From open to minimally invasive: evolving surgical approach for incidental gallbladder cancer (with video)

Background: Incidental gallbladder cancer (iGBC) presents unique management challenges. This retrospective single-center study evaluates perioperative and long-term outcomes following oncologic revisional resection (ORR) via open and minimally invasive surgery (MIS) over a 25-year period. Methods: Patients diagnosed T1b–T3 iGBC undergone ORR (anatomical resection of liver segments 4b–5 and regional lymphadenectomy) from January 2000 through December 2024 were included. Perioperative and oncologic outcomes were compared between surgical approaches using multivariable and inverse probability of treatment weighting (IPTW) analyses. Results: A total of 95 patients were included. While MIS was associated with longer operative times and more frequent use of vascular clamping, it resulted in shorter hospital stays without compromising oncologic outcomes. Five-year cancer-specific and recurrence-free survival rates were 64.3% and 55.8%, respectively, with no significant differences between surgical approaches. Multivariable analysis confirmed that long-term prognosis is predominantly determined by tumor biology, specifically T-stage ≥ 3, positive lymph nodes, perineural/lymphovascular invasion, and residual disease, rather than surgical technique. Conclusion: Findings from this study support the safe integration of minimally invasive approach for iGBC ORR in experienced centers, offering comparable oncologic efficacy, improved recovery profiles and supporting its broader adoption.