Department of Surgery and Cancer Research Institute, Seoul National University Hospital, Seoul, Korea.
J Hepatobiliary Pancreat Sci. 2020 Jun;27(6):324-330. doi: 10.1002/jhbp.717. Epub 2020 Feb 15.
Simple laparoscopic cholecystectomy is sufficient for patients with early gallbladder cancer (GBC). However, because advanced GBCs of T2 or more advanced stages require more complex procedures such as liver resection and lymph node dissection, minimally invasive surgery (MIS) has not been popularized. To evaluate the applicability of MIS for GBC, we report the early outcomes of robotic extended cholecystectomies (RECs).
Thirteen patients who radiologically suspected to have T2 or more advanced stages of GBC underwent REC from February 2018 to April 2019. Thirty-nine patients who underwent open extended cholecystectomy were selected by 1:3 propensity score matching, and the differences of clinicopathologic features according to surgical methods were analyzed.
Compared with open method, operation time, estimated blood loss, postoperative complication rate, and number of retrieved lymph nodes were not significantly different. In REC group, duration of hospital stay was shorter (6.6 vs 8.3 days, P = .002) and postoperative pain was significantly lower in the REC group (P = .024).
The early outcomes of REC were favorable with regard to early recovery and less pain, with similar number of retrieved lymph nodes. REC is a promising option for treatment of GBC, but further long-term survival studies are needed.
早期胆囊癌（GBC）患者只需进行单纯腹腔镜胆囊切除术即可。然而，由于 T2 期及更晚期的进展期 GBC 需要更复杂的手术，如肝切除术和淋巴结清扫术，因此微创手术（MIS）并未得到普及。为了评估 MIS 治疗 GBC 的适用性，我们报告了机器人扩大胆囊切除术（RECs）的早期结果。
从 2018 年 2 月至 2019 年 4 月，13 例影像学怀疑患有 T2 期或更晚期 GBC 的患者接受了 REC。通过 1:3 倾向评分匹配选择了 39 例接受开放性扩大胆囊切除术的患者，并分析了根据手术方法的临床病理特征差异。
与开放方法相比，手术时间、估计出血量、术后并发症发生率和淋巴结检出数无显著差异。在 REC 组中，住院时间更短（6.6 天 vs 8.3 天，P=0.002），术后疼痛明显减轻（P=0.024）。
RECs 的早期结果在早期恢复和减轻疼痛方面表现良好，且淋巴结检出数相似。RECs 是治疗 GBC 的一种有前途的选择，但需要进一步进行长期生存研究。
