recovery of laparoscopic-guided total mesorectal excision in patients with rectal cancer. J Minim Access Surg 2024; 20:258-265. [PMID: 38240276 DOI: 10.4103/jmas.jmas_122_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/25/2023] [Indexed: 07/26/2024] Open
Abstract
INTRODUCTION To explore the surgical effect and gastrointestinal functional recovery of laparoscopic-guided total mesorectal excision (LGTME) in patients with rectal cancer. PATIENTS AND METHODS A total of 150 rectal cancer patients who underwent surgical treatment in our hospital from July 2022 to July 2023 were selected and randomly divided into two groups using a random number table. There were 75 cases in the control group (CG) who underwent traditional open rectal total mesorectal excision surgery and 75 cases in the experimental group (EG) who underwent LGTME. The surgical effects of the two groups were compared, and the gastrointestinal and anal functional recovery of the two groups were compared before and after treatment. RESULTS Intraoperative bleeding, incision length, time to initial feeding and time to anal exhaust in the EG were significantly lower than those in the CG ( P < 0.05). Before treatment, there was no significant difference in gastrointestinal function and anal function between the two groups ( P > 0.05). After treatment, the levels of motilin, gastrin, neuropeptide Y and basic fibroblast growth factor in the EG were significantly higher than those in the CG, with statistical significance ( P < 0.05); the maximum anal systolic pressure and resting anal sphincter pressure in the EG were significantly lower than those in the CG ( P < 0.05); the rectal sensitivity threshold volume (RSTV) and rectal maximum volume threshold in the EG were significantly higher than those in the CG ( P < 0.05). There was no significant difference in most postoperative complications between the two groups ( P > 0.05). CONCLUSION LGTME improves the surgical effects of rectal cancer patients, promotes the recovery of gastrointestinal function and has a small effect on anal function indicators, thereby reducing hospital stay.
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Affiliation(s)
- Xingli Jiang
- Department of General Surgery, The People's Hospital of Yuhuan, Yuhuan, China
| | - Zhenfeng Cai
- Department of Anaesthesiology, The People's Hospital of Yuhuan, Yuhuan, China
| | - Xintao Dai
- Department of Anaesthesiology, The People's Hospital of Yuhuan, Yuhuan, China
| | - Luofeng Pan
- Department of General Surgery, The People's Hospital of Yuhuan, Yuhuan, China
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Minamimura K, Aoki Y, Kaneya Y, Matsumoto S, Arai H, Kakinuma D, Oshiro Y, Kawano Y, Watanabe M, Nakamura Y, Suzuki H, Yoshida H. Current Status of Robotic Hepatobiliary and Pancreatic Surgery. J NIPPON MED SCH 2024; 91:10-19. [PMID: 38233127 DOI: 10.1272/jnms.jnms.2024_91-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Laparoscopic surgery is performed worldwide and has clear economic and social benefits in terms of patient recovery time. It is used for most gastrointestinal surgical procedures, but laparoscopic surgery for more complex procedures in the esophageal, hepatobiliary, and pancreatic regions remains challenging. Minimally invasive surgery that results in accurate tumor dissection is vital in surgical oncology, and development of surgical systems and instruments plays a key role in assisting surgeons to achieve this. A notable advance in the latter half of the 1990s was the da Vinci Surgical System, which involves master-slave surgical support robots. Featuring high-resolution three-dimensional (3D) imaging with magnification capabilities and forceps with multi-joint function, anti-shake function, and motion scaling, the system compensates for the drawbacks of conventional laparoscopic surgery. It is expected to be particularly useful in the field of hepato-biliary-pancreatic surgery, which requires delicate reconstruction involving complex liver anatomy with diverse vascular and biliary systems and anastomosis of the biliary tract, pancreas, and intestines. The learning curve is said to be short, and it is hoped that robotic surgery will be standardized in the near future. There is also a need for a standardized robotic surgery training system for young surgeons that can later be adapted to a wider range of surgeries. This systematic review describes trends and future prospects for robotic surgery in the hepatobiliary-pancreatic region.
