META ANALYSIS OF OUTCOMES OF MINIMALLY INVASIVE VS OPEN SURGERY IN HILAR CHOLANGIOCARCINOMA aarathi.vijayashanker@nhs.net

 

META ANALYSIS OF OUTCOMES OF MINIMALLY INVASIVE VS OPEN SURGERY IN HILAR CHOLANGIOCARCINOMA

5

United Kingdom

Oral or Poster

Hilar cholangiocarcinoma (HCCA) is a rare and aggressive malignancy of the bile ducts, with radical resection remaining the only curative treatment. Traditionally managed by open surgery involving major hepatectomy, caudate lobectomy, lymphadenectomy, and biliary reconstruction, this approach is effective but associated with significant morbidity. Minimally invasive surgery (MIS), encompassing laparoscopic and robotic techniques, has emerged as an alternative, potentially reducing perioperative morbidity while maintaining oncological efficacy.

We conducted a systematic review and meta-analysis, registered with PROSPERO, to compare outcomes between MIS and open surgery for HCCA. Comprehensive searches across PubMed, EMBASE, and the Cochrane Library up to December 2024 identified 1522 records. After exclusions, 10 retrospective cohort studies (2004- 2022) with 432 MIS and 1631 open cases were included, predominantly from China.

Results demonstrated that MIS was associated with significantly longer operative times (mean difference: +123.6 minutes, P=0.005), yet reduced intraoperative blood loss (−83.3 mL, P=0.03) and lower transfusion rates (OR=0.65, P=0.05). No significant differences were observed in major complications (Clavien–Dindo ≥3), 90-day mortality, length of hospital stay, or rates of bile leak, bleeding, or respiratory complications. Oncological outcomes, including R0 resection rates, lymph node yield, vascular reconstruction, and recurrence patterns, were comparable between groups.

MIS for HCCA, although technically demanding and associated with longer operative duration, offers reduced blood loss and equivalent short-term oncological outcomes compared with open surgery. These findings support MIS as a feasible and safe alternative in high-volume expert centres with appropriate patient selection.