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Oncologic safety of robotic extended cholecystectomy for gallbladder cancer

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Abstract

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.

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Acknowledgements

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by Korea government (MSIT) (No. 2022R1A2C2011122).

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Author notes

  1. Young Jae Cho and Won-Gun Yun have contributed equally to this work as co-first authors.

Authors and Affiliations

  1. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea

    Young Jae Cho, Won-Gun Yun, Hye-Sol Jung, Mirang Lee, Youngmin Han, Wooil Kwon & Jin-Young Jang

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Correspondence to Jin-Young Jang.

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Young Jae Cho, Won-Gun Yun, Hye-Sol Jung, Mirang Lee, Youngmin Han, Wooil Kwon, and Jin-Young Jang have no conflicts of interest or financial ties to disclose.

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Cho, Y.J., Yun, WG., Jung, HS. et al. Oncologic safety of robotic extended cholecystectomy for gallbladder cancer. Surg Endosc 37, 9089–9097 (2023). https://doi.org/10.1007/s00464-023-10463-6

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