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Affiliation(s)
| | - Yuto Aoki
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Youhei Kaneya
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | | | - Hiroki Arai
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Daisuke Kakinuma
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Yukio Oshiro
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Yoichi Kawano
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
| | | | | | - Hideyuki Suzuki
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital
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Liu W, Xiong F, Wu G, Wang Q, Wang B, Chen Y. Biliary-enteric reconstruction in laparoscopic radical resection of hilar cholangiocarcinoma: a single-center retrospective cohort study. BMC Cancer 2023; 23:456. [PMID: 37202725 DOI: 10.1186/s12885-023-10942-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE To evaluate the feasibility and quality of biliary-enteric reconstruction (BER) in laparoscopic radical resection of hilar cholangiocarcinoma (LsRRH) versus open surgery and propose technical recommendations. METHODS Data of 38 LsRRH and 54 radical laparotomy resections of hilar cholangiocarcinoma (LtRRH) cases were collected from our institution. BER was evaluated via biliary residuals numbers, number of anastomoses, anastomosis manner, suture method, time consumption, and postoperative complication. RESULTS In the LsRRH group, patients were relatively younger; Bismuth type I had a higher proportion while type IIIa and IV were less and required no revascularization. In LsRRH and LtRRH groups, respectively, the biliary residuals number was 2.54 ± 1.62 and 2.47 ± 1.46 (p > 0.05); the number of anastomoses was 2.04 ± 1.27 and 2.57 ± 1.33 (p > 0.05); the time of BER was 65.67 ± 21.53 and 42.5 ± 19.77 min (p < 0.05), 15.08 ± 3.64% and 11.76 ± 2.54% of the total operation time (p < 0.05); postoperative bile leakage incidence was 15.79% and 16.67% (p > 0.05); 14 ± 10.28 and 17 ± 9.73 days for healing (p < 0.05); anastomosis stenosis rate was 2.63% and 1.85% (p > 0.05). Neither group had a biliary hemorrhage or bile leakage-related death. CONCLUSION The selection bias in LsRRH mainly affects tumor resection than BER. Our cohort study indicates that BER in LsRRH is technically feasible and equals anastomotic quality to open surgery. However, its longer and a more significant proportion of total operation time represent that BER has higher technical requirements and is one of the critical rate-limiting steps affecting the minimal invasiveness of LsRRH.
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Affiliation(s)
- Wenzheng Liu
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Fei Xiong
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Guanhua Wu
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Qi Wang
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Bing Wang
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yongjun Chen
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
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Wang M, Qin T, Zhang H, Li J, Deng X, Zhang Y, Zhao W, Fan Y, Li D, Chen X, Feng Y, Zhu S, Xing Z, Yu G, Xu J, Xie J, Dou C, Ma H, Liu G, Shao Y, Chen W, Liu J, Liu J, Yin X, Qin R. Laparoscopic versus open surgery for perihilar cholangiocarcinoma: a multicenter propensity score analysis of short- term outcomes. BMC Cancer 2023; 23:394. [PMID: 37138243 PMCID: PMC10157952 DOI: 10.1186/s12885-023-10783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Laparoscopic surgery (LS) has been increasingly applied in perihilar cholangiocarcinoma (pCCA). In this study, we intend to compare the short-term outcomes of LS versus open operation (OP) for pCCA in a multicentric practice in China. METHODS This real-world analysis included 645 pCCA patients receiving LS and OP at 11 participating centers in China between January 2013 and January 2019. A comparative analysis was performed before and after propensity score matching (PSM) in LS and OP groups, and within Bismuth subgroups. Univariate and multivariate models were performed to identify significant prognostic factors of adverse surgical outcomes and postoperative length of stay (LOS). RESULTS Among 645 pCCAs, 256 received LS and 389 received OP. Reduced hepaticojejunostomy (30.89% vs 51.40%, P = 0.006), biliary plasty requirement (19.51% vs 40.16%, P = 0.001), shorter LOS (mean 14.32 vs 17.95 d, P < 0.001), and lower severe complication (CD ≥ III) (12.11% vs. 22.88%, P = 0.006) were observed in the LS group compared with the OP group. Major postoperative complications such as hemorrhage, biliary fistula, abdominal abscess, and hepatic insufficiency were similar between LS and OP (P > 0.05 for all). After PSM, the short-term outcomes of two surgical methods were similar, except for shorter LOS in LS compared with OP (mean 15.19 vs 18.48 d, P = 0.0007). A series subgroup analysis demonstrated that LS was safe and had advantages in shorting LOS. CONCLUSION Although the complex surgical procedures, LS generally seems to be safe and feasible for experienced surgeons. TRIAL REGISTRATION NCT05402618 (date of first registration: 02/06/2022).
