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Chee MYM, Wu AGR, Fong KY, Yew A, Koh YX, Goh BKP. Robotic, laparoscopic and open surgery for gallbladder cancer: a systematic review and network meta-analysis. Surg Endosc 2024:10.1007/s00464-024-11162-6. [PMID: 39148006 DOI: 10.1007/s00464-024-11162-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Minimally invasive oncological resections have become increasingly widespread in the surgical management of cancers. However, the role of minimally invasive surgery (MIS) for gallbladder cancer (GBC) remains unclear. We aim to perform a systematic review and network meta-analysis of existing literature to evaluate the safety and feasibility of laparoscopic and robotic surgery in the management of GBC compared to open surgery (OS) by comparing outcomes. METHODS A literature search of the PubMed/MEDLINE (2000 to December 2021) and EMBASE (2000 to December 2021) databases was conducted. The primary outcome studied was overall survival, and secondary outcomes studied were postoperative morbidity, severe complications, incidence of bile leak, length of hospital stay, operation time, R0 resection rate, local recurrence and lymph node yield. RESULTS Thirty-two full-text articles met the eligibility criteria and were included in the final analysis with a total of 5883 patients undergoing either OS or MIS (laparoscopic or robotic) for GBC. 1- and 2-stage meta-analyses did not reveal any significant differences between OS, laparoscopic and robotic surgery in terms of overall survival, R0 resection, lymph node harvest, local recurrence and post-operative complications. Patients who underwent OS had significantly longer hospitalization stay and intra-operative blood loss compared to those who underwent laparoscopic or robotic surgery. Network meta-analysis did not reveal any significant differences between post-operative and survival outcomes of laparoscopic vs robotic surgery groups. CONCLUSION This network meta-analysis suggests that both laparoscopic and robotic surgery are safe and effective approaches in the surgical management of GBC, with post-operative and survival outcomes comparable to OS. An MIS approach may also lead to shorter hospitalization stay, less intraoperative blood loss and post-operative complications compared to OS. There was no obvious benefit of either MIS approach (laparoscopic versus robotic) over the other.
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Affiliation(s)
- Madeline Yen Min Chee
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
- Ministry of Health Holdings Singapore, Singapore, Singapore
| | | | - Khi-Yung Fong
- Ministry of Health Holdings Singapore, Singapore, Singapore
| | - Ashley Yew
- Ministry of Health Holdings Singapore, Singapore, Singapore
| | - Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore
- Surgery, Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.
- Surgery, Academic Clinical Program, Duke-National University of Singapore Medical School, Singapore, Singapore.
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, 20 College Road, Academia Level 5, Singapore, 169856, Singapore.
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Mellado S, Chirban AM, Shapera E, Rivera B, Panettieri E, Vivanco M, Conrad C, Sucandy I, Vega EA. Innovations in surgery for gallbladder cancer: A review of robotic surgery as a feasible and safe option. Am J Surg 2024; 233:37-44. [PMID: 38443272 DOI: 10.1016/j.amjsurg.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/24/2024] [Accepted: 02/12/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND This study evaluates the efficacy and safety of robotic-assisted surgical techniques in the treatment of gallbladder cancer, comparing it with traditional open and laparoscopic methods. METHODS A systematic review of the literature searched for comparative analyses of patient outcomes following robotic, open, and laparoscopic surgeries, focusing on oncological results and perioperative benefits. RESULTS Five total studies published between 2019 and 2023 were identified. Findings indicate that robotic-assisted surgery for gallbladder cancer is as effective as traditional methods in terms of oncological outcomes, with potential advantages in precision and perioperative recovery. CONCLUSIONS Robotic surgery offers a viable and potentially advantageous alternative for gallbladder cancer treatment, warranting further research to confirm its benefits and establish comprehensive surgical guidelines.
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Affiliation(s)
- Sebastian Mellado
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA; Tufts University School of Medicine, Boston, MA, USA
| | - Ariana M Chirban
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA; University of California San Diego School of Medicine, San Diego, CA, USA
| | - Emanuel Shapera
- Digestive Health Institute, Advent Health Tampa, Tampa, FL, USA
| | - Belen Rivera
- Department of Surgery, Clinica Alemana de Santiago, Santiago, Chile
| | - Elena Panettieri
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA; Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marcelo Vivanco
- Department of Surgery, Clinica Alemana de Santiago, Santiago, Chile
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Iswanto Sucandy
- Digestive Health Institute, Advent Health Tampa, Tampa, FL, USA
| | - Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA.
