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Robotic Approach for Lymphadenectomy in Biliary Tumours: The Missing Ring Between the Benefits of Laparoscopic and Reproducibility of Open Approach?

Authors :
Francesca Ratti
Federica Cipriani
Sara Ingallinella
Antonella Tudisco
Marco Catena
Luca Aldrighetti
Source :
Annals of surgery.
Publication Year :
2022

Abstract

This study aimed to evaluate the oncological adequacy of lymphadenectomy (LND) for biliary tumours and surgical outcomes of resections performed using robotic, laparoscopic, and open approaches, and to compare the techniques within a weighted propensity score analysis.The need to perform formal LND is considered a limit for the applicability of minimally invasive liver surgery.Overall, 25 robotic resections with LND (2021-2022) from a single centre constituted the study group (Rob Group), matched by inverse probability treatment weighting with 97 laparoscopic (Lap Group) and 113 open (Open Group) procedures to address the primary endpoint. A "per-period" analysis was performed comparing the characteristics and outcomes of the Rob Group with the first 25 consecutive laparoscopic liver resections with associated LND (LapInit Group).Minimally invasive techniques performed equally well regarding the number of harvested nodes, blood transfusions, functional recovery, length of stay, and major morbidity and provided a short-term benefit to patients when compared with the open technique. A better performance of the robotic approach over laparoscopic approach (and both approaches over the open technique) was recorded for patients achieving LND with retrieval of6 nodes. The open approach reduced both the operative time and time for LND, and robotic surgery performed better than laparoscopic surgery.Minimally invasive techniques are excellent tools for the management of LND in patients with biliary tumours, showing feasibility, and oncological adequacy. Robotics could contribute to the large-scale diffusion of these procedures with a high profile of complexity.

Subjects

Subjects :
Surgery

Details

ISSN :
15281140
Database :
OpenAIRE
Journal :
Annals of surgery
Accession number :
edsair.doi.dedup.....30f43de7a62b22fec020b6b90c2a5889