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Affiliation(s)
- Min Wang
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Tingting Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Hang Zhang
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Jingdong Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Hepatobiliary, Pancreatic and Intestinal Diseases Research Institute of North Sichuan Medical College, Nanchong, 637000, China
| | - Xiaxing Deng
- Department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 310000, China
| | - Yuhua Zhang
- Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310003, China
| | - Wenxing Zhao
- Department of General Surgery, the Affiliated Hospital of Xuzhou Medical University Xuzhou, Jiangsu, 221000, China
| | - Ying Fan
- Department of the Second General Surgery, Sheng Jing Hospital of China Medical University, Liaoning, 110000, China
| | - Dewei Li
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xuemin Chen
- Department of Hepatopancreatobiliary Surgery, Third Affiliated Hospital of Soochow University, Suzhou, 213003, China
| | - Yechen Feng
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Siwei Zhu
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China
| | - Zhongqiang Xing
- Department of Hepato-Pancreato-Biliary Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang, 050017, Hebei, China
| | - Guangsheng Yu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China
| | - Jian Xu
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Hepatobiliary, Pancreatic and Intestinal Diseases Research Institute of North Sichuan Medical College, Nanchong, 637000, China
| | - Junjie Xie
- Department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 310000, China
| | - Changwei Dou
- Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310003, China
| | - Hongqin Ma
- Department of General Surgery, the Affiliated Hospital of Xuzhou Medical University Xuzhou, Jiangsu, 221000, China
| | - Gangshan Liu
- Department of the Second General Surgery, Sheng Jing Hospital of China Medical University, Liaoning, 110000, China
| | - Yue Shao
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Weibo Chen
- Department of Hepatopancreatobiliary Surgery, Third Affiliated Hospital of Soochow University, Suzhou, 213003, China
| | - Jun Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, 27397 Jingshi Road, Jinan, 250022, China.
| | - Jianhua Liu
- Department of Hepato-Pancreato-Biliary Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang, 050017, Hebei, China.
| | - Xinmin Yin
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, 410005, Hunan, China.
