Perihilar cholangiocarcinoma: are we ready to step towards minimally invasiveness?

The primary endpoint of this study is to evaluate the feasibility and safety of the laparoscopic approach in selected types of PeriHilar Cholangiocarcinoma (PHC). Secondary endpoint is to evaluate the potential advantages of laparoscopic approach over the open counterpart. From 2018, an MILS program for PHC was undertaken in selected patients: 16 patients constituted the study group (out of 261 operated between 2004 and 2019) and was compared with a group of patients operated by open technique (control group) in the previous period through a propensity score matching with a 1:2 ratio. Intraoperative and postoperative outcomes were evaluated and compared, focusing on blood loss, length of surgery, conversion to open approach, and complications. Laparoscopic resections resulted in statistically significant longer procedures (360 vs 275 min, p = 0.048). Conversion rate was 18.8%, being oncological concerns the most frequent reason for conversion (3/3 cases). A lower blood loss (380 vs 470, p = 0.048) and minor intraoperative blood transfusions (12.5% vs 21.9%, p = 0.032) were recorded in the study group. A number of retrieved nodes and rate of R0 resections were similar between the two groups. Patients in the MILS group had shorter length of stay (median 10) compared with open group (median 14), p = 0.048. The laparoscopic approach in PHC, so far maintained in an exploratory phase with the biliary-enteric anastomosis performed through the service incision, demonstrates adequate feasibility and safety standards when conducted in carefully selected patients and in centers with expertise.