The emerging role of minimally-invasive surgery for gallbladder cancer: A comparison to open surgery

Background: Minimally-invasive surgery (MIS) is gaining traction within surgical oncology. We aim to evaluate outcomes of patients with gallbladder cancer undergoing MIS surgery compared to open surgery. Methods: Using the institutional cancer registry and administrative databases, we retrospectively reviewed patients who underwent a central hepatectomy with portal lymphadenectomy for gallbladder cancer from 2011 - 2014. We excluded gallbladder cancer patients without oncologic resection and those with metastatic disease. Results: Thirty-four patients underwent surgery: 17 MIS (14 robotic, three laparoscopic), and 17 open. There was no statistically significant difference in median operative time (MIS = 182 vs open = 190 min; P =.23) or R0 resection (MIS = 88.2% vs open = 88.2%; P = 1.0); however, the MIS cohort had less intraoperative blood loss (median 50 ml vs 400 ml; P =.006) and placement of perihepatic drains (29.4% vs 76.5%; P =.01) compared to open. MIS cohort went to oral pain medications quicker (two vs three days; P =.02) and discharged home earlier (four vs six days; P =.018), than the open cohort. No differences in postoperative 30-day complication rates were noted (52.9% vs 52.9%; P = 1.0). Conclusion: The minimally-invasive approach to liver surgery is a safe and equally effective technique for the management of the gallbladder cancer with improvement in blood loss and length of stay.