Abstract：
BACKGROUND: Perihilar cholangiocarcinoma, intrahepatic cholangiocarcinoma (IHCC), and gall bladder cancer are difficult malignancies to treat and are characterized by a tendency for local recurrence and a generally unfavorable prognosis. Surgical resection offers the only potential cure, conventionally performed via the open approach. Although minimally invasive approaches show promise, data remain limited.
METHODS: With the institutional review board\'s approval, we prospectively followed 100 patients between 2013 and 2023 who underwent robotic surgical resection for perihilar, IHCC, and gallbladder cholangiocarcinoma. Data are presented as median (mean ± SD). Significance was accepted at P ≤ .05.
RESULTS: The median patient age was 70 years, and the median operative duration was 333 min, with an estimated blood loss of 200 mL. Importantly, no unplanned conversions occurred, and only 1 intraoperative complication occurred within the IHCC cohort. The median length of stay was 4 days. There were a total of 19 postoperative complications and 19 readmissions within 30 days. Additionally, there were 3 in-hospital mortalities and 5 90-day mortalities. R0 resection was achieved in 87% of patients and R1 resection in 13%. At a median follow-up of 36 months, 62% of patients demonstrated disease-free survival, whereas 6% continued to live with the disease, and 32% did not survive.
CONCLUSIONS: Our experience demonstrates the feasibility and safety of robotic resection for these complex malignancies, yielding promising short-term outcomes. Further investigation is required to ascertain the long-term oncologic outcomes.
METHODS: With the institutional review board\'s approval, we prospectively followed 100 patients between 2013 and 2023 who underwent robotic surgical resection for perihilar, IHCC, and gallbladder cholangiocarcinoma. Data are presented as median (mean ± SD). Significance was accepted at P ≤ .05.
RESULTS: The median patient age was 70 years, and the median operative duration was 333 min, with an estimated blood loss of 200 mL. Importantly, no unplanned conversions occurred, and only 1 intraoperative complication occurred within the IHCC cohort. The median length of stay was 4 days. There were a total of 19 postoperative complications and 19 readmissions within 30 days. Additionally, there were 3 in-hospital mortalities and 5 90-day mortalities. R0 resection was achieved in 87% of patients and R1 resection in 13%. At a median follow-up of 36 months, 62% of patients demonstrated disease-free survival, whereas 6% continued to live with the disease, and 32% did not survive.
CONCLUSIONS: Our experience demonstrates the feasibility and safety of robotic resection for these complex malignancies, yielding promising short-term outcomes. Further investigation is required to ascertain the long-term oncologic outcomes.
摘要：
背景：肝门部胆管癌，肝内胆管癌，胆囊癌是很难治疗的恶性肿瘤，其特点是局部复发倾向和预后普遍不利。手术切除是唯一潜在的治疗方法,通常通过开放式方法执行。虽然微创方法显示出希望，数据仍然有限。
方法：经IRB批准，我们前瞻性随访了2013-2023年间100例接受机器人手术切除肺门周围的患者，肝内（IHCC）和胆囊胆管癌。数据表示为中值(平均值±标准偏差)。在p≤0.05时接受显著性。
结果：患者年龄中位数为70岁，中位手术时间为333分钟，估计失血量为200mL。重要的是,没有计划外的转换，IHCC队列中仅发生1例术中并发症。中位住院时间为4天。术后并发症共19例，30天内再入院19例。此外,有3例住院死亡率和5例90天死亡率。87%的患者实现了R0切除，R1切除13%。在中位随访36个月时，62%的患者无病生存,而6%的人继续患有这种疾病，32%的人没有存活。
结论：我们的经验证明了机器人切除这些复杂恶性肿瘤的可行性和安全性，产生有希望的短期结果。需要进一步的调查以确定长期的肿瘤学结果。
方法：经IRB批准，我们前瞻性随访了2013-2023年间100例接受机器人手术切除肺门周围的患者，肝内（IHCC）和胆囊胆管癌。数据表示为中值(平均值±标准偏差)。在p≤0.05时接受显著性。
结果：患者年龄中位数为70岁，中位手术时间为333分钟，估计失血量为200mL。重要的是,没有计划外的转换，IHCC队列中仅发生1例术中并发症。中位住院时间为4天。术后并发症共19例，30天内再入院19例。此外,有3例住院死亡率和5例90天死亡率。87%的患者实现了R0切除，R1切除13%。在中位随访36个月时，62%的患者无病生存,而6%的人继续患有这种疾病，32%的人没有存活。
结论：我们的经验证明了机器人切除这些复杂恶性肿瘤的可行性和安全性，产生有希望的短期结果。需要进一步的调查以确定长期的肿瘤学结果。