| | - Renyi Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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Qin T, Wang M, Zhang H, Li J, Deng X, Zhang Y, Zhao W, Fan Y, Li D, Chen X, Feng Y, Zhu S, Xing Z, Yu G, Xu J, Xie J, Dou C, Ma H, Liu G, Shao Y, Chen W, Xu S, Liu J, Liu J, Yin X, Qin R. The Long-Term Outcome of Laparoscopic Resection for Perihilar Cholangiocarcinoma Compared with the Open Approach: A Real-World Multicentric Analysis. Ann Surg Oncol 2023; 30:1366-1378. [PMID: 36273058 PMCID: PMC9589740 DOI: 10.1245/s10434-022-12647-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study was to compare the short- and long-term outcomes of laparoscopic surgery (LS) and open surgery (OP) for perihilar cholangiocarcinoma (PHC) using a large real-world dataset in China. METHODS Data of patients with PHC who underwent LS and OP from January 2013 to October 2018, across 10 centers in China, were extracted from medical records. A comparative analysis was performed before and after propensity score matching (PSM) in the LS and OP groups and within the study subgroups. The Cox proportional hazards mixed-effects model was applied to estimate the risk factors for mortality, with center and year of operation as random effects. RESULTS A total of 467 patients with PHC were included, of whom 161 underwent LS and 306 underwent OP. Postoperative morbidity, such as hemorrhage, biliary fistula, abdominal abscess, and hepatic insufficiency, was similar between the LS and OP groups. The median overall survival (OS) was longer in the LS group than in the OP group (NA vs. 22 months; hazard ratio [HR] 1.19, 95% confidence interval [CI] 1.02-1.39, p = 0.024). Among the matched datasets, OS was comparable between the LS and OP groups (NA vs. 35 months; HR 0.99, 95% CI 0.77-1.26, p = 0.915). The mixed-effect model identified that the surgical method was not associated with long-term outcomes and that LS and OP provided similar oncological outcomes. CONCLUSIONS Considering the comparable long-term prognosis and short-term outcomes of LS and OP, LS could be a technically feasible surgical method for PHC patients with all Bismuth-Corlett types of PHC.
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Affiliation(s)
- Tingting Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Min Wang
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hang Zhang
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jingdong Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Hepatobiliary, Pancreatic and Intestinal Diseases Research Institute of North Sichuan Medical College, Nanchong, China
| | - Xiaxing Deng
- Department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhua Zhang
- Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310003, China
| | - Wenxing Zhao
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University Xuzhou, Jiangsu, China
| | - Ying Fan
- Department of the Second General Surgery, Sheng Jing Hospital of China Medical University, Liaoning, China
| | - Dewei Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemin Chen
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Suzhou, China
| | - Yechen Feng
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Siwei Zhu
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Zhongqiang Xing
- Department of Hepato-Pancreato-Biliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Guangsheng Yu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shangdong, China
| | - Jian Xu
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Hepatobiliary, Pancreatic and Intestinal Diseases Research Institute of North Sichuan Medical College, Nanchong, China
| | - Junjie Xie
- Department of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Changwei Dou
- Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310003, China
| | - Hongqin Ma
- Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University Xuzhou, Jiangsu, China
| | - Gangshan Liu
- Department of the Second General Surgery, Sheng Jing Hospital of China Medical University, Liaoning, China
| | - Yue Shao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weibo Chen
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Suzhou, China
| | - Simiao Xu
- Department of Endocrinology, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Liu
- Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shangdong, China.
| | - Jianhua Liu
- Department of Hepato-Pancreato-Biliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
| | - Xinmin Yin
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China.
| | - Renyi Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Pure robotic major hepatectomy with biliary reconstruction for hepatobiliary malignancies: first European results. Surg Endosc 2023:10.1007/s00464-023-09863-5. [PMID: 36759354 DOI: 10.1007/s00464-023-09863-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Combined liver and bile duct resection with biliary reconstruction for hepatobiliary malignancies are defined as highly complex surgical procedures. The robotic platform may overcome some major limitations of conventional laparoscopic surgery for these complex cases but its precise role is however still to be defined. METHODS In our institution, patients requiring major hepatectomy with biliary reconstruction for malignancies were consecutively selected for minimally invasive robotic surgery from September 2020. All surgeries were undertaken using the da Vinci Xi Surgical System® (Intuitive Surgical, Sunnyvale, CA, USA). Intra-operative technique and postoperative outcome were analyzed. RESULTS A total number of 10 patients (3 males and 7 females, median age 72 years) underwent robotic major hepatectomy and bile duct resection for hepatobiliary malignancies between September 2020 and March 2022. The indication for surgery was perihilar cholangiocarcinoma in 5 of 10 patients. Median operative time was 338 min and median blood loss was 110 mL. Postoperative length of stay was between 3 and 16 days (median: 9 days). There was no postoperative 90-day mortality. CONCLUSIONS A robotic approach for hepatobiliary malignancies requiring combined major hepatectomy and bile duct resection seems feasible and safe in experienced hands.
