Robotic versus open extended cholecystectomy for T1a-T3 gallbladder cancer: A matched comparison.

Background: The feasibility and safety of robotic extended cholecystectomy (REC) are still uncertain. This study was performed to compare the short- and long-term outcomes of REC with those of open extended cholecystectomy (OEC) for T1a-T3 gallbladder cancer.

Methods: From January 2015 to April 2022, 28 patients underwent REC in our center. To minimize any confounding factors, a 1:2 propensity score-matching analysis was conducted based on the patients' demographics, liver function indicators, T stage, and symptoms. The data regarding demographics, perioperative outcomes, and long-term oncologic outcomes were reviewed.

Results: The visual analogue scale score was significantly lower in the REC than OEC group immediately postoperatively (3.68 ± 2.09 vs. 4.73 ± 1.85,  = 0.008), on postoperative day 1 (2.96 ± 1.75 vs. 3.69 ± 1.41,  = 0.023), and on postoperative day 2 (2.36 ± 1.55 vs. 2.92 ± 1.21,  = 0.031). In addition, the REC group exhibited a shorter time to first ambulation ( = 0.043), a shorter time to drainage tube removal ( = 0.038), and a shorter postoperative stay ( = 0.037), but hospital costs were significantly higher in the REC group ( < 0.001). However, no statistically significant difference was found in the operation time ( = 0.134), intraoperative blood loss ( = 0.467), or incidence of postoperative morbidity ( = 0.227) or mortality ( = 0.289) between the REC and OEC groups. In regard to long-term outcomes, the 3-year disease-free survival rate was comparable between the OEC and REC groups (43.1% vs. 57.2%,  = 0.684), as was the 3-year overall survival rate (62.8% vs. 75.0%,  = 0.619).

Conclusion: REC can be an effective and safe alternative to OEC for selected patients with T1a-T3 gallbladder cancer with respect to short- and long-term outcomes.