Oncological and perioperative outcomes in minimally invasive hepatobiliary surgery: A review for the ESSO core curriculum.

BACKGROUND

Minimally invasive surgery (MIS) is associated with reduced surgical trauma and improved postoperative recovery. Its adoption in hepatobiliary (HB) surgical oncology has been more gradual and less extensive compared to other surgical subspecialities. This reflects the technical complexity of HB procedures, challenging anatomy, and frequent patient-related risk factors such as cirrhosis, portal hypertension, frailty, and malnutrition. In 2021, the European Society of Surgical Oncology (ESSO) updated its core curriculum to support standardized education of cancer surgeons. This review aligns with the ESSO curriculum and focuses on minimally invasive access in HB oncological surgery.

METHODS

A literature review was performed on MIS in HB oncology to address oncological outcomes including resection margin status, lymph node yield, as well as long-term oncological outcomes. Additionally, perioperative outcomes, including complications, blood loss, postoperative pain, length of hospital stay, and quality-of-life measures were assessed.

RESULTS

Current evidence indicates that, in appropriately selected patients, MIS in HB oncology is associated with reduced surgical trauma and favourable short-term outcomes, including lower postoperative morbidity and faster recovery. In patients with chronic liver disease, MIS may confer additional benefits through reduced postoperative liver dysfunction. Oncological surrogate outcomes appear comparable to open surgery in experienced centres, and emerging data suggest no compromise in long-term oncological outcomes.

CONCLUSIONS

MIS is a safe and effective approach for selected HB oncological procedures when performed in specialized centres. Standardization of MIS in HB surgery remains limited for some indications; however, data support its integration into clinical practice and training pathways in line with the ESSO curriculum.