91 Feasibility and Safety of Robotic Radical Resection for Hilar Cholangiocarcinoma in Highly Selected Patients: A Systematic Review and Meta-Analysis with Meta-Regression

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Abstract Aim To investigate feasibility and safety of robotic radical resection (RRR) for hilar cholangiocarcinoma (HCCA). Method A PRISMA-compliant meta-analysis with meta-regression (using random effects modelling) was performed including studies reporting outcomes of RRR in patients with HCCA. The risk of bias and certainty was assessed using the Joanna Briggs Institute tool and the GRADE system, respectively. Results Six studies comprising 295 patients were included. In highly selected patients (BMI <25 kg/m2; tumour size < 3 cm), RRR of HCCA was safe and feasible [Clavien-Dindo ≥ III complications: 14.8% (95% CI 8.7-20.8%); 30-day mortality: 1.9% (0-4.2%); conversion to open: 1.9% (0-4.2%); intraoperative blood loss: 210 ml (119-301); operative time: 481 minutes (339-623); R0 resection: 82.2% (75.0-89.4%); retrieved lymph nodes: 12 (9-16)]. Younger age (p=0.008), higher BMI (p=0.009), larger tumours (p=0.048), and performing liver resection (p=0.017) increased blood loss. ASA status ≥ III (p<0.001) and Bismuth IV disease (p<0.001) increased operative time. Preoperative biliary drainage (p=0.027) improved R0 resection rate. RRR resulted in less bleeding (MD:-184 ml, p=0.0005), longer operative time (MD: 162 minutes, p=0.001), and higher R0 resection rate (OR: 3.29, p=0.006) compared with open approach; however, robotic and laparoscopic approaches were comparable. Conclusions Subject to selection bias and type 2 error, RRR of HCCA may be safe and feasible in highly selected patients (favourable BMI and tumour size). The results of current study should not be used for definite conclusions but may provide information about potential predictors of the outcomes for hypothesis synthesis in future trials.

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