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Minagawa T, Itano O, Hasegawa S, Wada H, Abe Y, Kitago M, Katsura Y, Takeda Y, Adachi T, Eguchi S, Oshima G, Aiko S, Ome Y, Kobayashi T, Hashida K, Nara S, Esaki M, Watanabe J, Ohtani H, Endo Y, Shirobe T, Tokumitsu Y, Nagano H. Short- and long-term outcomes of laparoscopic radical gallbladder resection for gallbladder carcinoma: A multi-institutional retrospective study in Japan. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:1046-1054. [PMID: 37306108 DOI: 10.1002/jhbp.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND/PURPOSE Laparoscopic resection of gallbladder carcinomas remains controversial. This study aimed to evaluate the surgical and oncological outcomes of laparoscopic procedures for suspected gallbladder carcinoma (GBC). METHODS In this retrospective study, data regarding suspected GBC treated with laparoscopic radical cholecystectomy before 2020 in Japan, was included. Patient characteristics, surgical procedure details, surgical outcomes, and long-term outcomes were analyzed. RESULTS Data of 129 patients with suspected GBC who underwent laparoscopic radical cholecystectomy were retrospectively collected from 11 institutions in Japan. Among them, 82 patients with pathological GBC were included in the study. Laparoscopic gallbladder bed resection was performed in 114 patients and laparoscopic resection of segments IVb and V was performed in 15 patients. The median operation time was 269 min (range: 83-725 min), and the median intraoperative blood loss was 30 mL (range: 0-950 mL). The conversion and postoperative complication rates were 8% and 2%, respectively. During the follow-up period, the 5-year overall survival rate was 79% and the 5-year disease-free survival rate was 87%. Recurrence was detected in the liver, lymph nodes, and other local tissues. CONCLUSION Laparoscopic radical cholecystectomy is a treatment option with potential favorable outcomes in selected patients with suspected GBC.
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Affiliation(s)
- Takuya Minagawa
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Osamu Itano
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Shinichiro Hasegawa
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yuta Abe
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Minoru Kitago
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiteru Katsura
- Department of Surgery, Kansai Rosai Hospital, Japan Organization of Occupational Health and Safety, Osaka, Japan
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, Japan Organization of Occupational Health and Safety, Osaka, Japan
| | - Tomohiko Adachi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Go Oshima
- Department of Surgery, Eiju General Hospital, Tokyo, Japan
| | - Satoshi Aiko
- Department of Surgery, Eiju General Hospital, Tokyo, Japan
| | - Yusuke Ome
- Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiki Kobayashi
- Department of Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Kazuki Hashida
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Satoshi Nara
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Minoru Esaki
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Jota Watanabe
- Department of Gastroenterological Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hiromi Ohtani
- Department of Gastroenterological Surgery, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Yutaka Endo
- Department of Surgery, Tamakyuryu Hospital, Tokyo, Japan
| | - Takashi Shirobe
- Department of Surgery, Hamamatsu-Minami Hospital, Shizuoka, Japan
| | - Yukio Tokumitsu
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Machado MAC, Lobo Filho M, Makdissi F. ASO Author Reflections: Robotic Radical Surgery for Incidental Gallbladder Cancer is on the Rise. Ann Surg Oncol 2023; 30:3398-3399. [PMID: 36967452 DOI: 10.1245/s10434-023-13356-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/28/2023]
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Machado MAC, Mattos BV, Lobo Filho MM, Makdissi F. Robotic Hepatic Bisegmentectomy (s4b + s5) and Hilar Lymphadenectomy for Incidental Gallbladder Cancer Using Glissonian Approach. Ann Surg Oncol 2023; 30:3392-3397. [PMID: 36683100 DOI: 10.1245/s10434-023-13125-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/09/2023] [Indexed: 01/23/2023]
Abstract
BACKGROUND Gallbladder carcinoma is a rare cancer with a poor prognosis and the most common biliary tract malignancy. This video shows robotic treatment of a patient with incidental gallbladder cancer diagnosed after laparoscopic cholecystectomy. The operation consisted of a robotic bisegmentectomy (liver segments 4b and 5) using a Glissonian approach and a hilar lymphadenectomy. METHODS A 73-year-old woman with no relevant history underwent a laparoscopic cholecystectomy at another hospital facility. The pathology revealed a gallbladder carcinoma. The patient was then referred for further treatment. Pathologic revision confirmed T2a carcinoma and staging was negative for distant metastases. The multidisciplinary team decided on a radical resection that will consist of a hilar lymphadenectomy and a frozen section of the cystic stump along the resection of segments 4b and 5. A robotic approach was proposed, and consent was obtained. RESULTS The operation time was 300 min and was performed 21 days after the cholecystectomy. Estimated blood loss was 120 mL with no transfusions required during or after the procedure. The postoperative recovery was uneventful, and the patient was discharged on the fourth postoperative day. The final pathology showed no residual disease in the liver specimen and no metastases among 16 removed lymph nodes. CONCLUSIONS The robotic approach is safe and feasible for radical treatment after incidentally discovered gallbladder cancer. The Glissonian approach is useful for anatomic resection of liver segments 4b and 5. This video can help oncologic surgeons to perform this challenging procedure.
