Robotic bile duct resection for cancer near the liver hilum (perihilar cholangiocarcinoma) is known as the most technically difficult operation in liver surgery. The hilum is where all the blood vessels feeding the liver are located and also where the bile duct draining the liver is passing through.
The anatomical uniqueness of the hilum makes cancer easy to spread and difficult to resect. Often, the bile duct cancer has invaded the important artery or vein by the time of diagnosis, making the tumor unresectable.
Due this difficulty, not many centers or surgeons are comfortable tackling this disease. When managed by inexperienced surgeons, the oncological tumor resection can be compromised / inadequate leading to poor outcomes.
The vast majority of bile duct resection and reconstructions are performed via traditional open operation. The bile duct reconstruction needs very high precision to minimize bile leak, which can subsequently lead to a bile duct narrowing (stricture).
Dr. Sucandy and his team are the most experience team in the US in performing this type of operation via minimally invasive approach, having completed many open method. At the beginning of the liver program, this operation was done via open. However, after completing more than 200 robotic liver resections, Dr Sucandy introduced robotic approach specifically for perihilar cholangiocarcinoma, also known as klatskin tumor.
Since 2016, Dr Sucandy and his team had performed 26 robotic klatskin tumor resections, which include removal of bile duct together with right or left side of the liver. This is a major operation but this is what necessary to cure the patient.
Dr Sucandy said, “robotic klatskin tumor resection is the last frontier in minimally invasive liver and bile duct cancer surgery.” This operation can take up to 10 hours to complete and requires extensive experience in bile duct and liver surgery.
Recently, Dr Sucandy was invited by the Editor of Mini-Invasive Surgery journal to share his experience in robotic Klatskin tumor resection. This is to introduce the innovative surgical techniques to other surgeons in Europe and worldwide.
In fact, during his visit to University of Modena in November 2022, Dr. Sucandy performed a robotic klatskin tumor resection in a 68 year old woman from Reggio Emilia with the Italian team. The operation went well and the patient was discharged 5 days after the operation. The operation was completed in collaboration with Professor Dibenedetto, the Chairman of the Surgery Department and Liver transplant unit in Modena.
In the article, Dr Sucandy shared the preoperative, intraoperation and postoperative variables of each patient. The operative outcomes, clinical results and complications were also discussed in detail.
More importantly, Dr. Sucandy published the oncological outcomes as well we long-term survival data of those patients after their robotic operation. The outcomes are encouraging as long as the operation is performed by an experienced surgeon who has extensive experience in open and robotic bile duct cancer operation.
More than 65% of those patients are still alive after 5 years of their robotic operation. Majority of them were also able to complete adjuvant chemotherapy after the operation, making the chance for cancer recurrence as low as possible. In this most difficult surgery, Dr. Sucandy is considered a pioneer and his expertise has brought him to an international stage as an expert visiting professor at many major academic institution in Europe and America.