Laparoscopic radical cholecystectomy for suspected early gall bladder carcinoma: thinking beyond convention

Senthilnathan, Palanisamy; Patel, Nikunj; Sabnis, Sandeep C; Palanisamy, N.; Anand, Vijay; Palanivelu, Praveen Raj; Parthasarthi, R.; Palanivelu, Chinnusamy

doi:10.1007/s00464-015-4495-0

Cited by 47 publications

(38 citation statements)

References 36 publications

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“…Tumor recurrence occurred in a few patients, with systemic recurrence being more frequent incidence of systemic recurrence. The survival outcomes after laparoscopic surgery were similar to or better than those after open surgery [11-13]. Yoon et al [13] reported favorable long-term outcomes after laparoscopic surgery for GBC, with a 5-year actual survival rate of more than 90%.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

“…The survey and previous reports of laparoscopic extended cholecystectomy for GBC revealed that the most common procedure was liver wedge resection and LN dissection including the LNs around the hepatoduodenal ligament, the common hepatic artery, and the superior portion of the pancreas. With the accumulation of experience, some experts reported more advanced laparoscopic surgeries such as IVb + V segmentectomy, bile duct resection, and para-aortic LN sampling, although the advantages of these procedures remain controversial, even in open surgery [6, 11, 14, 15]. Laparoscopic bile duct resection was performed when the tumor involved the bile duct, but not for complete LN dissection.…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

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Survey Results of the Expert Meeting on Laparoscopic Surgery for Gallbladder Cancer and a Review of Relevant Literature

et al. 2018

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Background: Favorable outcomes of laparoscopic surgery for gallbladder cancer (GBC) have been reported; yet consensus on the indications and surgical techniques for laparoscopic surgery for GBC is lacking. Objective: To evaluate the current status of laparoscopic surgery for GBC by analyzing the results of a survey of experts and by reviewing the relevant published literature. Methods: Before an expert meeting was held on September 10, 2016 in Seoul, Korea, an international survey was undertaken of expert surgeons in the field of GBC surgery. Results: The majority of surgeons who responded agreed that laparoscopic surgery has an acceptable role for suspicious or early GBC, and that laparoscopic extended cholecystectomy has a value comparable to that of open surgery in selected patients with GBC. However, the selection criteria for laparoscopic surgery for overt GBC and the details of the surgical techniques varied among surgeons. Conclusions: This survey and literature review revealed that laparoscopic surgery for GBC is performed in highly selected cases. However, the favorable outcomes in the published reports and the positive view of experienced surgeons for this operative procedure suggest a high likelihood that laparoscopic surgery will be more frequently performed for GBC in the future.

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Section: Discussion and Literature Reviewmentioning

confidence: 99%

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Survey Results of the Expert Meeting on Laparoscopic Surgery for Gallbladder Cancer and a Review of Relevant Literature

et al. 2018

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“…No significant difference in survival rate between the 2 procedures has been reported. Recent reports on laparoscopic extended cholecystectomy for GBC have demonstrated the technical feasibility and safety of laparoscopic wedge resection, and the feasibility of laparoscopic IVb/V resection for GBC has also been reported [5, 9, 25]. …”

Section: Resultsmentioning

confidence: 99%

“…Laparoscopic bile duct resection may be performed in cases with positive cystic duct margins or involvement of the bile duct by tumor. Laparoscopic IVb/V segmentectomy has been performed in some centers [5, 9, 25]. …”

Section: Resultsmentioning

confidence: 99%

“…A laparoscopic approach for GBC is still controversial among hepatobiliary/pancreatic surgeons. Although this procedure has been contraindicated in patients with GBC for some time, many recent reports have shown that laparoscopic surgery does not adversely affect the perioperative and survival outcomes of patients with GBC [3-9]. One recent report showed that laparoscopic extended cholecystectomy for GBC achieved an outcome comparable with that of open surgery over long-term follow-up [10].…”

