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Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery

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Robot-assisted liver resections in locally advanced intrahepatic cholangiocarcinoma

https://doi.org/10.16931//1995-5464.2023-4-61-70

Abstract

Aim. To evaluate the immediate results of robot-assisted liver resections in locally advanced intrahepatic cholangiocarcinoma.

Materials and methods. The research methodology involved the analysis of intraoperative and direct results of robotassisted liver resections from 2015 to June 2023.

Results. Total of 89 patients with intrahepatic cholangiocarcinoma underwent surgery. Open liver resection was performed in 59 cases (66.3%), laparoscopic resection – in 22 cases (24.7%), robot-assisted resection – in 8 cases (8.9%). The share of massive liver resections accounted for 83%. The average duration of robot-assisted liver resection amounted to 545 (327–640) minutes, blood loss volume – 300 (100–750) ml, number of resected lymph nodes – 7 (5–11), resection margin width – 6 (5–14) mm. All patients underwent extensive resection with elements of vascular or biliary resection. Severe complications developed only in half of the patients. No deaths or liver failures were reported. The average duration of hospital stay after surgery amounted to 11 (6–15) days.

Conclusion. Robot-assisted liver resections expand the indications for minimally invasive surgeries in intrahepatic cholangiocarcinoma due to patients with locally advanced forms. Satisfactory immediate results justify further accumulation and evaluation of the experience of such interventions.

About the Authors

M. G. Efanov
A.S. Loginov Moscow Clinical Scientific and Practical Center, Department of Health of Moscow
Russian Federation

Mikhail G. Efanov – Doct. of Sci. (Med.), Head of the Department of Hepato-pancreato-biliary Surgery

86, Shosse Entuziastov, Moscow, 111123, Russian Federation



N. N. Britskaia
A.S. Loginov Moscow Clinical Scientific and Practical Center, Department of Health of Moscow
Russian Federation

Natalia N. Britskaia – Cand. of Sci. (Med.), Doctoral Candidate

86, Shosse Entuziastov, Moscow, 111123, Russian Federation



P. V. Tarakanov
A.S. Loginov Moscow Clinical Scientific and Practical Center, Department of Health of Moscow
Russian Federation

Pavel V. Tarakanov – Cand. of Sci. (Med.), Researcher of the Department of Hepato-pancreato-biliary Surgery

86, Shosse Entuziastov, Moscow, 111123, Russian Federation



A. A. Koroleva
A.S. Loginov Moscow Clinical Scientific and Practical Center, Department of Health of Moscow
Russian Federation

Anna A. Koroleva – Cand. of Sci. (Med.), Senior Researcher of the Department of Hepato-pancreato-biliary Surgery

86, Shosse Entuziastov, Moscow, 111123, Russian Federation



A. N. Vankovich
A.S. Loginov Moscow Clinical Scientific and Practical Center, Department of Health of Moscow

Andrey N. Vankovich – Cand. of Sci. (Med.), Researcher of the Department of Hepato-pancreato-biliary Surgery

86, Shosse Entuziastov, Moscow, 111123, Russian Federation



D. E. Kovalenko
A.S. Loginov Moscow Clinical Scientific and Practical Center, Department of Health of Moscow
Russian Federation

Dmitry E. Kovalenko – Researcher of the Department of Hepato-pancreato-biliary Surgery

86, Shosse Entuziastov, Moscow, 111123, Russian Federation



V. V. Tsvirkun
A.S. Loginov Moscow Clinical Scientific and Practical Center, Department of Health of Moscow
Russian Federation

Victor V. Tsvirkun – Doct. of Sci. (Med.), Professor, Chief Researcher

86, Shosse Entuziastov, Moscow, 111123, Russian Federation



References

1. Yoon Y.I., Kim K.H., Kang S.H., Kim W.J., Shin M.H., Lee S.K., Jung D.H., Park G.C., Ahn C.S., Moon D.B., Ha T.Y., Song G.W., Hwang S., Lee S.G. Pure laparoscopic versus open right hepatectomy for hepatocellular carcinoma in patients with cirrhosis: a propensity score matched analysis. Ann. Surg. 2017; 265 (5): 856–863. https://doi.org/10.1097/SLA.0000000000002072. PMID: 27849661

