Robotic versus laparoscopic liver resection for intrahepatic cholangiocarcinoma: a head-to-head multicenter propensity score-matched analysis.
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Delvecchio Antonella, Caringi Silvio, Marino Rebecca, Conci Simone, Alaimo Laura, Gringeri Enrico, De Nardi Clarissa, Ardito Francesco, Famularo Simone, De Carlis Riccardo, Centonze Leonardo, Mocchegiani Federico, Benedetti Cacciaguerra Andrea, Belli Andrea, Ringressi Maria N, Serenari Matteo, Giannone Fabio, Libia Annarita, Di Francesco Fabrizio, McDonnell Declan, Gruttadauria Salvatore, Spampinato Marcello G, Panaro Fabrizio, Cescon Matteo, Grazi Gian L, Izzo Francesco, Vivarelli Marco, De Carlis Luciano, Giuliante Felice, Cillo Umberto, Ruzzenente Andrea, Ratti Francesca, Memeo Riccardo
Аннотация
METHODS: We retrospectively analyzed consecutive patients with iCCA who underwent MILS in 13 Italian hepatobiliary centers. Patients were stratified by surgical approach (LLR vs RLR) and matched 2:1 by propensity score matching (PSM). Primary endpoints were oncological outcomes and adequacy of lymph node dissection (LND). Secondary endpoints included intraoperative and short-term postoperative outcomes.
RESULTS: Overall, 645 patients (468 LLR, 177 RLR) were included; after PSM, 511 patients (334 LLR, 177 RLR) were analyzed. RLR achieved higher R0 resection rates (p = 0.002) and a greater mean lymph node yield (p = 0.001). Overall survival (OS) and disease-free survival (DFS) were comparable between groups. RLR was also associated with lower conversion rates, fewer postoperative complications, and shorter hospital stay.
CONCLUSION: RLR for iCCA is safe and provides advantages in margin status, lymph node dissection, and perioperative outcomes, while long-term oncological outcomes (OS and DFS) are comparable to LLR.