Expert consensus on robotic radical resection for perihilar cholangiocarcinoma

doi:10.3877/cma.j.issn.1674-6899.2025.02.002

Abstract

Abstract:

Objective

To standardize robotic radical resection for perihilar cholangiocarcinoma and improve perioperative safety and long-term survival of patients, this expert consensus is formulated.

Methods

The Minimally Invasive Surgery Professional Committee and the Intelligent Medicine Professional Committee of the Chinese Research Hospital Association initiated and organized experts in minimally invasive surgery for biliary tract tumor in China. This expert consensus was drafted based on literature and practice,followed by several rounds of voting, feedback, discussion and revision.

Results

Eleven recommendations were put forward covering six aspects of this operation including preoperative evaluation and surgical planning, indications and contraindications, perioperative safety and efficacy, feasibility of cases requiring vascular reconstruction, survival and recurrence, as well as learning curve.

Conclusion

After thorough evaluation and comprehensive planning, it is safe and eligible for surgical centers with adequate experience in robotic hepatobiliary and pancreatic surgery to carry out this operation. The advantages of robotic approach over other approaches in terms of complications, prognosis and learning curve, still need to be supported and clarified by evidence with higher quality obtained via more application and practice.

Key words: Robotic surgery, Perihilar cholangiocarcinoma, Expert consensus, Radical resection

Minimally Invasive Surgery Professional Committee of the Chinese Research Hospital Association The, Intelligent Medicine Professional Committee of the Chinese Research Hospital Association The. Expert consensus on robotic radical resection for perihilar cholangiocarcinoma[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(02): 73-77.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2025.02.002

