Laparoscopic surgery for oncologic extended resection of T1b and T2 incidental gallbladder carcinoma at a high-volume ce
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and Other Interventional Techniques
Laparoscopic surgery for oncologic extended resection of T1b and T2 incidental gallbladder carcinoma at a high‑volume center: a single‑center experience in China Parbatraj Regmi1 · Hai‑Jie Hu1 · Yin Chang‑Hao1 · Fei Liu1 · Wen‑Jie Ma1 · Cong‑Dun Ran1 · Jun‑Ke Wang1 · Aliza Paudyal1 · Nan‑Sheng Cheng1 · Fu‑Yu Li1 Received: 30 May 2020 / Accepted: 27 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Surgical treatment is still the most effective treatment for gallbladder cancer. For the patients with stage T1b and above, the current guidelines recommend the extended radical operation, and oncologic extended resection can benefit the survival of the patients. The laparoscopic approach is still in the early phase, and its safety and oncological outcomes are not well known. Objective To evaluate the technical feasibility and oncological outcomes of laparoscopic surgery for oncologic extended resection of early-stage incidental gallbladder carcinoma. Results This study included 18 male and 32 female patients. Twenty patients underwent laparoscopic oncologic extended resection and 30 patients underwent open oncologic extended resection. All of the patients had R0 resection. A laparoscopic approach was associated with less intraoperative blood loss (242 ± 108.5 vs 401 ± 130.3; p 0.05), residual disease (20% vs 23.3%; p > 0.05), and postoperative morbidity (15% vs 20%; p > 0.05). During follow-up time of median 20.95 (12–29.5) months, no significant difference was found between the two groups for early tumor recurrence (10% vs 13.33%; p > 0.05) and disease-free survival (p > 0.05). Conclusion Laparoscopic surgery may offer similar intraoperative, perioperative, and short-term oncological outcomes as an open oncologic extended resection for incidental gallbladder carcinoma. Keywords Incidental gallbladder carcinoma · Oncologic extended resection · Laparoscopic surgery Early gallbladder cancer (GBC) lacks specific symptoms and is frequently diagnosed incidentally on routine histopathological examination of gallbladder resected for benign disease. Incidental finding of GBC (IGBC) in cholecystectomy specimens is 0.25–0.89% [1]. Increased incidence of GBC is noted in recent decades due to an increase in cholecystectomy cases and routine histopathological examination of the specimen. Due to early-stage diagnosis, IGBC carries a comparatively favorable prognosis than those presenting with symptoms [2, 3]. Since the residual disease has been * Fu‑Yu Li [email protected] 1
Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China
identified in a significant number of patients with IGBC, revision surgery is required to improve prognosis [4]. However, one recent study has shown that index cholecystectomy (IC) before oncologic re-resection negatively impacts survival in T2b GBC [5]. Timing, approach, and extent of resection remain debated. Revision surgery for oncologic extended resection (
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