Robotic Liver Resection for Gallbladder Cancer: Does Common Bile Duct Resection Matter? An International Propensity-Matched Study.

BACKGROUND: Minimally invasive common bile duct resection (CBDR) for gallbladder cancer (GBC) is technically demanding, and comparative perioperative and oncological outcomes of robotic liver resection (LR) with versus without CBDR remain poorly characterized. We conducted a propensity score-matched (PSM) study evaluating outcomes of robotic GBC resection with or without CBDR. METHODS: This international, multicenter retrospective study included patients undergoing fully-robotic LR for non-metastatic GBC, with or without CBDR. Outcomes were analyzed before and after 1:1 PSM across 18 high-volume hepatobiliary centers between 2013 and 2024. RESULTS: A total of 138 patients were included, 21 (15.2%) undergoing CBDR and 117 (84.8%) did not. Before matching, perioperative outcomes were comparable between CBDR and non-CBDR. After matching, no significant differences were observed in operative time, blood loss (175 vs. 100 mL, p = 0.292), conversion to open, bile leak (12.5% vs. 12.5%, p = 0.536), Clavien–Dindo ≥ III complications (12.5% vs. 12.5%, p = 1), or length of hospitalization (5 vs. 4 days; p = 0.084). No differences were found in lymph node yield (8.5 vs. 7; p = 0.437), recurrence, or 90-day mortality (12.5% vs. 18.8%, p = 1). After median follow-up of 17 months, overall and disease-free survivals were comparable both before and after PSM. CBDR was not an independent predictor of disease recurrence [HR 2.36, (95% CI 0.72–7.72); p = 0.155] or overall mortality and showed no association with retrieval of ≥ 6 lymph nodes [OR 1.00, (95% CI 0.37–2.68); p = 1] or R0 margins. CONCLUSION: Robotic CBDR for GBC is safe and feasible, achieving perioperative clinical and oncological outcomes comparable to robotic LR without CBDR.