Laparoscopic Radical Cholecystectomy for Primary or Incidental Early Gallbladder Cancer: The New Rules Governing the Treatment of Gallbladder Cancer

Abstract

Aim To evaluate the technical feasibility and oncologic safety of laparoscopic radical cholecystectomy (LRC) for primary or incidental early gallbladder cancer (GBC) treatment. Methods Articles reporting LRC for GBC were reviewed from the first case reported in 2010 to 2015 (129 patients). 116 patients had a preoperative diagnosis of gallbladder cancer (primary GBC). 13 patients were incidental cases (IGBC) discovered during or after a laparoscopic cholecystectomy. Results The majority of patients who underwent LRC were pT2 (62.7% GBC and 63.6% IGBC). Parenchyma-sparing operation with wedge resection of the gallbladder bed or resection of segments IVb-V were performed principally. Laparoscopic lymphadenectomy was carried out according to the reported depth of neoplasm invasion. Lymph node retrieved ranged from 3 to 21. Some authors performed routine sampling biopsy of the inter-aorto-caval lymph nodes (16b1 station) before the radical treatment. No postoperative mortality was documented. Discharge mean day was POD 5th. 16 patients had post operative morbidities. Bile leakage was the most frequent post-operative complication. 5 y-survival rate ranged from 68.75 to 90.7 months. Conclusion Laparoscopy can not be considered as a dogmatic contraindication to GBC but a primary approach for early case (pT1b and pT2) treatment.

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.…”

Short-term outcomes of minimally invasive surgery for patients presenting with suspected gallbladder cancer: Report of 8 cases

“…At present, there are limited studies reporting on the outcomes of MIS for GBCa, and its role remains controversial. [51718192021222324] Details of these studies have been summarised in Table 2. Of note, a recent large study from Korea demonstrated favourable long-term oncologic results in a 10-year prospective cohort study, supporting the oncologic safety of the laparoscopic approach.…”

Outcomes of Surgery for Gallbladder Cancer: Single Center Experience

“…This is a unique finding because until now, the long-term prognostic significance of lymph node metastases has been analyzed in the current literature; however, our study is the first one to analyze the early postoperative effects of the advanced stages of the disease. The reported rates of postoperative mortality and morbidities ranged between 10% and 20% in various studies [6, 7]. However, these complications were observed following major abdominal surgery, and a stage-related correlation has not been done.…”