Section: Introductionmentioning

confidence: 98%

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Laparoscopic Surgery for Gallbladder Cancer: An Expert Consensus Statement

et al. 2018

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Background: Despite the increasing number of reports on the favorable outcomes of laparoscopic surgery for gallbladder cancer (GBC), there is no consensus regarding this surgical procedure. Objective: The study aimed to develop a consensus statement on the application of laparoscopic surgery for GBC based on expert opinions. Methods: A consensus meeting among experts was held on September 10, 2016, in Seoul, Korea. Results: Early concerns regarding port site/peritoneal metastasis after laparoscopic surgery have been abated by improved preoperative recognition of GBC and careful manipulation to avoid bile spillage. There is no evidence that laparoscopic surgery is associated with decreased survival compared with open surgery in patients with early-stage GBC if definitive resection during/after laparoscopic cholecystectomy is performed. Although experience with laparoscopic extended cholecystectomy for GBC has been limited to a few experts, the postoperative and survival outcomes were similar between laparoscopic and open surgeries. Laparoscopic reoperation for postoperatively diagnosed GBC is technically challenging, but its feasibility has been demonstrated by a few experts. Conclusions: Laparoscopic surgery for GBC is still in the early phase of the adoption curve, and more evidence is required to assess this procedure.

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Comparison of oncological outcomes after open and laparoscopic re-resection of incidental gallbladder cancer

Vega

Aretxabala

Qiao

et al. 2019

British Journal of Surgery

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Background The safety and oncological efficacy of laparoscopic re-resection of incidental gallbladder cancer have not been studied. This study aimed to compare laparoscopic with open re-resection of incidentally discovered gallbladder cancer while minimizing selection bias. Methods This was a multicentre retrospective observational cohort study of patients with incidental gallbladder cancer who underwent re-resection with curative intent at four centres between 2000 and 2017. Overall survival (OS) and recurrence-free survival (RFS) were analysed by intention to treat. Inverse probability of surgery treatment weighting using propensity scoring was undertaken. Results A total of 255 patients underwent re-resection (190 open, 65 laparoscopic). Nineteen laparoscopic procedures were converted to open operation. Surgery before 2011 was the only factor associated with conversion. Duration of hospital stay was shorter after laparoscopic re-resection (median 4 versus 6 days; P < 0·001). Three-year OS rates for laparoscopic and open re-resection were 87 and 62 per cent respectively (P = 0·502). Independent predictors of worse OS were residual cancer found at re-resection (hazard ratio (HR) 1·91, 95 per cent c.i. 1·17 to 3·11), blood loss of at least 500 ml (HR 1·83, 1·23 to 2·74) and at least four positive nodes (HR 3·11, 1·46 to 6·65). In competing-risks analysis, the RFS incidence was higher for laparoscopic re-resection (P = 0·038), but OS did not differ between groups. Independent predictors of worse RFS were one to three positive nodes (HR 2·16, 1·29 to 3·60), at least four positive nodes (HR 4·39, 1·96 to 9·82) and residual cancer (HR 2·42, 1·46 to 4·00). Conclusion Laparoscopic re-resection for selected patients with incidental gallbladder cancer is oncologically non-inferior to an open approach. Dissemination of advanced laparoscopic skills and timely referral of patients with incidental gallbladder cancer to specialized centres may allow more patients to benefit from this operation.

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Laparoscopic radical cholecystectomy for suspected early gall bladder carcinoma: thinking beyond convention

Abstract: Laparoscopic radical cholecystectomy with lymphadenectomy can be a viable alternative for management of early GBC in terms of technical feasibility and oncological clearance along with offering the conventional advantages of minimal access approach.

Cited by 47 publications

References 36 publications

Survey Results of the Expert Meeting on Laparoscopic Surgery for Gallbladder Cancer and a Review of Relevant Literature

Survey Results of the Expert Meeting on Laparoscopic Surgery for Gallbladder Cancer and a Review of Relevant Literature

Laparoscopic Surgery for Gallbladder Cancer: An Expert Consensus Statement

Comparison of oncological outcomes after open and laparoscopic re-resection of incidental gallbladder cancer

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