Current Role of Minimally Invasive Radical Cholecystectomy for Gallbladder Cancer

Abstract

Background. For Tis and T1a gallbladder cancer (GbC), laparoscopic cholecystectomy can provide similar survival outcomes compared to open cholecystectomy. However, for patients affected by resectable T1b or more advanced GbC, open approach radical cholecystectomy (RC), consisting in gallbladder liver bed resection or segment 4b-5 bisegmentectomy, with locoregional lymphadenectomy, is considered the gold standard while minimally invasive RC (MiRC) is skeptically considered. Aim. To analyze current literature on perioperative and oncologic outcomes of MiRC for patients affected by GbC. Methods. A Medline review of published articles until June 2016 concerning MiRC for GbC was performed. Results. Data relevant for this review were presented in 13 articles, including 152 patients undergoing an attempt of MiRC for GbC. No randomized clinical trial was found. The approach was laparoscopic in 147 patients and robotic in five. Conversion was required in 15 (10%) patients. Postoperative complications rate was 10% with no mortality. Long-term survival outcomes were reported by 11 studies, two of them showing similar oncologic results when comparing MiRC with matched open RC. Conclusions. Although randomized clinical trials are still lacking and only descriptive studies reporting on limited number of patients are available, current literature seems suggesting that when performed at highly specialized centers, MiRC for GbC is safe and feasible and has oncologic outcomes comparable to open RC.

Systematic review of management of incidental gallbladder cancer after cholecystectomy

“…One concern is that laparoscopic access has been associated with a reduced lymph node yield. Open or laparoscopic access for resection appears to have no effect on outcome in early gallbladder cancers, whereas data on the minimally invasive approach in more advanced cancers (T2 or above) are based on small series and not established as a standard approach.…”

Introductory Chapter: Advancements in the Management of Gallbladder Diseases

“…The most important risk factor is gallstones. The majority of GBCs are adenocarcinomas, followed by squamous cell, adenosquamous, and undifferentiated carcinomas [7].…”

Robotic surgery for gallbladder cancer: Operative technique and early outcomes

“…Outcomes following radical cholecystectomy with the minimally invasive approach are rarely reported . Two systematic reviews for the minimally invasive approach concluded that it cannot be considered as a dogmatic contraindication for GBC …”

“…11,12 Two systematic reviews for the minimally invasive approach concluded that it cannot be considered as a dogmatic contraindication for GBC. 13,14 Robotic surgery is evolving and it offers many technical advantages over laparoscopy. Since its inception, many technical modifications have been added to the da Vinci robotic surgical system (dVSS) benefitting the surgeon and improving patient outcomes.…”