Minimally invasive surgery for hilar cholangiocarcinoma: state of art and future perspectives

医学 侵入性外科 肝切除术 外科 胆管 腹腔镜手术 机械人手术 微创手术 普通外科 腹腔镜检查 切除术
作者
Han Hu,Zhenru Wu,Yu Jin,Wen‐Jie Ma,Qin Yang,Jun‐Ke Wang,Fu‐Yu Li,Fu‐Yu Li
出处
期刊:Anz Journal of Surgery [Wiley]
卷期号:89 (5): 476-480 被引量:26
标识
DOI:10.1111/ans.14765
摘要

Background Hilar cholangiocarcinoma (HCCA) occurs in the core section of the biliary system and has a strong tendency to broadly invade the surrounding vascular system, perineural tissue and major liver parenchyma. Thus, minimally invasive resection can only be achieved in limited cases. This article reviews the current laparoscopic and robotic surgery techniques for HCCA and analyses the difficulties and limitations of the current minimally invasive surgical techniques for HCCA. Methods A systematic literature search was conducted using multiple electronic databases. All studies involving minimally invasive resections of HCCA were included (up to November 2017). Results Twelve studies were included, of which eight concerned laparoscopic surgery of HCCA and four involved robotic surgery for HCCA. For laparoscopic surgery, most of the surgical procedures were limited to partial hepatectomy or even bile duct resection; the post‐operative morbidity rate was approximately 38.9% (range 0–100%); those with fewer complications were mostly restricted to Bismuth type I or type II carcinomas. For robotic surgery, only one study concerned caudate lobectomy of HCCA, with a reported median operative time of 703 min and post‐operative morbidity of 90%. Conclusions Minimally invasive surgery for HCCA is restricted to highly selected cases and is deemed technically achievable in experienced hands. However, technical and instrumental improvement is needed to reduce the relevant morbidity and popularize the use of minimally invasive surgery to treat HCCA.
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