2. Abu Hilal M., Aldrighetti L., Dagher I., Edwin B., Troisi R.I., Alikhanov R., Aroori S., Belli G., Besselink M., Briceno J., Gayet B., D'Hondt M., Lesurtel M., Menon K., Lodge P., Rotellar F., Santoyo J., Scatton O., Soubrane O., Sutcliffe R., Van Dam R., White S., Halls M.C., Cipriani F., Van der Poel M., Ciria R., Barkhatov L., Gomez-Luque Y., Ocana-Garcia S., Cook A., Buell J., Clavien P.A., Dervenis C., Fusai G., Geller D., Lang H., Primrose J., Taylor M., Van Gulik T., Wakabayashi G., Asbun H., Cherqui D. The Southampton Consensus Guidelines for laparoscopic liver surgery: from indication to implementation. Ann. Surg. 2018; 268 (1): 11–18. https://doi.org/10.1097/SLA.0000000000002524. PMID: 29064908

3. Harimoto N., Shimada M., Tsujita E., Maehara S., Rikimaru T., Yamashita Y., Maeda T., Tanaka S., Shirabe K., Sugimachi K. Laparoscopic hepatectomy and dissection of lymph nodes for intrahepatic cholangiocarcinoma. Case report. Surg. Endosc. 2002; 16 (12): 1806. https://doi.org/10.1007/s00464-002-4511-z

4. Giulianotti P.C., Bianco F.M., Daskalaki D., Gonzalez- Ciccarelli L.F., Kim J., Benedetti E. Robotic liver surgery: technical aspects and review of the literature. Hepatobiliary Surg. Nutr. 2016; 5 (4): 311–321. https://doi.org/10.21037/hbsn.2015.10.05

5. Regmi P., Hu H.J., Paudyal P., Liu F., Ma W.J., Yin C.H., Jin Y.W., Li F.Y. Is laparoscopic liver resection safe for intrahepatic cholangiocarcinoma? A meta-analysis. Eur. J. Surg. Oncol. 2021; 47 (5): 979–989. https://doi.org/10.1016/j.ejso.2020.11.310

6. Zhao X., Gao F.W., Jiang K.Y., Yang J., Xie Q.Y., Gong J., Yang M.Y., Mao T.Y., Lei Z.H. Laparoscopic or open liver resection for intrahepatic cholangiocarcinoma: a meta-analysis and systematic review. Front. Oncol. 2023; 13: 1096714. https://doi.org/10.3389/fonc.2023.1096714

7. Guerrini G.P., Esposito G., Tarantino G., Serra V., Olivieri T., Catellani B., Assirati G., Guidetti C, Ballarin R., Magistri P., Di Benedetto F. Laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma: the first meta-analysis. Langenbecks Arch. Surg. 2020; 405 (3): 265–275. https://doi.org/10.1007/s00423-020-01877-0

8. Tol J.A., Gouma D.J., Bassi C., Dervenis C., Montorsi M., Adham M., Andrén-Sandberg A., Asbun H.J., Bockhorn M., Büchler M.W., Conlon K.C., Fernández-Cruz L., Fingerhut A., Friess H., Hartwig W., Izbicki J.R., Lillemoe K.D., Milicevic M.N., Neoptolemos J.P., Shrikhande S.V., Vollmer C.M., Yeo C.J., Charnley R.M.; International Study Group on Pancreatic Surgery. Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery. 2014; 156 (3): 591–600. https://doi.org/10.1016/j.surg.2014.06.016.

9. Gavriilidis P., Roberts K.J., Aldrighetti L., Sutcliffe R.P. A comparison between robotic, laparoscopic and open hepatectomy: a systematic review and network meta-analysis. Eur. J. Surg. Oncol. 2020; 46 (7): 1214–1224. https://doi.org/10.1016/j.ejso.2020.03.227

10. Liu R., Wakabayashi G., Kim H.J., Choi G.H., Yiengpruksawan A., Fong Y., He J., Boggi U., Troisi R.I., Efanov M., Azoulay D., Panaro F., Pessaux P., Wang X.Y., Zhu J.Y., Zhang S.G., Sun C.D., Wu Z., Tao K.S., Yang K.H., Fan J., Chen X.P. International consensus statement on robotic hepatectomy surgery in 2018. World J. Gastroenterol. 2019; 25 (12): 1432–1444. https://doi.org/10.3748/wjg.v25.i12.1432

