Minimally invasive surgery is gaining support for resection of gallbladder cancer (GBC). This study aims to compare operative and early outcomes of robotic resection (RR) to open resection (OR) from a single institution performing a high volume of robotic HPB surgery.
Methods
Twenty patients with GBC underwent RR from January 2013 to August 2019. Outcomes were compared to a historical control of 23 patients with OR. Radical cholecystectomy for suspected GBC and completion operations for incidental GBC after routine cholecystectomy were both included.
Results
Robotic resection had lower blood loss compared to OR (150 vs 350 mL, P = .002) and shorter postoperative length of stay (2.5 vs 6 days, P < .001), while median operative time was similar (193 vs 208 min, P = .604). There were no statistical differences in 30-day major complications or readmissions. No 30-day mortalities occurred. There was no statistical difference in survival trend (P = .438) or median lymph node harvest (5 vs 3, P = .189) for RR compared to OR.
Conclusion
Robotic resection of GBC is safe and efficient, with lower length of hospital stay and blood loss compared to OR. Technical benefits of robotic-assisted surgery may prove advantageous though larger studies are still needed.
JaruvongvanichVYangJDPeeraphatditTRobertsLR. The incidence rates and survival of gallbladder cancer in the USA. Eur J Cancer Prev. 2019;28(1):1-9. doi:10.1097/CEJ.0000000000000402
2.
ZhangWJXuGFZouXP, et al.Incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy. World J Surg. 2009;33(12):2651-2656. doi:10.1007/s00268-009-0218-9
3.
OuchiKSuzukiMSaijoSItoKMatsunoS. Do recent advances in diagnosis and operative management improve the outcome of gallbladder carcinoma?Surgery. 1993;113(3):324-329.
4.
SmithGCParksRWMadhavanKKGardenOJ. A 10-year experience in the management of gallbladder cancer. HPB (Oxford). 2003;5(3):159-166. doi:10.1080/13651820310000037
5.
GoetzeTO. Gallbladder carcinoma: Prognostic factors and therapeutic options. World J Gastroenterol. 2015;21(43):12211-12217. doi:10.3748/wjg.v21.i43.12211
6.
ZhaoXLiXYJiW. Laparoscopic versus open treatment of gallbladder cancer: A systematic review and meta-analysis. J Minim Access Surg. 2018;14(3):185-191. doi:10.4103/jmas.JMAS_223_16
7.
ChandraVNehraDParentR, et al.A comparison of laparoscopic and robotic assisted suturing performance by experts and novices. Surgery. 2010;147(6):830-839. doi:10.1016/j.surg.2009.11.002
8.
MarohnMRHanlyEJ. Twenty-first century surgery using twenty-first century technology: Surgical robotics. Curr Surg. 2004;61(5):466-473. doi:10.1016/j.cursur.2004.03.009
9.
ChangLSatavaRMPellegriniCASinananMN. Robotic surgery: Identifying the learning curve through objective measurement of skill. Surg Endosc. 2003;17(11):1744-1748. doi:10.1007/s00464-003-8813-6
10.
HuangYChuaTCMaddernGJSamraJS. Robotic cholecystectomy versus conventional laparoscopic cholecystectomy: A meta-analysis. Surgery. 2017;161(3):628-636. doi:10.1016/j.surg.2016.08.061
11.
QiuJChenSChengyouD. A systematic review of robotic-assisted liver resection and meta-analysis of robotic versus laparoscopic hepatectomy for hepatic neoplasms. Surg Endosc. 2016;30(3):862-875. doi:10.1007/s00464-015-4306-7
12.
DaouadiMZureikatAHZenatiMS, et al.Robot-assisted minimally invasive distal pancreatectomy is superior to the laparoscopic technique. Ann Surg. 2013;257(1):128-132. doi:10.1097/SLA.0b013e31825fff08
13.
KohnGPOverbyDWMartinieJB. Robotic choledochojejunostomy with intracorporeal Roux limb construction. Int J Med Robot. 2008;4(3):263-267. doi:10.1002/rcs.206
14.
KohnGPMartinieJB. Laparoscopic robot-assisted completion cholecystectomy: A report of three cases. Int J Med Robot. 2009;5(4):406-409. doi:10.1002/rcs.270
15.
LymanWBPasseriMSastryA, et al.Robotic-assisted versus laparoscopic left pancreatectomy at a high-volume, minimally invasive center. Surg Endosc. 2019;33, 2991-3000. doi: 10.1007/s00464-018-6565-6
16.
BakerEHRossSWSeshadriR, et al.Robotic pancreaticoduodenectomy: Comparison of complications and cost to the open approach. Int J Med Robot. 2016;12(3):554-560. doi:10.1002/rcs.1688
17.
DindoDDemartinesNClavienPA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-213.
18.
ClavienPABarkunJde OliveiraML, et al.The Clavien-Dindo classification of surgical complications: Five-year experience. Ann Surg. 2009;250(2):187-196. doi:10.1097/SLA.0b013e3181b13ca2
19.
GuerriniGPLaurettaABellucoC, et al.Robotic versus laparoscopic distal pancreatectomy: An up-to-date meta-analysis. BMC Surg. 2017;17(1):105. doi:10.1186/s12893-017-0301-3
20.
GavriilidisPLimCMenahemBLahatESalloumCAzoulayD. Robotic versus laparoscopic distal pancreatectomy - The first meta-analysis. HPB (Oxford). 2016;18(7):567-574. doi:10.1016/j.hpb.2016.04.008
21.
FruscioneMPickensRBakerEH, et al.Robotic-assisted versus laparoscopic major liver resection: Analysis of outcomes from a single center. HPB (Oxford). 2019;21(7):906-911. doi:10.1016/j.hpb.2018.11.011
22.