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Bahra M, Ossami Saidy RR. Current status of robotic surgery for hepato-pancreato-biliary malignancies. Expert Rev Anticancer Ther 2022; 22:939-946. [PMID: 35863758 DOI: 10.1080/14737140.2022.2105211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Robotic surgery is an emerging aspect of gastrointestinal surgery. Hepato-pancreato-biliary surgery is currently being explored for a broad spectrum of indications, entities, and postoperative outcomes. Noninferiority and financial aspects are the focus of studies. In this review, the impact on oncological therapies is assessed. AREAS COVERED An extensive literature review was conducted, and relevant studies and articles and reviews for robotic surgery in the field of hepato-pancreato-biliary surgery were examined. Special attention was given to the oncological aspects of robotic surgery and its possible impact on the therapy of malignant neoplasms. EXPERT OPINION Robotic-assisted surgery for oncological indications is promising, in part, an established technique that has already shown its advantages in the last decade, although high-quality studies are missing. Upcoming experience must consider the oncological benefit and putative new indications in a rapidly changing field of anti-neoplastic regimens. Also, robotic surgery may possess the ability to accelerate digitalization and AI-based augmentation in this context.
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Affiliation(s)
- Marcus Bahra
- Krankenhaus Waldfriede, Akademisches Lehrkrankenhaus der Charité, Zentrum für Onkologische Oberbauchchirurgie und Robotik, Argentinische Allee 40, 14163 Berlin
| | - Ramin Raul Ossami Saidy
- Krankenhaus Waldfriede, Akademisches Lehrkrankenhaus der Charité, Zentrum für Onkologische Oberbauchchirurgie und Robotik, Argentinische Allee 40, 14163 Berlin
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A Retrospective, Single-Centre Study on the Learning Curve for Liver Tumor Open Resection in Patients with Hepatocellular Cancers and Intrahepatic Cholagangiocarcinomas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084872. [PMID: 35457739 PMCID: PMC9031011 DOI: 10.3390/ijerph19084872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Liver resections have become the first-line treatment for primary malignant tumors and, therefore, are considered a core aspect of surgical training. This study aims to evaluate the learning curve for the safety of open hemihepatectomy procedures for patients suffering from hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC). METHODS This single tertiary center retrospective analysis includes 81 consecutive cases of right or left hemihepatectmy. A cumulative sum (CUSUM) control chart was used to investigate the learning curve. RESULTS The CUSUM curve for operative time and blood loss level peaked at the 29th and 30th case, respectively. The CUSUM curve for minor adverse effects (mAEs) and severe adverse effects (sAEs) showed a downward slope after the 27th and 36th procedures; the curve, however, remained within the acceptable range throughout the entire study. CONCLUSION When performing open hemihepatectomies in patients with HCC and ICC, the stabilization of the operative time and intraoperative blood loss level are gained earlier than sAEs risk reduction.