11. Efanov M.G., Alikhanov R.B., Kazakov I.V., Vankovich A.N., Melekhina O.V., Kulezneva Yu.V., Elizarova N.I., Koroleva A.A., Kovalenko D.E., Tsvirkun V.V. Robot-assisted and open resections for perihilar cholangiocarcinoma. Comparative analysis of the immediate outcomes. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2020; 25 (4): 60–70. https://doi.org/10.16931/1995-5464.2020460-70 (In Russian)

12. Ziogas I.A., Giannis D., Esagian S.M., Economopoulos K.P., Tohme S., Geller D.A. Laparoscopic versus robotic major hepatectomy: a systematic review and meta-analysis. Surg. Endosc. 2021; 35 (2): 524–535. https://doi.org/10.1007/s00464-020-08008-2

13. Chong C.C.N., Lok H.T., Fung A.K.Y., Fong A.K.W., Cheung Y.S., Wong J., Lee K.F., Lai P.B.S. Robotic versus laparoscopic hepatectomy: application of the difficulty scoring system. Surg. Endosc. 2020; 34 (5): 2000–2006. https://doi.org/10.1007/s00464-019-06976-8

14. Fagenson A.M., Gleeson E.M., Pitt H.A., Lau K.N. Minimally invasive hepatectomy in North America: laparoscopic versus robotic. J. Gastrointest. Surg. 2021; 25 (1): 85–93. https://doi.org/10.1007/s11605-020-04703-6

15. Chen P.D., Wu C.Y., Hu R.H., Chen C.N., Yuan R.H., Liang J.T., Lai H.S., Wu Y.M. Robotic major hepatectomy: is there a learning curve? Surgery. 2017; 161 (3): 642–649. https://doi.org/10.1016/j.surg.2016.09.025

16. Magistri P., Guerrini G.P., Ballarin R., Assirati G., Tarantino G., Di Benedetto F. Improving outcomes defending patient safety: the learning journey in robotic liver resections. Biomed. Res. Int. 2019; 2019: 1835085. https://doi.org/10.1155/2019/1835085

17. Di Benedetto F., Petrowsky H., Magistri P., Halazun K.J. Robotic liver resection: hurdles and beyond. Int. J. Surg. 2020; 82S: 155–162. https://doi.org/10.1016/j.ijsu.2020.05.070

18. Kamarajah S.K., Bundred J., Manas D., Jiao L., Hilal M.A., White S.A. Robotic versus conventional laparoscopic liver resections: a systematic review and meta-analysis. Scand. J. Surg. 2021; 110 (3): 290–300. https://doi.org/10.1177/1457496920925637

19. Boggi U., Caniglia F., Amorese G. Laparoscopic robot-assisted major hepatectomy. J. Hepatobiliary Pancreat. Sci. 2014; 21 (1): 3–10. https://doi.org/10.1002/jhbp.34

20. Spampinato M.G., Coratti A., Bianco L., Caniglia F., Laurenzi A., Puleo F., Ettorre G.M., Boggi U. Perioperative outcomes of laparoscopic and robot-assisted major hepatectomies: an Italian multi-institutional comparative study. Surg. Endosc. 2014; 28 (10): 2973–2979. https://doi.org/10.1007/s00464-014-3560-4

21. Chiow A.K.H., Fuks D., Choi G.H., Syn N., Sucandy I., Marino M.V., Prieto M., Chong C.C., Lee J.H., Efanov M., Kingham T.P., Choi S.H., Sutcliffe R.P., Troisi R.I., Pratschke J., Cheung T.T., Wang X., Liu R., D'Hondt M., Chan C.Y., Tang C.N., Han H.S., Goh B.K.P.; International Robotic and Laparoscopic Liver Resection Study Group collaborators. International multicentre propensity score-matched analysis comparing robotic versus laparoscopic right posterior sectionectomy. Br. J. Surg. 2021; 108 (12): 1513–1520. https://doi.org/10.1093/bjs/znab321

