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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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References

  1. Kim HS, Park JW, Kim H, Han Y, Kwon W, Kim SW, Hwang YJ, Kim SG, Kwon HJ, Vinuela E, Járufe N, Roa JC, Han IW, Heo JS, Choi SH, Choi DW, Ahn KS, Kang KJ, Lee W, Jeong CY, Hong SC, Troncoso A, Losada H, Han SS, Park SJ, Yanagimoto H, Endo I, Kubota K, Wakai T, Ajiki T, Adsay NV, Jang JY (2018) Optimal surgical treatment in patients with T1b gallbladder cancer: an international multicenter study. J Hepatobiliary Pancreat Sci 25:533–543

    Article  Google Scholar 

  2. Yoon YS, Han HS, Cho JY, Choi Y, Lee W, Jang JY, Choi H (2015) Is laparoscopy contraindicated for gallbladder cancer? A 10-year prospective cohort study. J Am Coll Surg 221:847–853

    Article  PubMed  Google Scholar 

  3. Lee SE, Kim KS, Kim WB, Kim IG, Nah YW, Ryu DH, Park JS, Yoon MH, Cho JY, Hong TH, Hwang DW, Choi DW, The Korean Association of Hepato-Biliary-Pancreatic Surgery (2014) Practical guidelines for the surgical treatment of gallbladder cancer. J Korean Med Sci 29:1333–1340

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nagino M, Hirano S, Yoshitomi H, Aoki T, Uesaka K, Unno M, Ebata T, Konishi M, Sano K, Shimada K, Shimizu H, Higuchi R, Wakai T, Isayama H, Okusaka T, Tsuyuguchi T, Hirooka Y, Furuse J, Maguchi H, Suzuki K, Yamazaki H, Kijima H, Yanagisawa A, Yoshida M, Yokoyama Y, Mizuno T, Endo I (2021) Clinical practice guidelines for the management of biliary tract cancers 2019: the 3rd English edition. J Hepatobiliary Pancreat Sci 28:26–54

    Article  PubMed  Google Scholar 

  5. Regmi P, Hu HJ, Chang-Hao Y, Liu F, Ma WJ, Ran CD, Wang JK, Paudyal A, Cheng NS, Li FY (2021) Laparoscopic surgery for oncologic extended resection of T1b and T2 incidental gallbladder carcinoma at a high-volume center: a single-center experience in China. Surg Endosc 35:6505–6512

    Article  PubMed  Google Scholar 

  6. Zhao X, Li XY, Ji W (2018) Laparoscopic versus open treatment of gallbladder cancer: a systematic review and meta-analysis. J Minim Access Surg 14:185–191

    Article  PubMed  PubMed Central  Google Scholar 

  7. Zhang L, Hou C, Xu Z, Wang L, Ling X, Xiu D (2018) Laparoscopic treatment for suspected gallbladder cancer confined to the wall: a 10-year study from a single institution. Chin J Cancer Res 30:84–92

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Castro CM, Santibañez SP, Rivas TC, Cassis NJ (2018) Totally laparoscopic radical resection of gallbladder cancer: technical aspects and long-term results. World J Surg 42:2592–2598

    Article  PubMed  Google Scholar 

  9. Ome Y, Hashida K, Yokota M, Nagahisa Y, Okabe M, Kawamoto K (2017) Laparoscopic approach to suspected T1 and T2 gallbladder carcinoma. World J Gastroenterol 23:2556–2565

    Article  PubMed  PubMed Central  Google Scholar 

  10. Byun Y, Choi YJ, Kang JS, Han Y, Kim H, Kwon W, Jang JY (2020) Early outcomes of robotic extended cholecystectomy for the treatment of gallbladder cancer. J Hepatobiliary Pancreat Sci 27:324–330

    Article  PubMed  Google Scholar 

  11. Kim S, Yoon YS, Han HS, Cho JY, Choi Y (2018) Laparoscopic extended cholecystectomy for T3 gallbladder cancer. Surg Endosc 32:2984–2985

    Article  PubMed  Google Scholar 

  12. Shen BY, Zhan Q, Deng XX, Bo H, Liu Q, Peng CH, Li HW (2012) Radical resection of gallbladder cancer: could it be robotic? Surg Endosc 26:3245–3250

    Article  PubMed  Google Scholar 

  13. Shyr Y-M, Wang S-E, Chen S-C, Shyr B-U (2020) Robotic pancreaticoduodenectomy in the era of minimally invasive surgery. J Chin Med Assoc 83:639–643

    Article  PubMed  Google Scholar 

  14. Kwon W, Kim H, Han Y, Hwang YJ, Kim SG, Kwon HJ, Vinuela E, Jarufe N, Roa JC, Han IW, Heo JS, Choi SH, Choi DW, Ahn KS, Kang KJ, Lee W, Jeong CY, Hong SC, Troncoso AT, Losada HM, Han SS, Park SJ, Kim SW, Yanagimoto H, Endo I, Kubota K, Wakai T, Ajiki T, Adsay NV, Jang JY (2020) Role of tumour location and surgical extent on prognosis in T2 gallbladder cancer: an international multicentre study. Br J Surg 107:1334–1343

