Advances in Minimally Invasive Surgery for Biliary Tract Cancer from the Viewpoint of Liver Surgery: A Task-Based Framework for Disease-Specific Procedures

Biliary tract cancer (BTC) surgery often requires more than organ resection, and the role of minimally invasive surgery (MIS) cannot be adequately interpreted by disease subtype alone because operative complexity varies substantially within each subtype. This narrative review evaluates recent evidence for laparoscopic and robotic surgery in BTC from a task-based perspective, focusing on liver resection, lymphadenectomy, bile duct resection and reconstruction, vascular or multivisceral procedures, and pancreatic resection. Peripheral intrahepatic cholangiocarcinoma, which is often of the small-duct type, represents the most established field for minimally invasive liver resection, although lymphadenectomy remains inconsistent. Central intrahepatic cholangiocarcinoma, which is often of the large-duct type, should be considered separately because increasing hilar involvement may require systematic lymphadenectomy and bile duct resection and reconstruction, making the operation more similar to that for perihilar cholangiocarcinoma. Perihilar cholangiocarcinoma remains the highest-task-load frontier of BTC-MIS, typically requiring major liver resection with caudate lobectomy, bile duct resection, lymphadenectomy, and reconstruction of multiple small bile ducts. Current evidence is derived predominantly from retrospective studies of highly selected patients treated at expert centers. Gallbladder cancer should be stratified into Tis/T1a disease, T1b/T2 and selected T3 disease suitable for standard extended cholecystectomy, bile duct-involved disease, and locally advanced disease. Distal cholangiocarcinoma should be evaluated within the evidence base for minimally invasive pancreaticoduodenectomy rather than liver surgery. Overall, current evidence most strongly supports MIS for selected patients with peripheral intrahepatic cholangiocarcinoma and for standard extended cholecystectomy in selected patients with gallbladder cancer. Minimally invasive pancreaticoduodenectomy may also be considered for selected patients with distal cholangiocarcinoma in experienced centers. Central intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, bile duct-involved gallbladder cancer, and locally advanced gallbladder cancer require cautious patient selection, standardized reporting, and prospective multicenter validation.