Ryan C Pickens, MD1, Jesse K Sulzer, MD, PhD1, Erin E Isenberg, BSPH2, Keith J Murphy, MSPH3, Lee Ocuin, MD1, Erin Baker, MD1, John B Martinie, MD, FACS1, David A Iannitti, MD, FACS1, Dionisios Vrochides, MD, PhD, FACS, FRCSC1. 1Department of Surgery, Atrium Health, 2University of North Carolina at Chapel Hill, 3Carolinas Center for Surgical Outcomes Science, Atrium Health
Introduction: This study aims to demonstrate that robotic-assisted radical cholecystectomy is safe and effective. Minimally-invasive radical cholecystectomy has gradually gained approval as a safe and oncologically acceptable modality in the treatment of resectable gallbladder cancer. While robotic-assisted hepatopancreatobiliary surgery has been increasingly described with comparable results to laparoscopic approaches such as for primary liver and pancreatic tail malignancies, current literature for resection of gallbladder cancer has almost exclusively reported laparoscopic experience. We present a comparison of robotic-assisted and laparoscopic radical cholecystectomies at a high-volume center.
Methods and Procedures: A retrospective review was performed on all cases of robotic radical cholecystectomy (RRC) and laparoscopic radical cholecystectomy (LRC) at our institution from January 2013 to August 2018. Patients undergoing either radical cholecystectomy for gallbladder cancer detected preoperatively (cholecystectomy with 4b/5 hepatectomy and portal lymphadenectomy) or a completion operation for malignancy identified after routine cholecystectomy (4b/5 hepatectomy, cystic duct resection, and/or portal lymphadenectomy only) were both included. Any case converted to open was excluded from comparison. Operative details, tumor pathology, clinical and oncologic outcomes were analyzed.
Results: Twenty-seven patients underwent minimally invasive radical cholecystectomy for resectable gallbladder cancer (20 robotic, 7 laparoscopic). Fifteen patients (55.5%) underwent a completion operation for cancer detected after cholecystectomy. No conversions to open occurred in the robotic cohort, however 1 patient was converted from laparoscopic to open due to safety concerns during adhesiolysis. Three patients in the RRC (15%) did not undergo hepatic resection as the original tumor was on the gallbladder free edge and no residual tumor was identified on ultrasound. Median age, ASA score, estimated blood loss, and operative time were similar between groups. R0 resection was achieved in 66.7% of laparoscopic cases (4/6) and 83.3% of robotic cases (15/18). Median lymph node harvest was greater for the RRC (p=0.043). Postoperative outcomes for median 30-day Clavien 3+ complications, readmissions, and postoperative length of stay as well as final pathology for local invasion, nodal and metastatic spread were similar between cohorts. During a mean follow-up of 21 months (SD 27.18), 6 patients in the RRC (30%) and 2 patients in the LRC (33.3%) developed recurrence.
Conclusions: At a high volume minimally invasive center, robotic-assisted radical cholecystectomy is safe with comparable oncologic benefit when a minimally-invasive approach is possible for select patients. Increased utilization of minimally invasive surgery for gallbladder cancer may demonstrate additional technical benefits of robotic-assistance compared to laparoscopy for patients previously only offered open resection.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95273
Program Number: P667
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster