Robotic Liver Resection for Intrahepatic Cholangiocarcinoma: Perioperative and Oncologic Outcomes From a Single-Institution Experience

Background Robotic liver resection (RLR) for intrahepatic cholangiocarcinoma (ICC) remains a newly adopted approach with limited data supporting its oncologic validity. We aimed to evaluate perioperative outcomes and early oncologic metrics following RLR for ICC at a single hepatobiliary center. Methods A retrospective analysis was conducted on patients undergoing RLR for histologically confirmed ICC between January 2018 and December 2024. Data were collected and analyzed using descriptive statistics. Results Thirty-five patients underwent RLR for ICC. Mean age was 69 years, with 66% male and a mean ASA grade of III. Major resections comprised 54% of cases, with no conversions to open surgery or intraoperative complications. Mean operative time was 321 years and mean estimated blood loss was 239 mL. R0 resection was achieved in 97% of cases. Mean lymph node harvested was 5, with 37% of patients having ≥6 nodes retrieved. Mean tumor size was 6 cm, with 94% of patients harboring tumors >2 cm and 60% staged as N0. Postoperative complication rate was 34%, with Clavien-Dindo ≥III at 14%. No reoperation occurred. 90-day mortality was 6%. Mean length of stay was 6 days. At a mean follow-up of 21 months, recurrence was observed in 25% of patients, with a mean disease-free survival of 17 months. Conclusion Robotic liver resection for ICC is safe and feasible, yielding high rates of R0 resection, low conversion and complication rates, with acceptable oncological outcomes. These findings support the continued integration of robotics in complex liver oncology.