    Article  CAS  PubMed  Google Scholar 

  15. Matsui S, Tanioka T, Nakajima K, Saito T, Kato S, Tomii C, Hasegawa F, Muramatsu S, Kaito A, Ito K (2023) Surgical and oncological outcomes of wedge resection versus segment 4b + 5 resection for T2 and T3 gallbladder cancer: a meta-analysis. J Gastrointest Surg. https://doi.org/10.1007/s11605-023-05698-6

    Article  PubMed  Google Scholar 

  16. Nag HH, Sachan A, Nekarakanti PK (2021) Laparoscopic versus open extended cholecystectomy with bi-segmentectomy (s4b and s5) in patients with gallbladder cancer. J Minim Access Surg 17:21–27

    Article  Google Scholar 

  17. Goel M, Khobragade K, Patkar S, Kanetkar A, Kurunkar S (2019) Robotic surgery for gallbladder cancer: operative technique and early outcomes. J Surg Oncol 119:958–963

    Article  PubMed  Google Scholar 

  18. Jang JY, Heo JS, Han Y, Chang J, Kim JR, Kim H, Kwon W, Kim SW, Choi SH, Choi DW, Lee K, Jang KT, Han SS, Park SJ (2016) Impact of type of surgery on survival outcome in patients with early gallbladder cancer in the era of minimally invasive surgery: oncologic safety of laparoscopic surgery. Medicine (Baltimore) 95:e3675

    Article  PubMed  Google Scholar 

  19. Washington K, Rocha F (2021) Approach to resectable biliary cancers. Curr Treat Options Oncol 22:97

    Article  PubMed  Google Scholar 

  20. Peters BS, Armijo PR, Krause C, Choudhury SA, Oleynikov D (2018) Review of emerging surgical robotic technology. Surg Endosc 32:1636–1655

    Article  PubMed  Google Scholar 

  21. Leal Ghezzi T, Campos Corleta O (2016) 30 years of robotic surgery. World J Surg 40:2550–2557

    Article  PubMed  Google Scholar 

  22. Kim HS, Kim H, Han Y, Lee M, Kang YH, Sohn HJ, Kang JS, Kwon W, Jang JY (2022) ROBOT-assisted pancreatoduodenectomy in 300 consecutive cases: annual trend analysis and propensity score-matched comparison of perioperative and long-term oncologic outcomes with the open method. J Hepatobiliary Pancreat Sci 29:301–310

    Article  PubMed  Google Scholar 

  23. Lee SE, Choi YS, Kim YH, Heo JS, Jeong CY, Lee WJ, Seo HI, Yoon YS, Jang JY (2020) Prognostic significance of tumor location in T2 gallbladder cancer: a Korea Tumor Registry System Biliary Pancreas (KOTUS-BP) database analysis. J Clin Med 9:3268

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Kishi Y, Nara S, Esaki M, Hiraoka N, Shimada K (2018) Extent of lymph node dissection in patients with gallbladder cancer. Br J Surg 105:1658–1664

    Article  CAS  PubMed  Google Scholar 

  25. Vega EA, Yamashita S, Chun YS, Kim M, Fleming JB, Katz MH, Tzeng CW, Raghav KP, Vauthey JN, Lee JE, Conrad C (2017) Effective laparoscopic management lymph node dissection for gallbladder cancer. Ann Surg Oncol 24:1852

    Article  PubMed  Google Scholar 

  26. Sakata J, Kobayashi T, Tajima Y, Ohashi T, Hirose Y, Takano K, Takizawa K, Miura K, Wakai T (2017) Relevance of dissection of the posterior superior pancreaticoduodenal lymph nodes in gallbladder carcinoma. Ann Surg Oncol 24:2474–2481

    Article  Google Scholar 

  27. Kasai M, Cipriani F, Gayet B, Aldrighetti L, Ratti F, Sarmiento JM, Scatton O, Kim KH, Dagher I, Topal B, Primrose J, Nomi T, Fuks D, Abu Hilal M (2018) Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data. Surgery 163:985–995

    Article  Google Scholar 

  28. Gonzalez-Ciccarelli LF, Quadri P, Daskalaki D, Milone L, Gangemi A, Giulianotti PC (2017) Robotic approach to hepatobiliary surgery. Chirurg 88:19–28

    Article  CAS  PubMed  Google Scholar 

  29. Liu GJ, Li XH, Chen YX, Sun HD, Zhao GM, Hu SY (2013) Radical lymph node dissection and assessment: impact on gallbladder cancer prognosis. World J Gastroenterol 19:5150–5158

    Article  PubMed  PubMed Central  Google Scholar 

  30. Negi SS, Singh A, Chaudhary A (2011) Lymph nodal involvement as prognostic factor in gallbladder cancer: location, count or ratio? J Gastrointest Surg 15:1017–1025

    Article  PubMed  Google Scholar 

  31. Fan DX, Xu RW, Li YC, Zhao BQ, Sun MY (2018) Impact of the number of examined lymph nodes on outcomes in patients with lymph node-negative gallbladder carcinoma. World J Gastroenterol 24:2886–2892

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ito H, Ito K, D’Angelica M, Gonen M, Klimstra D, Allen P, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR (2011) Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg 254:320–325

    Article  PubMed  Google Scholar 

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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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