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Robotic, laparoscopic and open surgery for gallbladder cancer: a systematic review and network meta-analysis
Madeline Yen Min Chee1,2, Andrew Guan Ru Wu2, Khi-Yung Fong2
1Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Singapore, Singapore.
Introduction:
Minimally invasive oncological resections have become increasingly widespread in the surgical management of cancers. However, the role of minimally invasive surgery (MIS) for gallbladder cancer (GBC) remains unclear. We aim to perform a systematic review and network meta-analysis of existing literature to evaluate the safety and feasibility of laparoscopic and robotic surgery in the management of GBC compared to open surgery (OS) by comparing outcomes.
Methods:
A literature search of the PubMed/MEDLINE (2000 to December 2021) and EMBASE (2000 to December 2021) databases was conducted. The primary outcome studied was overall survival, and secondary outcomes studied were postoperative morbidity, severe complications, incidence of bile leak, length of hospital stay, operation time, R0 resection rate, local recurrence and lymph node yield.
Results:
Thirty-two full-text articles met the eligibility criteria and were included in the final analysis with a total of 5883 patients undergoing either OS or MIS (laparoscopic or robotic) for GBC. 1- and 2-stage meta-analyses did not reveal any significant differences between OS, laparoscopic and robotic surgery in terms of overall survival, R0 resection, lymph node harvest, local recurrence and post-operative complications. Patients who underwent OS had significantly longer hospitalization stay and intra-operative blood loss compared to those who underwent laparoscopic or robotic surgery. Network meta-analysis did not reveal any significant differences between post-operative and survival outcomes of laparoscopic vs robotic surgery groups.
Conclusion:
This network meta-analysis suggests that both laparoscopic and robotic surgery are safe and effective approaches in the surgical management of GBC, with post-operative and survival outcomes comparable to OS. An MIS approach may also lead to shorter hospitalization stay, less intraoperative blood loss and post-operative complications compared to OS. There was no obvious benefit of either MIS approach (laparoscopic versus robotic) over the other.
Insights
Minimally invasive surgery (MIS) for gallbladder cancer (GBC) shows outcomes comparable to open surgery (OS). MIS approaches may reduce hospital stay and blood loss, with no significant difference between laparoscopic and robotic surgery.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Minimally invasive oncological resections are common, but their role in gallbladder cancer (GBC) is not well-defined.
- Evaluating the safety and feasibility of laparoscopic and robotic surgery for GBC is crucial.
Purpose of the Study:
- To systematically review and perform a network meta-analysis of studies comparing minimally invasive surgery (MIS) with open surgery (OS) for GBC.
- To assess oncological and perioperative outcomes of different surgical approaches for GBC.
Main Methods:
- A comprehensive literature search of PubMed/MEDLINE and EMBASE databases (2000-2021) was performed.
- Included studies compared overall survival, morbidity, complications, bile leak, hospital stay, operation time, R0 resection, local recurrence, and lymph node yield.
- Network meta-analysis was used to compare outcomes between open surgery, laparoscopic surgery, and robotic surgery for GBC.
Main Results:
- Thirty-two studies with 5883 patients were analyzed.
- No significant differences were found in overall survival, R0 resection, lymph node yield, local recurrence, or postoperative complications between OS, laparoscopic, and robotic surgery.
- Open surgery patients experienced longer hospital stays and greater intraoperative blood loss compared to MIS groups.
Conclusions:
- Laparoscopic and robotic surgery are safe and effective for GBC management, with outcomes comparable to open surgery.
- Minimally invasive approaches may offer benefits like shorter hospital stays and reduced blood loss.
- No significant advantage of laparoscopic over robotic surgery, or vice versa, was identified.
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