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2025/V18/I02/73

References 30

1	Mansour JC,Aloia TA,Crane CH,et al.Hilar cholangiocarcinoma: expert consensus statement[J]. HPB(Oxford), 2015, 17(8):691-699.
2	Serrablo A, Tejedor L. Outcome of surgical resection in Klatskin tumors[J]. World J Gastrointest Oncol, 2013, 5(7):147-158.
3	McPherson S, Reese C, Wendler MC. Methodology update: delphi studies[J]. Nurs Res, 2018, 67(5):404-410.
4	Branch of Biliary Surgery, Chinese Society of Surgery; Chinese Medical Association, Chinese Medical Doctor Association in Chinese Committee of Biliary Surgeons. Expert consensus on the laparoscopic radical resection of gallbladder cancer(2023)[J]. Chin J Surg,2024, 62(4):265-272.
5	Bismuth H, Corlette MB. Intrahepatic cholangioenteric anastomosis in carcinoma of the hilus of the liver[J]. Surg Gynecol Obstet,1975, 140(2):170-178.
6	Bismuth H, Nakache R, Diamond T. Management strategies in resection for hilar cholangiocarcinoma[J]. Ann Surg, 1992, 215(1):31-38.
7	Hu M, Xu D, Zhang Y, et al. Efficacy and safety of robotic surgery versus open surgery for hilar cholangiocarcinoma: a systematic review and meta-analysis[J]. Int J Surg, 2025,111(1):1301-1310.
8	Guadagni S, Comandatore A, Furbetta N, et al. Robotic hepatectomy plus biliary reconstruction for bismuth type III and type IV hilar cholangiocarcinoma: state of the art and literature review[J]. J Pers Med, 2023, 14(1):12.
9	Sucandy I, Marques HP, Lippert T, et al. Clinical outcomes of robotic resection forperihilarcholangiocarcinoma:a first,multicenter, trans-atlantic, expert-center, collaborative study[J].Ann Surg Oncol, 2024, 31(1):81-89.
10	Berardi G, Lucarini A, Colasanti M, et al. Minimally invasive surgery for perihilar cholangiocarcinoma: a systematic review of the short- and long-term results[J]. Cancers (Basel), 2023, 15(11):3048.
11	Cipriani F, Ratti F, Fiorentini G, et al. Systematic review of perioperative and oncologic outcomes of minimally-invasive surgery for hilar cholangiocarcinoma[J]. Updates Surg, 2021, 73(2):359-377.
12	Tang W, Qiu JG, Deng X, et al. Minimally invasive versus open radical resection surgery for hilar cholangiocarcinoma: Comparable outcomes associated with advantages of minimal invasiveness[J].PLoS One, 2021, 16(3):e0248534.
13	Xu Y, Wang H, Ji W, et al. Robotic radical resection for hilar cholangiocarcinoma: perioperative and long-term outcomes of an initial series[J]. Surg Endosc, 2016, 30(7):3060-3070.
14	Chou S,ChangZY,ZhaoGD,etal.Robotichilar cholangiocarcinoma radical resection compared with laparotomy in prognosis[J]. Chin J Surg, 2020, 58(3):230-234.
15	Knitter S, Feldbrügge L, Nevermann N, et al. Robotic versus laparoscopic versus open major hepatectomy - an analysis of costs and postoperative outcomes in a single-center setting[J]. Langenbecks Arch Surg, 2023, 408(1):214.
16	D'Amico FE, Mescoli C, Caregari S, et al. Impact of positive radial margin on recurrence and survival in perihilar cholangiocarcinoma[J]. Cancers (Basel), 2022, 14(7):1680.
17	Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability,and outcome in 225 patients with hilar cholangiocarcinoma[J]. Ann Surg, 2001, 234(4):507-517; discussion 517-9.
18	Bagante F, Tran T, Spolverato G, et al. Perihilar cholangiocarcinoma:number of nodes examined and optimal lymph node prognostic scheme[J]. J Am Coll Surg, 2016, 222(5):750-759.e2.
19	Kone LB, Bystrom PV, Maker AV. Robotic surgery for biliary tract cancer[J]. Cancers (Basel), 2022, 14(4):1046.
20	Cillo U, D'Amico FE, Furlanetto A, et al. Robotic hepatectomy and biliary reconstruction for perihilar cholangiocarcinoma: a pioneer western case series[J]. Updates Surg, 2021, 73(3):999-1006.
21	Cillo U, D'Amico FE, Furlanetto A, et al. Robotic hepatectomy and biliary reconstruction for perihilar cholangiocarcinoma: a pioneer western case series[J]. Updates Surg, 2021, 73(3):999-1006.
22	Magistri P, Pang NQ, Guidetti C, et al. Robotic approach for perihilar cholangiocarcinoma: from Bismuth 1 to vascular resection[J]. Eur J Surg Oncol, 2023, 49(11):107002.
23	Xiong Y, Jingdong L, Zhaohui T, et al. A consensus meeting on expert recommendations on operating specifications for laparoscopic radical resection of hilar cholangiocarcinoma[J]. Front Surg, 2021,8:731448.
24	Tan CL, Zhang H, Peng B, et al. Outcome and costs of laparoscopic pancreaticoduodenectomy during the initial learning curve vs laparotomy[J]. World J Gastroenterol, 2015, 21(17):5311-9. doi: 10.3748/wjg.v21.i17.5311. PMID: 25954105;PMCID: PMC4419072.
25	O'Connor VV, Vuong B, Yang ST, et al. Robotic minor hepatectomy offers a favorable learning curve and may result in superior perioperative outcomes compared with laparoscopic approach[J]. Am Surg, 2017, 83(10):1085-1088. PMID: 29391100.
26	Magistri P, Guerrini GP, Ballarin R, et al. Improving outcomes defending patient safety: the learning journey in robotic liver resections[J]. Biomed Res Int, 2019:1835085.
27	Zhu P, Liao W, Ding ZY, et al. Learning curve in robot-assisted laparoscopic liver resection[J]. J Gastrointest Surg, 2019, 23(9):1778-1787.
28	Chen PD, Wu CY, Hu RH, et al. Robotic major hepatectomy: Is?there a learning curve?[J]. Surgery, 2017, 161(3):642-649.
29	Liu Q, Zhang T, Hu M, et al. Comparison of the learning curves for robotic left and right hemihepatectomy: a prospective cohort study[J]. Int J Surg, 2020, 81:19-25.
30	Zhang T, Zhao ZM, Gao YX, et al. The learning curve for a surgeon in robot-assisted laparoscopic pancreaticoduodenectomy: a retrospective study in a high-volume pancreatic center[J]. Surg Endosc, 2019, 33(9):2927-2933.

