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Published on: June 24, 2022
Comparing robotic and open surgical techniques in gallbladder cancer management: a detailed systematic review and
Jie Wang1, Zhao Li1, Lin-Lin Chen2
1Department of Hepato-Biliary-Pancrease II, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Abstract:
This meta-analysis aims to evaluate the safety and oncological outcomes of robotic surgery compared to open surgery in treating gallbladder cancer (GBC). In October 2023, we performed a literature search across major global databases such as PubMed, Embase, and the Cochrane Library. We employed a Review Manager for parameter comparisons. This study has been registered with PROSPERO under the identifier CRD42023476686. Our final meta-analysis incorporated 5 cohort studies, encompassing a total of 353 patients. Compared to the Open Group (OG), the Robotic Group (RG) had reduced intraoperative blood loss (WMD - 217.72 ml, 95% CI - 371.08 to - 64.35; p = 0.005), shorter hospital stay (WMD - 1.80 days, 95% CI - 2.66 to - 0.95; p < 0.0001), and fewer overall complications (OR 0.31, 95% CI 0.10-0.97; p = 0.04). However, there was no significant difference between the two groups in terms of operation duration, postoperative inpatient days, readmission rate, major complications, 1-year postoperative survival, 2-year postoperative survival, and mortality rates. In our study, we found that for patients with gallbladder cancer, robotic radical cholecystectomy offers certain potential advantages over open radical cholecystectomy. This suggests that robotic radical cholecystectomy might be the optimal choice for treating gallbladder cancer. However, further validation from high-quality randomized clinical trials is required.
Insights
Robotic surgery for gallbladder cancer (GBC) shows reduced blood loss, shorter hospital stays, and fewer complications than open surgery. While promising, further high-quality trials are needed to confirm robotic radical cholecystectomy as the optimal GBC treatment.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Comparative Effectiveness Research
Background:
- Gallbladder cancer (GBC) treatment traditionally involves open surgery.
- Evaluating newer surgical modalities like robotic surgery is crucial for improving patient outcomes.
Approach:
- A meta-analysis of 5 cohort studies (353 patients) compared robotic radical cholecystectomy (RG) with open radical cholecystectomy (OG).
- Literature search conducted across PubMed, Embase, and Cochrane Library up to October 2023.
- PROSPERO registration: CRD42023476686.
Key Points:
- Robotic surgery demonstrated significantly reduced intraoperative blood loss (p=0.005) and shorter hospital stays (p<0.0001).
- Overall complication rates were lower in the robotic group (OR 0.31, p=0.04).
- No significant differences were observed in operation duration, postoperative stay, readmission, major complications, or survival rates.
Conclusions:
- Robotic radical cholecystectomy offers potential advantages in safety and recovery for GBC patients compared to open surgery.
- Robotic surgery may represent an optimal choice for GBC treatment, warranting further investigation.
- High-quality randomized clinical trials are necessary to validate these findings.