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Spiegelberg J, Iken T, Diener MK, Fichtner-Feigl S. Robotic-Assisted Surgery for Primary Hepatobiliary Tumors-Possibilities and Limitations. Cancers (Basel) 2022; 14:cancers14020265. [PMID: 35053429 PMCID: PMC8773643 DOI: 10.3390/cancers14020265] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Primary liver malignancies are some of the most common and fatal tumors today. Robotic-assisted liver surgery is becoming increasingly interesting for both patients and surgeons alike. Up to date, prospective comparative studies around the topic are scarce. This leads us to an ever existing controversy about the efficacy, safety, and economic benefits of robotic surgery as an extension of traditional minimally invasive surgery over open liver surgery. However, there is evidence that robotic-assisted surgery is, after passing the learning curve, equivalent in terms of feasibility and safety, and in some cases superior to traditional laparoscopic hepatic resection. With this work, we want to provide an overview of the latest and most significant reviews and meta-analyses focusing on robotic hepatectomy in primary liver malignancies. We outline the technical aspects of robotic-assisted surgery and place them into the context of technical, surgical, and oncological outcomes compared with laparoscopic and open resection. When chosen per case individually, any hepatic resection can be performed robotically to overcome limitations of laparoscopic surgery by an experienced team. In this paper, we propose that prospective studies are needed to prove efficacy for robotic-assisted resection in liver malignancy. Abstract Hepatocellular and cholangiocellular carcinoma are fatal primary hepatic tumors demanding extensive liver resection. Liver surgery is technically challenging due to the complex liver anatomy, with an intensive and variant vascular and biliary system. Therefore, major hepatectomies in particular are often performed by open resection and minor hepatectomies are often performed minimally invasively. More centers have adopted robotic-assisted surgery, intending to improve the laparoscopic surgical limits, as it offers some technical benefits such as seven degrees of freedom and 3D visualization. The da Vinci® Surgical System has dominated the surgical robot market since 2000 and has shown surgical feasibility, but there is still much controversy about its economic benefits and real benefits for the patient over the gold standard. The currently available retrospective case studies are difficult to compare, and larger, prospective studies and randomized trials are still urgently missing. Therefore, here we summarize the technical, surgical, and economic outcomes of robotic versus open and laparoscopic hepatectomies for primary liver tumors found in the latest literature reviews and meta-analyses. We conclude that complex robotic liver resections (RLR) are safe and feasible after the steep learning curve of the surgical team has plateaued. The financial burden is lower in high volume centers and is expected to decrease soon as new surgical systems will enter the market.
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Sucandy I, Shapera E, Jacob K, Luberice K, Crespo K, Syblis C, Ross SB, Rosemurgy AS. Robotic resection of extrahepatic cholangiocarcinoma: Institutional outcomes of bile duct cancer surgery using a minimally invasive technique. J Surg Oncol 2021; 125:161-167. [PMID: 34524689 DOI: 10.1002/jso.26674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/09/2021] [Accepted: 08/28/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study is to report our early experience and outcomes, the first in North America, of Extrahepatic Cholangiocarcinoma (EHC) resection with Roux-en Y Hepaticojejunostomy reconstruction via the robotic approach. METHODS With Institutional Review Board approval, 15 patients who underwent robotic resection of EHC were studied. RESULTS Patients were 74 (73 ± 8.9) years of age. There were 9 men and 6 women. Average body mass index was 24 (27 ± 6.3) kg·m-2 . Mean & Median ASA class was 3. Median Tumor size was 2 (2 ± 1.3) cm. There were no intraoperative complications. Operative duration was 453 (443 ± 85.0) minutes and the estimated blood loss was 150 (182 ± 138.4) ml. No patient required admission to the intensive care unit. Hospital length of stay was 4 (6 ± 3.2) days. There was one patient with Clavien-Dindo Class 3 or greater complication. No mortality was seen in this series. DISCUSSION Robotic resection of EHC is safe, feasible, and reproducible with excellent clinical outcomes. Consequently, the robotic technique should be considered in some patients requiring EHC resection.
