Robotic Surgery for Biliary Tract Cancer

SIMPLE SUMMARY: Complete surgical resection of biliary tract cancer provides the best chance at long-term survival. These surgeries are complex and can be associated with high morbidity and prolonged recovery. Minimally invasive approaches have been shown to improve some of these outcomes in other cancers. However, there is a paucity of data in biliary cancer, and even less is known about the outcomes of surgery utilizing a robotic platform. The present review reports the pooled outcomes of robotic surgery for 259 patients with biliary tract cancer. These outcomes are often equivalent to or improved compared to contemporary data on open surgery. The published data lack prospective or randomized studies. Thus, to evaluate any of the potential benefits of robotic surgery for biliary tract cancer, higher-quality studies are needed. ABSTRACT: Biliary tract cancer consists of cholangiocarcinoma (CC) and gallbladder cancer (GBC). When resectable, surgery provides the best chance at long-term survival. Unfortunately, surgery for these tumors is associated with long operative times, high morbidities, and prolonged hospital stays. Minimally invasive surgery has been shown to impact selected outcomes, including length of stay, in other diseases, and robotic surgery may offer additional advantages compared to laparoscopic surgery in treating bile duct cancers. This is a systematic review of robotic surgery for biliary tract cancer. Predetermined selection criteria were used to appraise the literature. The PRISMA guidelines were followed. In total, 20 unique articles with a total of 259 patients with biliary tract cancer undergoing robotic surgery met the inclusion criteria. For CC and GBC, respectively, the weighted average operative time was 401 and 277 min, the estimated blood loss was 348 and 260 mL, the conversion rate to open was 7 and 3.5%, the all-cause morbidity was 52 and 9.7%, the major morbidity was 12 and 4.4%, the perioperative mortality was 1.4 and 0%, the length of stay was 15 and 4.8 days, the positive margin rate was 27 and 9%, and the number of lymph nodes retrieved was 4.2 and 8. Robotic surgery for biliary tract cancer appears non-inferior to open surgery when compared to the published contemporary data. However, the current literature on the topic is of low quality, and future prospective/randomized studies are needed.