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Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
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Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
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Jiayi W, Shelat VG. Robot-assisted radical cholecystectomy for gallbladder cancer: A review. J Clin Transl Res 2022; 8:103-109. [PMID: 35392126 PMCID: PMC8983392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/15/2021] [Accepted: 01/08/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Radical cholecystectomy (RC) is recommended for Gallbladder cancer (GbC) patients with resectable T1b or higher stage. Traditionally, open RC is preferred over minimally invasive approach. Robotic surgery is increasingly gaining popularity and there are reports of robotic RC (RRC) for GbC. RRC is still new and mostly performed in high-volume centers with access to robotic technology. AIM This study aims to review the current literature on the safety and feasibility of RRC for GbC. METHODS We performed a systematic review of RRC for GbC using PubMed and Embase until December 2020. The primary endpoint was major complications, while the secondary endpoints were conversion to open, R0 resection, and early recurrence. RESULTS Seven studies with 74 patients were included in the study. Overall, four patients (5.41%) required open conversion. Five out of 74 patients (6.76%) experienced post-operative complications. There was no post-operative mortality. Among the patients with surgical margins reported (n = 63), 61 patients had negative margins (96.8%) and only two patients had positive margins. Two-year survival outcomes were reported as 60.5-100%. RELEVANCE FOR PATIENTS This is the first review that summarizes the current evidence on RRC for GbC. The endpoints suggest that RRC is feasible and safe in selected patients and when done in experienced centers. Understanding the strengths and limitations of RRC compared to other established therapeutic options may potentially aid surgeons in formulating the optimal treatment plan for GbC patients.
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Affiliation(s)
- Weng Jiayi
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Corresponding author: Weng Jiayi Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, 117597, Singapore. Tel: +65 98592965
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Robotic Surgery for Biliary Tract Cancer. Cancers (Basel) 2022; 14:cancers14041046. [PMID: 35205792 PMCID: PMC8869869 DOI: 10.3390/cancers14041046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/13/2022] [Accepted: 02/16/2022] [Indexed: 12/26/2022] Open
Abstract
Biliary tract cancer consists of cholangiocarcinoma (CC) and gallbladder cancer (GBC). When resectable, surgery provides the best chance at long-term survival. Unfortunately, surgery for these tumors is associated with long operative times, high morbidities, and prolonged hospital stays. Minimally invasive surgery has been shown to impact selected outcomes, including length of stay, in other diseases, and robotic surgery may offer additional advantages compared to laparoscopic surgery in treating bile duct cancers. This is a systematic review of robotic surgery for biliary tract cancer. Predetermined selection criteria were used to appraise the literature. The PRISMA guidelines were followed. In total, 20 unique articles with a total of 259 patients with biliary tract cancer undergoing robotic surgery met the inclusion criteria. For CC and GBC, respectively, the weighted average operative time was 401 and 277 min, the estimated blood loss was 348 and 260 mL, the conversion rate to open was 7 and 3.5%, the all-cause morbidity was 52 and 9.7%, the major morbidity was 12 and 4.4%, the perioperative mortality was 1.4 and 0%, the length of stay was 15 and 4.8 days, the positive margin rate was 27 and 9%, and the number of lymph nodes retrieved was 4.2 and 8. Robotic surgery for biliary tract cancer appears non-inferior to open surgery when compared to the published contemporary data. However, the current literature on the topic is of low quality, and future prospective/randomized studies are needed.
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Tschuor C, Pickens RC, Isenberg EE, Motz BM, Salibi PN, Robinson JN, Murphy KJ, Iannitti DA, Baker EH, Vrochides D, Martinie JB. Robotic Resection of Gallbladder Cancer: A Single-Center Retrospective Comparative Study to Open Resection. Am Surg 2021:31348211047491. [PMID: 34652250 DOI: 10.1177/00031348211047491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND 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.