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Affiliation(s)
- Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, Tampa, Florida, USA
| | - Emanuel Shapera
- Digestive Health Institute, AdventHealth Tampa, Tampa, Florida, USA
| | - Kevin Jacob
- Digestive Health Institute, AdventHealth Tampa, Tampa, Florida, USA
| | - Kenneth Luberice
- Digestive Health Institute, AdventHealth Tampa, Tampa, Florida, USA
| | - Kaitlyn Crespo
- Digestive Health Institute, AdventHealth Tampa, Tampa, Florida, USA
| | - Cameron Syblis
- Digestive Health Institute, AdventHealth Tampa, Tampa, Florida, USA
| | - Sharona B Ross
- Digestive Health Institute, AdventHealth Tampa, Tampa, Florida, USA
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Xu X. Diagnosis of hilar cholangiocarcinoma using intravoxel incoherent motion diffusion-weighted magnetic resonance imaging. Abdom Radiol (NY) 2021; 46:3159-3167. [PMID: 33660039 DOI: 10.1007/s00261-021-02997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/02/2021] [Accepted: 02/11/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate the value of intravoxel incoherent motion diffusion-weighed magnetic resonance imaging (IVIM-DWI) in discriminating the pathological grades of hilar cholangiocarcinoma (HC). PATIENTS AND METHODS Thirty-seven HC patients were enrolled and received routine and advanced DWI scanning with multiple b-values. IVIM-DWI images were obtained using echo-planar imaging sequence. RESULTS The consistency of the maximum cross-sectional area ROI measuring method was higher than that of the repeated sampling ROI measuring method. ADCslow values were closely correlated with the pathological grades of HC. The degrees of biliary dilatation and MELD scores had no influence on the negative correlation between ADCslow values and the pathological degrees of HC patients. CONCLUSIONS ADCslow values could be applied in indicating the pathological grades of HC, which was independent on the extent of biliary dilatation.
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Cillo U, D'Amico FE, Furlanetto A, Perin L, Gringeri E. Robotic hepatectomy and biliary reconstruction for perihilar cholangiocarcinoma: a pioneer western case series. Updates Surg 2021; 73:999-1006. [PMID: 33861401 PMCID: PMC8184707 DOI: 10.1007/s13304-021-01041-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/22/2021] [Indexed: 12/24/2022]
Abstract
Open surgery is the standard of care for perihilar cholangiocarcinoma (pCCA). With the aim of oncologic radicality, it requires a complex major hepatectomy with biliary reconstruction. The postoperative course is consequently often complicated, with severe morbidity and mortality rates of up to 27.5–54% and 18%, respectively. Robotic liver surgery is emerging as a safe, minimally-invasive technique with huge potential for pCCA management. After the first case described by Giulianotti in 2010, here we present the first western series of robot-assisted liver resections with biliary reconstruction for pCCA with the aim to preliminarily assess the feasibility and repeatability of the procedure. At our high-volume teaching hospital center dedicated to HPB surgery, 128 pCCA patients have been surgically treated in the last 15 years whereas more than 800 laparoscopic liver resections have been performed. Since the Da Vinci Xi Robotic platform was introduced in late 2018, 6 major robotic liver resections with biliary reconstruction have been performed, 4 of which were for pCCA. All 4 cases involved a left hepatectomy with caudate lobectomy. The median operating time was 840 min, with a median blood loss of 700 ml. One case was converted to open surgery during the reconstruction due to a short mesentery preventing the hepatico-jejunostomy. None of the patients experienced major complications, while minor complications occurred in 3 out of 4 cases. One biliary leak was managed conservatively. The median postoperative stay was 9 days. Negative biliary margins were achieved in 3 of the 4 cases. An included video clip shows the most relevant technical details. This preliminary series demonstrates that robot-assisted liver resection for pCCA is feasible. We speculate that the da Vinci platform has a relevant potential in pCCA surgery with particular reference to the multi-duct biliary reconstruction. Further studies are needed to better clarify the role of this high-cost technology in the minimally-invasive treatment of pCCA.
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Affiliation(s)
- Umberto Cillo
- Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, 2° Piano Policlinico, Via Giustiniani 2, 35128, Padua, Italy.
| | - Francesco Enrico D'Amico
- Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, 2° Piano Policlinico, Via Giustiniani 2, 35128, Padua, Italy
| | - Alessandro Furlanetto
- Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, 2° Piano Policlinico, Via Giustiniani 2, 35128, Padua, Italy
| | - Luca Perin
- Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, 2° Piano Policlinico, Via Giustiniani 2, 35128, Padua, Italy
| | - Enrico Gringeri
- Hepatobiliary Surgery and Liver Transplantation Unit, Padua University Hospital, 2° Piano Policlinico, Via Giustiniani 2, 35128, Padua, Italy
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