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Textbook Outcomes and Minimally Invasive Techniques in Resectable Gallbladder Cancer: A Global Cohort Study.

Simone Cremona1, Benedetto Ielpo1, Marcello Di Martino2

  • 1HPB Unit, Hospital Del Mar, Pompeu Fabra University, Barcelona, Spain.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
|September 6, 2025
PubMed
Summary

Textbook outcome (TO) in resectable gallbladder cancer (GbC) is achieved in 30.7% of patients, offering significant long-term benefits. Minimally invasive robotic surgery improved TO compared to laparoscopic approaches.

Keywords:
Gallbladder cancerLaparoscopyLymphadenectomyOpen surgeryRadical cholecystectomyRoboticTextbook outcomes

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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery
  • Cancer Research

Background:

  • Evaluating surgical quality is crucial for complex procedures like gallbladder cancer (GbC) resection.
  • Textbook Outcome (TO) serves as a key metric for assessing surgical quality and patient benefit.
  • Minimally Invasive (MI) techniques, including robotic (ROB) and laparoscopic (LPS) surgery, are increasingly used for GbC.

Purpose of the Study:

  • To assess the incidence and impact of Textbook Outcome (TO) in a global cohort of resectable gallbladder cancer (GbC) patients.
  • To identify independent predictors of achieving TO after GbC surgery.
  • To compare TO rates between open (OPEN) and minimally invasive (MI) approaches, specifically robotic (ROB) and laparoscopic (LPS).

Main Methods:

  • A global cohort study of 667 patients undergoing curative-intent hepatectomy and lymphadenectomy for GbC (T1b-T3) from 2012-2023 across 41 hospitals.
  • Textbook Outcome (TO) defined by absence of intraoperative transfusion, major complications, readmission, reoperation, 90-day mortality, with negative margins and ≥6 lymph nodes.
  • 1:1 propensity score matching compared TO in OPEN vs. MI approaches; MI-TO required no conversion.

Main Results:

  • Overall TO achieved in 30.7% of patients; no significant difference between OPEN and MI approaches.
  • Robotic surgery (ROB) independently increased TO (OR 4.297), with higher MI-TO rates (37.8% vs 23.2%) and better lymphadenectomy (≥6 nodes: 55.3% vs 40.6%) compared to LPS.
  • TO correlated with significantly lower 90-day mortality (HR 0.506) and cancer recurrence (HR 0.682).

Conclusions:

  • Achieving Textbook Outcome (TO) in resectable gallbladder cancer (GbC) occurs in approximately one-third of cases and is associated with substantial long-term patient benefits.
  • Minimally invasive surgery is effective for GbC, with robotic surgery demonstrating superior performance in MI-TO metrics compared to laparoscopy.
  • These findings establish a benchmark for surgical centers to improve outcomes in gallbladder cancer treatment.