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Affiliation(s)
- Christoph Tschuor
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.,Department of Surgical Gastroenterology and Transplantation, 53146Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, 4321University of Copenhagen, Copenhagen, Denmark
| | - Ryan C Pickens
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Erin E Isenberg
- School of Medicine, 6797University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Benjamin M Motz
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Patrick N Salibi
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Jordan N Robinson
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Keith J Murphy
- Carolinas Center for Surgical Outcomes Science, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - David A Iannitti
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Erin H Baker
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - John B Martinie
- Division of HPB Surgery, Department of Surgery, 22442Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
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Srivastava V, Verma K, Puneet. Surgical Management of Gallbladder Carcinoma. Indian J Surg 2021. [DOI: 10.1007/s12262-019-02050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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11
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Xu Y, Wang A, Dai Q, Fang Z, Li Z. Laparoscopic cholecystectomy with two incisions: an improved, feasible and safe technique with superior cosmetic outcomes. J Int Med Res 2021; 48:300060520980589. [PMID: 33351703 PMCID: PMC7758570 DOI: 10.1177/0300060520980589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Conventional laparoscopic cholecystectomy (CLC) is usually performed with four incisions. Minimally invasive surgery for gallbladder disease with less pain and smaller scars has become increasingly popular. This study reported a new, two-incision laparoscopic cholecystectomy (TILC) using conventional instruments. METHODS In this prospective study, 43 patients were recruited to undergo TILC and were compared with 43 historical cases undergoing CLC. We evaluated operative time, postoperative pain, cosmesis and complications. RESULTS There was no significant difference in gender, age, body mass index, bile duct damage, blood loss and postoperative hospital stay between the two groups. The mean operation time was longer with TILC than with CLC, but the difference was not statistically different. Postoperative pain scores were significantly lower with TILC than with CLC. The mean cosmetic satisfaction score was significantly higher with TILC than that with CLC. There was no significant difference in the incidence of complications between the two groups. CONCLUSION Our work demonstrates that TILC generates less postoperative pain and significantly improved cosmesis for patients. TILC is a safe and feasible alternative to CLC.
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Affiliation(s)
- Yongfu Xu
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Aidong Wang
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Qiqiang Dai
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Zheping Fang
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
| | - Zhenyu Li
- Department of Hepatobiliary Surgery, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai, China
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12
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Regmi P, Hu HJ, Chang-Hao Y, Liu F, Ma WJ, Ran CD, Wang JK, Paudyal A, Cheng NS, Li FY. 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 2020; 35:6505-6512. [PMID: 33174099 DOI: 10.1007/s00464-020-08146-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical treatment is still the most effective treatment for gallbladder cancer. For the patients with stage T1b and above, the current guidelines recommend the extended radical operation, and oncologic extended resection can benefit the survival of the patients. The laparoscopic approach is still in the early phase, and its safety and oncological outcomes are not well known. OBJECTIVE To evaluate the technical feasibility and oncological outcomes of laparoscopic surgery for oncologic extended resection of early-stage incidental gallbladder carcinoma. RESULTS This study included 18 male and 32 female patients. Twenty patients underwent laparoscopic oncologic extended resection and 30 patients underwent open oncologic extended resection. All of the patients had R0 resection. A laparoscopic approach was associated with less intraoperative blood loss (242 ± 108.5 vs 401 ± 130.3; p < 0.01) and shorter duration of postoperative hospital stay (6.2 ± 2.4 vs 8.6 ± 2.3; p < 0.01). There was no statistically significant difference between two groups for lymph nodes yield (5.4 ± 3.5 vs 5.8 ± 2.1; p > 0.05), incidence of lymphatic metastasis (15% vs 16.67%; p > 0.05), residual disease (20% vs 23.3%; p > 0.05), and postoperative morbidity (15% vs 20%; p > 0.05). During follow-up time of median 20.95 (12-29.5) months, no significant difference was found between the two groups for early tumor recurrence (10% vs 13.33%; p > 0.05) and disease-free survival (p > 0.05). CONCLUSION Laparoscopic surgery may offer similar intraoperative, perioperative, and short-term oncological outcomes as an open oncologic extended resection for incidental gallbladder carcinoma.
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Affiliation(s)
- Parbatraj Regmi
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yin Chang-Hao
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Cong-Dun Ran
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jun-Ke Wang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Aliza Paudyal
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Nan-Sheng Cheng
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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