22. Yang H.Y., Choi G.H., Chin K.M., Choi S.H., Syn N.L., Cheung T.T., Chiow A.K.H., Sucandy I., Marino M.V., Prieto M., Chong C.C., Lee J.H., Efanov M., Kingham T.P., Sutcliffe R.P., Troisi R.I., Pratschke J., Wang X., D'Hondt M., Tang C.N., Liu R., Park J.O., Rotellar F., Scatton O., Sugioka A., Long T.C.D., Chan C.Y., Fuks D., Han H.S., Goh B.K.P.; the International Robotic and Laparoscopic Liver Resection Study Group Investigators. Robotic and laparoscopic right anterior sectionectomy and central hepatectomy: multicentre propensity score-matched analysis. Br. J. Surg. 2022; 109 (4): 311–314. https://doi.org/10.1093/bjs/znab463

23. Chong C.C., Fuks D., Lee K.F., Zhao J.J., Choi G.H., Sucandy I., Chiow A.K.H., Marino M.V., Gastaca M., Wang X., Lee J.H., Efanov M., Kingham T.P., D'Hondt M., Troisi R.I., Choi S.H., Sutcliffe R.P., Chan C.Y., Lai E.C.H., Park J.O., Di Benedetto F., Rotellar F., Sugioka A., Coelho F.F., Ferrero A., Long T.C.D., Lim C., Scatton O., Liu Q., Schmelzle M., Pratschke J., Cheung T.T., Liu R., Han H.S., Tang C.N., Goh B.K.P.; International Robotic and Laparoscopic Liver Resection study group investigators. Propensity score-matched analysis comparing robotic and laparoscopic right and extended right hepatectomy. JAMA Surg. 2022; 157 (5): 436–444. https://doi.org/10.1001/jamasurg.2022.0161

24. Magistri P., Assirati G., Ballarin R., Di Sandro S., Di Benedetto F. Major robotic hepatectomies: technical considerations. Updates Surg. 2021; 73 (3): 989–997. https://doi.org/10.1007/s13304-020-00940-1

25. Khan S., Beard R.E., Kingham P.T., Fong Y., Boerner T., Martinie J.B., Vrochides D., Buell J.F., Berber E., Kahramangil B., Troisi R.I., Vanlander A., Molinari M., Tsung A. Long-term oncologic outcomes following robotic liver resections for primary hepatobiliary malignancies: a multicenter study. Ann. Surg. Oncol. 2018; 25 (9): 2652–2660. https://doi.org/10.1245/s10434-018-6629-9

26. Sucandy I., Luberice K., Lippert T., Castro M., Krill E., Ross S., Rosemurgy A. Robotic major hepatectomy: an institutional experience and clinical outcomes. Ann. Surg. Oncol. 2020; 27 (13): 4970–4979. https://doi.org/10.1245/s10434-020-08845-4

27. Li J., Tan X., Zhang X., Zhao G., Hu M., Zhao Z., Liu R. Robotic radical surgery for hilar cholangiocarcinoma: a singlecentre case series. Int. J. Med. Robot. 2020; 16 (2): e2076. https://doi.org/10.1002/rcs.2076

28. Zhang X.F., Bagante F., Chakedis J., Moris D., Beal E.W., Weiss M., Popescu I., Marques H.P., Aldrighetti L., Maithel S.K., Pulitano C., Bauer T.W., Shen F., Poultsides G.A., Soubrane O., Martel G., Groot Koerkamp B., Guglielmi A., Itaru E., Pawlik T.M. Perioperative and long-term outcome for intrahepatic cholangiocarcinoma: impact of major versus minor hepatectomy. J. Gastrointest. Surg. 2017; 21 (11): 1841–1850. https://doi.org/10.1007/s11605-017-3499-6


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Efanov M.G., Britskaia N.N., Tarakanov P.V., Koroleva A.A., Vankovich A.N., Kovalenko D.E., Tsvirkun V.V. Robot-assisted liver resections in locally advanced intrahepatic cholangiocarcinoma. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2023;28(4):61-70. (In Russ.) https://doi.org/10.16931//1995-5464.2023-4-61-70

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ISSN 1995-5464 (Print)
ISSN 2408-9524 (Online)