KhanSBeardREKinghamPT, et al.Long-term oncologic outcomes following robotic liver resections for primary hepatobiliary malignancies: A multicenter study. Ann Surg Oncol. 2018;25(9):2652-2660. doi:10.1245/s10434-018-6629-9
23.
StrosbergDSNguyenMCMuscarellaPNarulaVK. A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: Operative outcomes and cost analysis. Surg Endosc. 2017;31(3):1436-1441. doi:10.1007/s00464-016-5134-0
BuntAMHermansJSmitVTvan de VeldeCJFleurenGJBruijnJA. Surgical/pathologic-stage migration confounds comparisons of gastric cancer survival rates between Japan and Western countries. J Clin Oncol. 1995;13:19-25. doi:10.1200/JCO.1995.13.1.19
26.
CaplinSCerottiniJPBosmanFTConstandaMTGivelJC. For patients with Dukes’ B (TNM Stage II) colorectal carcinoma, examination of six or fewer lymph nodes is related to poor prognosis. Cancer. 1998;83:666-672.
27.
LeighNLSolomonDFeingoldD, et al.Staging gallbladder cancer with lymphadenectomy: The practical application of new AHPBA and AJCC guidelines. HPB (Oxford). 2019 Nov;21(11):1563-1569. doi:10.1016/j.hpb.2019.03.372
ChunYSPawlikTMVautheyJN. 8th edition of the AJCC cancer staging manual: Pancreas and hepatobiliary cancers. Ann Surg Oncol. 2017;25:845-847. doi:10.1245/s10434-017-6025-x
ZimmittiGManzoniAGueriniF, et al.Current role of minimally invasive radical cholecystectomy for gallbladder cancer. Gastroenterol Res Pract. 2016;2016:7684915. doi:10.1155/2016/7684915
32.
ShenBYZhanQDengXX, et al.Radical resection of gallbladder cancer: Could it be robotic?Surg Endosc. 2012;26(11):3245-3250. doi:10.1007/s00464-012-2330-4
33.
SinagraEGarritanoSIacopinelliSM, et al.Minimally invasive surgical approach for radicalization of incidental post-cholecystectomy gallbladder carcinoma: Safety, feasibility and outcomes. Minim Invasive Ther Allied Technol. 2018;27(4):217-220. doi:10.1080/13645706.2017.1410489
34.
ZengGTeoNGohBP. Short-term outcomes of minimally invasive surgery for patients presenting with suspected gallbladder cancer: Report of 8 cases. J Minim Access Surg. 2018;15(2):109-114. doi:10.4103/jmas.JMAS_229_17
35.
ChandaranaMPatkarSTamhankarAGargSBhandareMGoelM. Robotic resections in hepatobiliary oncology - initial experience with Xi da Vinci system in India. Indian J Cancer. 2017;54(1):52-55. doi:10.4103/ijc.IJC_132_17
36.
GeorgakisGVNovakSBartlettDLZureikatAHZehHJHoggME. The emerging role of minimally invasive surgery for gallbladder cancer: A comparison to open surgery. SM Min Inv Surg. 2017;1(2):1007.
37.
GoelMKhobragadeKPatkarSKanetkarAKurunkarS. Robotic surgery for gallbladder cancer: Operative technique and early outcomes. J Surg Oncol. 2019;119(7):958-963. doi:10.1002/jso.25422
38.
YoonYSHanHSChoJY, et al.Is laparoscopy contraindicated for gallbladder cancer? A 10-year prospective cohort study. J Am Coll Surg. 2015;221(4):847-853. doi:10.1016/j.jamcollsurg.2015.07.010
39.
ItanoOOshimaGMinagawaT, et al.Novel strategy for laparoscopic treatment of pT2 gallbladder carcinoma. Surg Endosc. 2015;29(12):3600-3607. doi:10.1007/s00464-015-4116-y
40.
AgarwalAKJavedAKalayarasanRSakhujaP. Minimally invasive versus the conventional open surgical approach of a radical cholecystectomy for gallbladder cancer: A retrospective comparative study. HPB (Oxford). 2015;17(6):536-541. doi:10.1111/hpb.12406
41.
BooneBAZenatiMHoggME, et al.Assessment of quality outcomes for robotic pancreaticoduodenectomy: Identification of the learning curve. JAMA Surg. 2015;150(5):416-422. doi:10.1001/jamasurg.2015.17
42.
GiulianottiPCCorattiAAngeliniM, et al.Robotics in general surgery: Personal experience in a large community hospital. Arch Surg. 2003;138(7):777-784. doi:10.1001/archsurg.138.7.777
43.
BerberEAkyildizHYAucejoFGunasekaranGChalikondaSFungJ. Robotic versus laparoscopic resection of liver tumours. HPB (Oxford). 2010;12(8):583-586. doi:10.1111/j.1477-2574.2010.00234.x
44.
AcherAWBleicherJCannonAScaifeC. Advances in surgery for pancreatic cancer. J Gastrointest Oncol. 2018;9(6):1037-1043. doi:10.21037/jgo.2018.05.05
45.
CarusoSPatritiARovielloF, et al.Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations. World J Gastroenterol. 2016;22(25):5694-5717. doi:10.3748/wjg.v22.i25.5694
46.
KimYMSonTKimHINohSHHyungWJ. Robotic D2 lymph node dissection during distal subtotal gastrectomy for gastric cancer: Toward procedural standardization. Ann Surg Oncol. 2016;23(8):2409-2410. doi:10.1245/s10434-016-5166-7
