Impact of Type of Surgery on Survival Outcome in Patients With Early Gallbladder Cancer in the Era of Minimally Invasive Surgery

Abstract

Laparoscopic surgery has been widely accepted as a feasible and safe treatment modality in many cancers of the gastrointestinal tract. However, most guidelines on gallbladder cancer (GBC) regard laparoscopic surgery as a contraindication, even for early GBC. This study aims to evaluate and compare recent surgical outcomes of laparoscopic and open surgery for T1(a,b) GBC and to determine the optimal surgical strategy for T1 GBC.The study enrolled 197 patients with histopathologically proven T1 GBC and no history of other cancers who underwent surgery from 2000 to 2014 at 3 major tertiary referral hospitals with specialized biliary-pancreas pathologists and optimal pathologic handling protocols. Median follow-up was 56 months. The effects of depth of invasion and type of surgery on disease-specific survival and recurrence patterns were investigated.Of the 197 patients, 116 (58.9%) underwent simple cholecystectomy, including 31 (15.7%) who underwent open cholecystectomy and 85 (43.1%) laparoscopic cholecystectomy. The remaining 81 (41.1%) patients underwent extended cholecystectomy. Five-year disease-specific survival rates were similar in patients who underwent simple and extended cholecystectomy (96.7% vs 100%, P = 0.483), as well as being similar in patients in the simple cholecystectomy group who underwent open and laparoscopic cholecystectomy (100% vs 97.6%, P = 0.543). Type of surgery had no effect on recurrence patterns.Laparoscopic cholecystectomy for T1 gallbladder cancer can provide similar survival outcomes compared to open surgery. Considering less blood loss and shorter hospital stay with better cosmetic outcome, laparoscopic cholecystectomy can be justified as a standard treatment for T1b as well as T1a gallbladder cancer when done by well-experienced surgeons based on exact pathologic diagnosis.

Systematic review of management of incidental gallbladder cancer after cholecystectomy

“…One concern is that laparoscopic access has been associated with a reduced lymph node yield. Open or laparoscopic access for resection appears to have no effect on outcome in early gallbladder cancers, whereas data on the minimally invasive approach in more advanced cancers (T2 or above) are based on small series and not established as a standard approach.…”

Management of incidental gallbladder cancer in a national cohort

“…This was also supported by a recent systematic review 7 , but with a very low certainty of evidence. Some studies 26,27 favoured re-resection for T1b incidental gallbladder cancer, whereas others 28,29 have not reported any benefit of re-resection in this patient group. The present authors found no significant difference in disease-specific survival for cholecystectomy alone versus re-resection in patients with T1b disease, but this result may be due to the small numbers in subgroup analysis.…”

Current Role of Minimally Invasive Radical Cholecystectomy for Gallbladder Cancer

“…In this context, increasing scientific evidence has shown that oncologic outcomes of LC are similar to open cholecystectomy for Tis and T1a GbC [7]. In contrast, for patients affected by T1b or higher stage tumor necessitating RC, a minimally invasive approach is questioned by majority of HPB surgeons.…”

“…GbC represents the most aggressive malignancy of the biliary tract and is characterized by an extremely poor prognosis. While increasing evidence shows that, for Tis and T1a GbC with clear margins and unbroken gallbladder, simple cholecystectomy, either laparoscopic or open, can be curative [4–7], for patients affected by resectable T1b or more advanced GbC, radical cholecystectomy (RC), consisting in liver resection (liver bed resection or segment 4b-5 bisegmentectomy) with locoregional lymphadenectomy, is the only available treatment to positively affect the prognosis [8–12]. …”