A. M. Azimuddin1, A. Boyev1, A. Jain1, E. M. Arvide1, Y. S. Chun1, C. D. Tzeng1, T. E. Newhook1, J. N. Vauthey1, N. Ikoma1, H. S. Tran Cao1 1University Of Texas MD Anderson Cancer Center, Department Of Surgical Oncology, Division Of Surgery, Houston, TX, USA
Introduction:
Little is reported about the performance of minimally invasive (MIS) approaches to completion radical cholecystectomy for incidentally diagnosed gallbladder cancer. However, the benefits of minimally invasive approaches have been described for other procedures, and they may be a viable option for patients with gallbladder cancer. We sought to evaluate clinical feasibility, safety, and oncologic efficacy of minimally invasive approaches to completion radical cholecystectomy.
Methods:
A retrospective cohort study was conducted on all patients from 2017 to 2021 who underwent minimally invasive completion radical cholecystectomy for T1b and above gallbladder cancer (GBC) at a single, high-volume comprehensive cancer center. Patient demographics, short-term peri-operative outcomes, and oncologic outcomes were obtained from the electronic medical record and a prospective surgical database.
Results:
Sixteen patients underwent MIS completion radical cholecystectomy for GBC T1b and above: 12 (75%) via robotic approach and 4 (25%) laparoscopic. The median age of the cohort was 67 (IQR 12.0), with 6 male and 10 female patients. The median BMI was 29.2 (IQR 8.6). The median operative time was 285.5 minutes (IQR 69.3), and the median estimated blood loss was 100 ml (IQR 150). Median lymph node retrieval was 4 (IQR 4.5), and two patients had one lymph node positive for metastatic adenocarcinoma each (12.5%). The cystic duct stump was re-resected in ten of the sixteen patients (62.5%). The median hospital length of stay was two days. 6 (37.5%) patients received discharge opioid prescriptions and the median oral morphine equivalent on discharge was 0. R0 resection was achieved in all cases. No complications occurred, 90-day readmission was zero, and the median follow-up time was 21.5 months. One of the sixteen (6.3%) patients had a recurrence of gallbladder cancer in the porta hepatis 37 months following surgery.
Conclusion:
Our data demonstrate encouraging peri-operative outcomes and oncological efficacy of a MIS approach to radical cholecystectomy and set the stage for future trials for comparison to the traditional open approach.