[1]	Zhaoyu Wang, Jun Jiang. Theories and technologies in surgical treatment of breast cancer： development and challenge [J]. Chinese Journal of Breast Disease(Electronic Edition), 2025, 19(01): 1-5.
[2]	Collaboration Group，Breast Cancer Specialty Committee，Hebei Anti-Cancer Association Nursing. Expert consensus on nursing management of central venous access in breast cancer patients [J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(06): 321-329.
[3]	Medical Quality Control Center for Infectious Diseases National. Expert consensus on quality improvement of pulmonary tuberculosis diagnosis and treatment [J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2025, 19(01): 9-14.
[4]	Medical Quality Center Central for Infectious Diseases National. Expert consensus on quality improvement for prevention of mother-to-child transmission of hepatitis B virus [J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2025, 19(01): 23-29.
[5]	Society for Integrated Health of Metabolic and Bariatric Surgery Chinese, Society for Metabolic and Bariatric Surgery Chinese, Obesity and Metabolic Surgery Collaborative Chinese. Chinese expert consensus on medical knowledge dissemination in metabolic and bariatric surgery（2024 edition） [J]. Chinese Archives of General Surgery(Electronic Edition), 2025, 19(01): 1-8.
[6]	Na Yang, Gang Hu, Yue Pan. Influence of neoadjuvant chemotherapy after breast-conserving surgery and modified radical mastectomy on serum markers of triple-negative breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(03): 345-348.
[7]	Yinzhen Pan, Xiuyu Zhang, Yantao Mai, Zhiqiang Liang. Clinical efficacy of two types of operation for intrahepatic cholangiocarcinoma [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 208-211.
[8]	Minimally Invasive Surgery Professional Committee of the Chinese Research Hospital Association The, Intelligent Medicine Professional Committee of the Chinese Research Hospital Association The. Expert consensus on pancreatic duct (repair) surgery [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(02): 65-72.
[9]	Invasive Surgery Professional Committee of the Chinese Minimally. Chinese expert consensus on laparoscopic caudate lobectomy （2024 Edition） [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(01): 1-7.
[10]	Invasive Surgery Professional Committee of the Chinese Minimally. Chinese expert consensus on laparoscopic partial splenectomy （2024 Edition） [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2025, 18(01): 8-14.
[11]	Qingguang Liu, Zhimin Geng, Dong Zhang, Qi Li. Current status and thinking of minimally invasive radical cholecystectomy for gallbladder cancer [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(02): 158-166.
[12]	Chong Zhang, Zongming Zhang, Zhuo Liu, Limin Liu, Yue Zhao, Hui Qi. Progress in diagnosis and treatment of hilar cholangiocarcinoma [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(02): 167-180.
[13]	Zhijie Wang, Wenzheng Wang, Jiagen Li, Minghui Xu, Xuedong Fang, Yuanyu Wu. Comparative study of clinical efficacy of robotic and laparoscopic radical resection for sigmoid cancer：a propensity score-matched analysis [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2025, 14(02): 155-160.
[14]	Kaiyu Wang, Tianyu Guo, Na Li, Jinghui Bai, Lei Zhang, Haoran Jin, Rui Zhang, Yefu Liu. Robot-assisted laparoscopic left hemicolectomy combined with resection of right posterior hepatic lobe metastasis：a case report [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2025, 14(02): 189-192.
[15]	Society of Digestive Endoscopology Chinese. Expert consensus on perioperative management of super m inimally invasive surgery in patients receiving antithrombotic therapy （2025，Beijing） [J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2025, 12(01): 7-14.

Please choose a citation manager

Content to export