Cho Young Jae, Yun Won-Gun, Jung Hye-Sol, Lee Mirang, Han Youngmin, Kwon Wooil, Jang Jin-Young
Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
Surg Endosc. 2023 Dec;37(12):9089-9097. doi: 10.1007/s00464-023-10463-6. Epub 2023 Oct 5.
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).
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.
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).
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.
尽管腹腔镜胆囊切除术适用于早期胆囊癌（GBC）的治疗，但微创手术在晚期GBC中并未广泛应用。这是因为晚期GBC需要复杂的手术技术，包括淋巴结清扫和肝切除术。机器人扩大胆囊切除术（REC）被认为可以克服腹腔镜手术的局限性，但缺乏肿瘤学安全性研究。因此，在本研究中，我们旨在评估REC与开放扩大胆囊切除术（OEC）相比的肿瘤学结局。
纳入2018年至2021年间因GBC接受扩大胆囊切除术且暂定分期为T2或更高的125例患者，并按手术方法进行分层。为尽量减少混杂因素，对接受REC的患者和接受OEC的患者进行1:1倾向评分匹配。
在短期结局方面，REC组的估计失血量（382.7 vs. 717.2 mL，P = 0.020）和住院时间（6.9 vs. 8.5天，P = 0.042）均显著低于OEC组。此外，从手术当天到术后第5天，REC组的主观疼痛评分显著低于OEC组（P = 0.006）。在长期结局方面，REC组[总生存期（OS），92.3%（92.3%）；无病生存期（DFS），84.6%（72.5%）]和OEC组[OS，96.8%（96.8%）；DFS，78.2%（78.2%）]的3年[5年]OS和DFS率无显著差异（OS为P = 0.807，DFS为P = 0.991）。
在本研究中，REC的短期结局优于OEC，长期生存结局无差异。此外，REC在术后疼痛方面优于OEC。因此，对于晚期GBC患者，与OEC相比，REC可能是一种恢复早的可行选择。
