Robotic versus laparoscopic liver resection for intrahepatic cholangiocarcinoma: a head-to-head multicenter propensity score-matched analysis.

IF 3.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2026-08-03 DOI:10.1016/j.hpb.2026.07.009

Antonella Delvecchio, Silvio Caringi, Rebecca Marino, Simone Conci, Laura Alaimo, Enrico Gringeri, Clarissa De Nardi, Francesco Ardito, Simone Famularo, Riccardo De Carlis, Leonardo Centonze, Federico Mocchegiani, Andrea Benedetti Cacciaguerra, Andrea Belli, Maria N Ringressi, Matteo Serenari, Fabio Giannone, Annarita Libia, Fabrizio Di Francesco, Declan McDonnell, Salvatore Gruttadauria, Marcello G Spampinato, Fabrizio Panaro, Matteo Cescon, Gian L Grazi, Francesco Izzo, Marco Vivarelli, Luciano De Carlis, Felice Giuliante, Umberto Cillo, Andrea Ruzzenente, Francesca Ratti, Riccardo Memeo

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引用次数: 0

Abstract

Background: Intrahepatic cholangiocarcinoma (iCCA) is an aggressive primary liver cancer for which surgical resection with lymphadenectomy remains the only potentially curative treatment. Although minimally invasive liver surgery (MILS) provides benefits over open surgery, whether robotic liver resection (RLR) offers advantages over laparoscopic resection (LLR) in oncological adequacy and perioperative outcomes remains unclear.

Methods: We retrospectively analyzed consecutive patients with iCCA who underwent MILS in 13 Italian hepatobiliary centers. Patients were stratified by surgical approach (LLR vs RLR) and matched 2:1 by propensity score matching (PSM). Primary endpoints were oncological outcomes and adequacy of lymph node dissection (LND). Secondary endpoints included intraoperative and short-term postoperative outcomes.

Results: Overall, 645 patients (468 LLR, 177 RLR) were included; after PSM, 511 patients (334 LLR, 177 RLR) were analyzed. RLR achieved higher R0 resection rates (p = 0.002) and a greater mean lymph node yield (p = 0.001). Overall survival (OS) and disease-free survival (DFS) were comparable between groups. RLR was also associated with lower conversion rates, fewer postoperative complications, and shorter hospital stay.

Conclusion: RLR for iCCA is safe and provides advantages in margin status, lymph node dissection, and perioperative outcomes, while long-term oncological outcomes (OS and DFS) are comparable to LLR.

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机器人与腹腔镜肝内胆管癌肝切除术：一项头对头的多中心倾向评分匹配分析。

背景：肝内胆管癌（iCCA）是一种侵袭性原发性肝癌，手术切除加淋巴结切除术仍然是唯一可能治愈的治疗方法。尽管微创肝脏手术（MILS）比开放手术更有优势，但机器人肝脏切除术（RLR）在肿瘤充分性和围手术期结果方面是否比腹腔镜切除（LLR）更有优势尚不清楚。方法：我们回顾性分析了意大利13个肝胆中心连续接受MILS治疗的iCCA患者。通过手术入路（LLR vs RLR）对患者进行分层，并通过倾向评分匹配（PSM）进行2:1匹配。主要终点是肿瘤预后和淋巴结清扫（LND）的适当性。次要终点包括术中和术后短期结果。结果：共纳入645例患者（468例LLR， 177例RLR）；PSM后，511例患者（334例LLR， 177例RLR）进行分析。RLR具有更高的R0切除率（p = 0.002）和更高的平均淋巴结清扫率（p = 0.001）。两组间总生存期（OS）和无病生存期（DFS）具有可比性。RLR还与较低的转换率、较少的术后并发症和较短的住院时间有关。结论：iCCA的RLR是安全的，在切缘状态、淋巴结清扫和围手术期预后方面具有优势，而长期肿瘤预后（OS和DFS）与LLR相当。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).