Robotic surgery of gallbladder cancer

Belli, Andrea; Patrone, Renato; Albino, Vittorio; Leongito, Maddalena; Piccirillo, Mauro; Granata, Vincenza; Pasta, Gilda; Palaia, Raffaéle; Izzo, Francesco

doi:10.20517/2574-1225.2020.70

Cited by 4 publications

(3 citation statements)

References 31 publications

(35 reference statements)

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“…This evidence together with the appropriateness of loco-regional lymphadenectomy and the reduced intraoperative blood loss reported in the majority of the analyzed studies, allow us to consider the laparoscopic approach non inferior to the open one in terms of operative outcomes. Therefore, is not surprising that the minimally invasive approach has been recently extended to the surgical treatment of hilar type cholangiocarcinoma[ 36 ] and gallbladder cancer[ 37 , 38 ]. These encouraging pivotal experiences seem to demonstrate the feasibility of minimally invasive surgery in a setting often requiring the completion of a major hepatic resection in association with loco-regional lymphadenectomy and the challenge of biliary reconstructions.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma: A systematic review

Patrone¹,

Izzo²,

Palaia³

et al. 2021

WJGO

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BACKGROUND Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer and is characterized by an aggressive behavior and a dismal prognosis. Radical surgical resection represents the only potentially curative treatment. Despite the increasing acceptance of laparoscopic liver resection for surgical treatment of malignant liver diseases, its use for ICC is not commonly performed. In fact, to achieve surgical free margins a major resection and/or vascular and/or biliary reconstructions is often needed, as well as an associated lymph node dissection. AIM To review and summarize the current evidences on the minimally invasive resection of ICC. METHODS A systematic review of the literature based on the criteria predetermined by the investigators was performed from the 1 st of January 2009 up to the 1 st of January 2021 in 4 databases (PubMed, Scopus, Google Scholar, and Cochrane databases). All retrospective and prospective studies reporting on the comparative outcomes of open vs minimally invasive treatment of ICC were included. An evaluation of manuscripts quality was achieved using Methodological Index for Non-Randomized Studies criteria and Newcastle-Ottawa Scale. RESULTS After a systematic search 9 studies fulfilled the inclusion criteria. Among the all 3012 included patients, 2450 were operated by an open approach and 562 by a minimally invasive (laparoscopic) approach. Baseline characteristics, tumor characteristics, surgical outcomes and oncological outcomes were collected and analyzed, highlighting values with a statistical significant difference between patients treated with open or laparoscopic approach. Shorter hospital stay and lower intraoperative blood losses were reported by some Authors in minimally invasive surgery, on the contrary, in the open group there was a higher number of lymphadenectomies and a higher percentage of major hepatectomies. CONCLUSION Minimally invasive resection of ICC has some short-term benefits and it is safe and feasible only in selected centers with a high experience in laparoscopic approach for liver surgery. Minimally invasive surgery, actually, was considered mainly in patients with a tumor with a diameter < 5 cm, without invasion of main biliary duct or main vessel and no vascular or biliary reconstructions were planned. Further studies are needed to elucidate its impact on long term oncologic outcomes.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma: A systematic review

Patrone¹,

Izzo²,

Palaia³

et al. 2021

WJGO

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“…The advent of robotic surgery is certainly another milestone in the evolution of minimally invasive surgery, even if the benefits are still a matter of debate for many subspecialties. With regard to GBC, several reports have been published [ 76 ]. Goel et al showed their results on 27 patients undergoing robotic surgery for GBC, with lower intraoperative bleedings and length of hospital stay when compared with an open approach, confirming its safety and feasibility [ 77 ].…”

Section: Clinical Management According To the Depth Of Invasionmentioning

confidence: 99%

Preoperative Assessment and Perioperative Management of Resectable Gallbladder Cancer in the Era of Precision Medicine and Novel Technologies: State of the Art and Future Perspectives

et al. 2022

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Gallbladder carcinoma (GBC) is a rare malignancy, with an estimated 5-year survival rate of less than 5% in the case of advanced disease. Surgery is the only radical treatment for early stages, but its application and effectiveness depend on the depth of tumoral invasion. The extent of resection is usually determined according to the T-stage. Therefore, an early and correct preoperative assessment is important for the prognosis, as well as for the selection of the most appropriate surgical procedure, to avoid unnecessary morbid surgeries and to reach the best outcomes. Several modalities can be used to investigate the depth of invasion, from ultrasounds to CT scans and MRI, but an ideal method still does not exist. Thus, different protocols are proposed according to different recommendations and institutions. In this scenario, the indications for laparoscopic and robotic surgery are still debated, as well as the role of new technologies such as next-generation sequencing and liquid biopsies. The aim of this article is to summarize the state of the art current modalities and future perspectives for assessing the depth of invasion in GBC and to clarify their role in perioperative management accordingly.

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“…While a randomized trial for a rare pathology is not feasible, larger cohort studies could still be conducted[ 82 , 83 ]. At present, the technical approach for the robotic surgery of GBC has been described in the literature, such as that of Belli et al [ 84 ]. Similar to the laparoscopic approach, the patient is positioned in reverse-Trendelenburg, with five ports being used which include the 3 ports for robotic instrumentation, 1 for the camera and 1 Laparoscopic port for an assistant surgeon[ 84 ].…”

Section: Newer Approaches To Managementmentioning

confidence: 99%

Gallbladder cancer: Historical treatment and new management options

Okumura¹,

Gogna²,

Gachabayov³

et al. 2021

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Gallbladder cancer is a rare, aggressive malignancy that has a poor overall prognosis. Effective treatment consists of early detection and surgical treatment. With the wide spread treatment of gallbladder disease with minimally invasive techniques, the rate of incidental gallbladder cancer has seen an equitable rise along with stage migration towards earlier disease. Although the treatment remains mostly surgical, newer modalities such as regional therapy as well as directed therapy based on molecular medicine has led to improved outcomes in patients with advanced disease. We aim to summarize the management of gallbladder cancer along with the newer developments in this formidable disease process.

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Robotic surgery of gallbladder cancer

Cited by 4 publications

References 31 publications

Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma: A systematic review

Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma: A systematic review

Preoperative Assessment and Perioperative Management of Resectable Gallbladder Cancer in the Era of Precision Medicine and Novel Technologies: State of the Art and Future Perspectives

Gallbladder cancer: Historical treatment and new management options

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