Robotic resection of extrahepatic cholangiocarcinoma (eCCA) is safe, feasible, and reproducible, according to a new study published in the Journal of Surgical Oncology.

“Because surgical resection provides the only chance for cure in extrahepatic cholangiocarcinoma, improving the risk‐to‐benefit ratio in the operating room, as the robotic platform does via small incisions, allows more patients to be considered for curative treatment and gain a survival benefit from it,” the study’s authors said.

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Out of the 15 patients who underwent robotic resection of eCCA, 11 achieved negative final margins after the procedure.

Operative duration was 453 (443±85.0) minutes. The robotic technique allowed for precise biliovascular dissection in the porta hepatis and R0 tumor clearance with minimal blood loss. Moreover, the study’s authors did not observe R2 resection in any of the patients. Estimated blood loss was 150 (182±138.4) mL.

The study did not register any intraoperative complications. Patients stayed in the hospital for 4 (6±3.2) days. One patient presented with Clavien‐Dindo Class 3 or greater complication post-surgery, but none required admission to the intensive care unit. Also, no deaths were reported.

Despite the positive outcomes, the use of robotic techniques to treat eCCA is still limited. According to Sucandy et al, “Due to the technical challenges of EHC resection and concerns in producing inferior oncological outcomes, minimally invasive resection is rarely attempted in the western world.”

The successful performance of robotic resection of eCCA requires proper patient selection, as well as an experienced surgeon to work with the technical complexity associated with the porta hepatis’ structures.


Sucandy I, Shapera E, Jacob K, et al. Robotic resection of extrahepatic cholangiocarcinoma: Institutional outcomes of bile duct cancer surgery using a minimally invasive technique. J Surg Oncol. Published online August 28, 2021. doi:10.1002/jso.26674