Textbook Outcomes and Minimally Invasive Techniques in Resectable Gallbladder Cancer: A Global Cohort Study

Introduction Surgery for resectable gallbladder cancer (GbC) encompasses complex operative management, and evaluating surgical quality through textbook outcome (TO) is crucial. This study aimed to assess TO incidence and impact in a global cohort, identify independent predictors, and evaluate TO rates of minimally invasive (MI) techniques, including robotic (ROB) and laparoscopic (LPS). Materials and methods This cohort study included patients undergoing curative-intent hepatectomy and lymphadenectomy for GbC (T1b-T3) from 2012 to 2023 in 41 hospitals. TO was defined as the absence of intraoperative transfusion, major complications, readmission, reoperation, or 90-day mortality, alongside negative margins and >= 6 retrieved lymph nodes. MI-TO additionally required no conversion. A 1:1 propensity score matching compared TO in open (OPEN) and MI approaches. Data were analyzed from July to November 2024. Results Among 667 patients (MI, 361; OPEN, 306), TO was achieved in 205 (30.7 %), with no difference between OPEN and MI. ROB independently increased TO (odds ratio, 4.297; p = 0.002), achieving higher MI-TO (37.8 % vs. 23.2 %; p = 0.003), better lymphadenectomy (>= 6 nodes: 55.3 % vs. 40.6 %; p = 0.009), and fewer OPEN conversions (1.2 % vs. 13.7 %; p < 0.001) than LPS. TO correlated with lower mortality (HR, 0.506; p = 0.001) and recurrence (HR, 0.682; p = 0.027). Conclusion TO in resectable GbC is achieved in one-third of cases, with significant long-term benefits. MI is effective, with ROB outperforming LPS in MI-TO measures. These results establish a benchmark for centers to enhance outcomes.