Oncologic safety of robotic extended cholecystectomy for gallbladder cancer.

Publisher: Springer Country of Publication: Germany NLM ID: 8806653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-2218 (Electronic) Linking ISSN: 09302794 NLM ISO Abbreviation: Surg Endosc Subsets: MEDLINE

Publication: 1992- : New York : Springer
Original Publication: [Berlin] : Springer International, c1987-

Gallbladder Neoplasms*/pathology ; Robotic Surgical Procedures*/adverse effects ; Cholecystectomy, Laparoscopic*/adverse effects ; Cholecystectomy, Laparoscopic*/methods ; Laparoscopy* ; Carcinoma*/surgery ; Carcinoma in Situ*/surgery; Humans ; Treatment Outcome ; Cholecystectomy/adverse effects ; Cholecystectomy/methods ; Lymph Node Excision/methods ; Retrospective Studies

Background: Although laparoscopic cholecystectomy is applicable for the treatment of early gallbladder cancer (GBC), minimally invasive surgery is not widely used for advanced GBC. This is because advanced GBCs necessitate complicated surgical techniques, including lymph node dissection and liver resection. Robotic extended cholecystectomy (REC) is thought to overcome the limitations of laparoscopic surgery, but oncological safety studies are lacking. Therefore, in this study, we aimed to evaluate the oncologic outcomes of REC compared with those of open extended cholecystectomy (OEC).
Methods: A total of 125 patients, who underwent extended cholecystectomy for GBC with tentative T2 or higher stage between 2018 and 2021, were included and stratified by surgical methods. To minimize the confounding factors, 1:1 propensity-score matching was performed between the patients who underwent REC and those who underwent OEC.
Results: Regarding short-term outcomes, the REC group showed significantly lower estimated blood loss (382.7 vs. 717.2 mL, P = 0.020) and shorter hospital stay (6.9 vs. 8.5 days, P = 0.042) than the OEC group. In addition, the REC group had significantly lower subjective pain scores than the OEC group from the day of surgery through the 5th postoperative day (P = 0.006). Regarding long-term outcomes, there were no significant differences in the 3-year [5-year] overall survival (OS) and disease-free survival (DFS) rates between the REC group [OS, 92.3% (92.3%); DFS, 84.6% (72.5%)] and the OEC group [OS, 96.8% (96.8%); DFS, 78.2% (78.2%)] (P = 0.807 for OS and 0.991 for DFS).
Conclusions: In this study, REC showed superior short-term outcomes to OEC and no difference in long-term survival outcomes. Additionally, REC was superior to OEC in terms of postoperative pain. Therefore, REC may be a feasible option with early recovery compared with OEC for patients with advanced GBC.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

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2022R1A2C2011122 Ministry of Science ICT and Future Planning

Keywords: Gallbladder cancer; Minimally invasive surgery; Open extended cholecystectomy; Robotic extended cholecystectomy; Robotic liver resection

Date Created: 20231005 Date Completed: 20231216 Latest Revision: 20240131

20240131

10.1007/s00464-023-10463-6

37798528