HPB Unit, Hospital del Mar, Barcelona, Spain.
HPB Unit, Hospital del Mar, Barcelona, Spain.
Surgery. 2024 Oct;176(4):1008-1015. doi: 10.1016/j.surg.2024.05.045. Epub 2024 Jul 15.
For patients with T1b gallbladder cancer or greater, an adequate lymphadenectomy should include at least 6 nodes. Studies comparing short- and long-term outcomes of the open approach with those of laparoscopy and robotic approaches are limited, with small sample sizes, and there are none comparing laparoscopic and robotic approaches. This study compared patients who underwent robotic, laparoscopic, and open resection of gallbladder cancer, evaluating short- and long-term outcomes.
We conducted a multicenter retrospective study of patients with T1b gallbladder cancer or greater (excluding combined organ resection and T4) who underwent open, laparoscopic, and robotic liver resection and lymphadenectomy between January 2012 and December 2022. The 3 groups were matched in terms of patient baseline and disease characteristics based on propensity score matching, comparing robotic with open and robotic with laparoscopic groups.
We enrolled 575 patients from 37 institutions. After propensity score matching, the median number of harvested nodes was higher in the robotic group than in the open (7 vs 5; P = .0150) and laparoscopic groups (7 vs 4; P < .001). The Pringle maneuver time was shorter with robotic resection than with laparoscopy (38 vs 59 minutes; P = .0034), and the robotic group also had a lower conversion rate (3% vs 14%, respectively; P = .005) and less estimated blood loss than open and laparoscopic resections. The perioperative morbidity and mortality rates did not differ. The robotic and laparoscopic approaches were associated with faster functional recovery than the open group. In the multivariate analysis, the factors related to the retrieval of at least 6 nodes were the robotic approach over open (odds ratio, 5.1529) and over laparoscopy (odds ratio, 6.7289) and the center experience (≥20 minimally invasive liver resections/year) (odds ratio, 4.962). After a mean follow-up of 42.6 months, overall survival and disease-free survival were not different between groups.
Compared with open and laparoscopic surgeries, the robotic approach for gallbladder cancer performed in a center with appropriate experience in minimally invasive surgery can provide adequate node retrieval.
对于 T1b 期或更晚期的胆囊癌患者，充分的淋巴结清扫术应至少包括 6 个淋巴结。比较开腹、腹腔镜和机器人手术的短期和长期结果的研究受到限制，样本量较小，且没有比较腹腔镜和机器人手术的研究。本研究比较了接受机器人、腹腔镜和开腹胆囊癌切除术的患者，评估了短期和长期结果。
我们进行了一项多中心回顾性研究，纳入了 2012 年 1 月至 2022 年 12 月期间接受开腹、腹腔镜和机器人肝切除术和淋巴结清扫术的 T1b 期或更大（不包括联合器官切除和 T4 期）胆囊癌患者。根据倾向评分匹配，将患者的基线和疾病特征在 3 组之间进行匹配，比较机器人与开腹组和机器人与腹腔镜组。
我们从 37 家机构共纳入了 575 名患者。在进行倾向评分匹配后，机器人组的淋巴结采集中位数高于开腹组（7 比 5；P=0.0150）和腹腔镜组（7 比 4；P<0.001）。机器人切除的阻断时间比腹腔镜切除短（38 比 59 分钟；P=0.0034），机器人组的转化率也较低（分别为 3%和 14%；P=0.005），出血量也少于开腹和腹腔镜切除术。围手术期发病率和死亡率无差异。机器人和腹腔镜组的功能恢复速度快于开腹组。多变量分析显示，与至少采集 6 个淋巴结相关的因素是机器人手术（与开腹相比，比值比为 5.1529；与腹腔镜相比，比值比为 6.7289）和中心经验（每年至少进行 20 例微创肝切除术）（比值比为 4.962）。在平均随访 42.6 个月后，各组的总生存率和无病生存率无差异。
与开腹和腹腔镜手术相比，在具有微创外科适当经验的中心进行的机器人胆囊癌手术可以提供充分的淋巴结清扫。
