Background: s/Aims: The definition of textbook outcome (TO) for liver surgery in patients with intrahepatic cholangiocarcinoma (ICC) varies depending on the data and TO model utilized in the study. This study aimed to clarify the separate estimation of TO in relation to its negative predictors, using two validated TO models for ICC surgery. Methods: We assessed the rates of achieving TO and failure of TO for both models in liver resection. Independent predictors of nonTO were identified through logistic regression and validated using AUC estimation. Results: TO was achieved in a similar proportion of patients across both models: 40% and 43%. The TO models did not differ in preoperative data affecting TO achievement. Independent predictors of non-TO for both models included tumor size > 10 cm,, open surgical approach, and biliary resection. TO achievement significantly differed among sub-groups that were homogeneous concerning the opposing values of the independent predictors, regardless of the TO model. The ratio of the frequency of negative predictors in the TO and non-TO groups, referred to as the TO coefficient, determines the likelihood of achieving TO given the presence of that predictor. Predictors were ranked by their negative impact on TO achievement, from the highest risk of TO failure (tumor size > 10 cm) to the lowest risk (open approach). Conclusions Independent predictors of non-TO may improve the transparency of TO assessment and reduce biases related to unaccounted negative prognostic factors. The impact of these independent predictors on TO realization can be estimated and ranked using TO coefficient calculations.

Background: s/Aims: Robotic surgery for perihilar cholangiocarcinoma is in the developmental and exploratory phase. The objective of this study was to compare the short-term outcomes and survival rates of robotic versus open resection for perihilar cholangiocarcinoma in a single center, and to determine the reliable scope of robotic interventions. Methods: A comparative analysis of outcomes from open and robotic resections at a single center was conducted using propensity score matching (PSM). The balance of covariates was assessed using standardized mean differences, and the robotic resection procedures adhered to the standards of open surgery. Results: PSM was effectively applied between 41 robotic and 82 open resections. No differences were observed in blood loss, overall and severe morbidity, 90-day mortality, or length of hospital stay. Robotic resections were longer but resulted in better immediate oncological outcomes. Median overall survival for the robotic and open groups was 44 and 30 months (p = 0.259) before PSM and 44 and 29 months (p = 0.164) after PSM respectively. Conversion was required in 8 cases. A subgroup analysis excluding conversions revealed no differences in immediate and long-term outcomes. All patients undergoing robotic resection for Bismuth types I and II were alive at a mean follow-up of 37 months. Conclusions The robotic approach is comparable to open resection regarding immediate outcomes and survival in select patients with perihilar cholangiocarcinoma. For patients with Bismuth type I and II tumors and early (stages I and II) TNM stages, robotic resection is a reliable treatment option when aligned with the principles of open surgery.

Background: s/Aims: Robotic surgery for perihilar cholangiocarcinoma is in the developmental and exploratory phase. The objective of this study was to compare the short-term outcomes and survival rates of robotic versus open resection for perihilar cholangiocarcinoma in a single center, and to determine the reliable scope of robotic interventions. Methods: A comparative analysis of outcomes from open and robotic resections at a single center was conducted using propensity score matching (PSM). The balance of covariates was assessed using standardized mean differences, and the robotic resection procedures adhered to the standards of open surgery. Results: PSM was effectively applied between 41 robotic and 82 open resections. No differences were observed in blood loss, overall and severe morbidity, 90-day mortality, or length of hospital stay. Robotic resections were longer but resulted in better immediate oncological outcomes. Median overall survival for the robotic and open groups was 44 and 30 months (p = 0.259) before PSM and 44 and 29 months (p = 0.164) after PSM respectively. Conversion was required in 8 cases. A subgroup analysis excluding conversions revealed no differences in immediate and long-term outcomes. All patients undergoing robotic resection for Bismuth types I and II were alive at a mean follow-up of 37 months. Conclusions The robotic approach is comparable to open resection regarding immediate outcomes and survival in select patients with perihilar cholangiocarcinoma. For patients with Bismuth type I and II tumors and early (stages I and II) TNM stages, robotic resection is a reliable treatment option when aligned with the principles of open surgery.

Background: s/Aims: Robotic surgery for perihilar cholangiocarcinoma is in the developmental and exploratory phase. The objective of this study was to compare the short-term outcomes and survival rates of robotic versus open resection for perihilar cholangiocarcinoma in a single center, and to determine the reliable scope of robotic interventions. Methods: A comparative analysis of outcomes from open and robotic resections at a single center was conducted using propensity score matching (PSM). The balance of covariates was assessed using standardized mean differences, and the robotic resection procedures adhered to the standards of open surgery. Results: PSM was effectively applied between 41 robotic and 82 open resections. No differences were observed in blood loss, overall and severe morbidity, 90-day mortality, or length of hospital stay. Robotic resections were longer but resulted in better immediate oncological outcomes. Median overall survival for the robotic and open groups was 44 and 30 months (p = 0.259) before PSM and 44 and 29 months (p = 0.164) after PSM respectively. Conversion was required in 8 cases. A subgroup analysis excluding conversions revealed no differences in immediate and long-term outcomes. All patients undergoing robotic resection for Bismuth types I and II were alive at a mean follow-up of 37 months. Conclusions The robotic approach is comparable to open resection regarding immediate outcomes and survival in select patients with perihilar cholangiocarcinoma. For patients with Bismuth type I and II tumors and early (stages I and II) TNM stages, robotic resection is a reliable treatment option when aligned with the principles of open surgery.