Long‐term survival following minimally invasive extended cholecystectomy for gallbladder cancer: A 7‐year experience from the National Cancer Database

Background Open extended cholecystectomy (O‐EC) has long been the recommended treatment for resectable gallbladder cancer (GBC), while the minimally‐invasive approach for EC (MIS‐EC) remains controversial. Our aim was to analyze overall survival of GBC patients treated with MIS‐EC vs O‐EC at the national level. Methods A retrospective review of the National Cancer Database of patients with resectable GBC (2010‐2016) and treated with either MIS‐EC or O‐EC was performed. Overall survival (OS) was compared by the surgical approach. Results A total of 680 patients were identified, of whom 235 (34.6%) underwent MIS‐EC. There were no differences in the rates of positive margins between MIS‐EC and O‐EC (14% vs 19%, respectively; P = .278), and in the mean lymph node yield (6.54 vs 6.66, respectively; P = .914). The median survival following MIS‐EC was significantly higher than that of O‐EC (39 vs 26 months; P = .048). After stratification by pathological stage and after adjustment, there was no significant difference in OS between the groups (HR = 0.9, 95% CI, 0.6‐1.5). Conclusion In this large national cohort, MIS‐EC oncologic outcomes were noninferior to the O‐EC. Proficiency with MIS techniques, proper patient selection, and referral to specialized centers may allow a greater benefit from this treatment modality.