ASO Author Reflections: Expanding Minimally Invasive Options for Perihilar Cholangiocarcinoma: The Use of Robotic Platform in Biliovascular Reconstruction

Excerpt

The surgical management of perihilar cholangiocarcinoma (pCCA), a tumor of biliary origin arising between the intra- and extrahepatic bile ducts, has historically been fraught with technical challenges and poor outcomes. The tumor anatomical location frequently leads to biliary obstruction, resulting in obstructive jaundice on presentation; left untreated, pCCA carries a grim prognosis, with a median overall survival of only 5–10 months.¹ Complete resection of the extrahepatic bile duct, often combined with major liver resection, offers the only chance for cure and long-term survival. Unfortunately, many patients present with locally advanced or metastatic tumors, rendering them ineligible for a curative resection. In these types of cases, while palliative systemic chemotherapy may improve survival, the physical toll of chemotherapy with its potential serious adverse effects, poor efficacy, and high costs are major problems. While liver transplantation through very strict institutional protocols may be applicable to very small groups of patients, the scarcity of liver grafts (either cadaveric or living donor) is a limiting factor, in addition to many other patient and tumor factors required to achieve this treatment. …