Outcomes and safety of minimally invasive surgery in gallbladder cancer: international, multicenter cohort study.

Abstract

INTRODUCTION: Gallbladder cancer (GbCa) is a highly aggressive malignancy with a poor prognosis. Radical surgical resection remains the primary curative approach. The advent of minimally invasive surgery (MIS), including laparoscopic and robotic techniques, offers potential benefits in perioperative recovery but raises concerns regarding oncological adequacy and surgical morbidity. This study aims to evaluate the safety, feasibility, and outcomes of MIS in GbCa through a comprehensive multicenter analysis. METHODS: A multicenter, retrospective cohort study was conducted, involving 218 patients who underwent radical resection for GbCa between 2009 and 2022. Data on patient demographics, clinical presentations, surgical details, perioperative outcomes, and oncological metrics were analyzed. Comparative subgroup analyses of laparoscopic, robotic, and open approaches were performed. RESULTS: MIS was performed in 41.8% of patients, with a conversion rate of 4.6%. The MIS group demonstrated significantly reduced operative time (median 210 vs. 287 minutes, p = 0.012), blood loss (median 200 vs. 300 mL, p < 0.001), and length of stay (median 6 vs. 9 days, p < 0.001), alongside higher lymph node yields (10 vs. 6, p = 0.006) and R0 resection rates (83.5% vs. 66.1%, p = 0.013). Overall survival and disease-free survival were comparable between MIS and open surgery groups. Robotic surgery exhibited lower bile leak rates compared to laparoscopic and open techniques (2.9% vs 21.4% vs 6.5%, p = 0.002). CONCLUSION: This study establishes MIS as a safe and effective surgical approach for GbCa, offering superior perioperative outcomes without compromising oncological safety. Robotic platforms may mitigate technical challenges associated with complex cases. Prospective studies are required to validate these findings and refine surgical strategies for GbCa management.