Abstract
Background
The laparoscopic cholecystectomy has allowed the detection of an increasing number of incidental gallbladder cancers (IGBC). Although laparoscopy is employed in the management of a variety of abdominal tumors, its use in gallbladder cancer is reduced and controversial. This study analyzes the role of laparoscopy in gallbladder cancer with the focus in IGBC.
Method
We evaluated our prospective series of 51 patients with an IGBC who were treated by laparoscopy between 2006 and 2016 at the Clinica Alemana in Santiago, Chile.
Results
The series comprised 7 men and 44 women. Age ranged from 43 to 76 years (mean age 60). Regarding wall involvement, 29 patients had a T2 tumor, which was the most common. 8 and 14 patients had T1b and T3 tumors, respectively. Of the patients, 17 underwent only laparoscopic exploration. This was due to the presence tumor dissemination not being observed in the preoperative staging. 10 patients had to be converted to complete the resection, whereas 24 patients were laparoscopically resected. The quality of the resected material was not different between those who were converted and those who were treated by laparoscopy. In the laparoscopic group, the average number of harvested lymph nodes was 7.9, not statistically different from the converted group. The mean of hospital stay in the laparoscopic group (4.3 days) was significantly lower than the converted group.
Conclusions
Laparoscopy has been shown to be a safe and feasible method for the management of IGBC. This method not only allows for a complete exploration, identifying a previously unseen residual tumor, but also makes it possible to accomplish the same oncology objectives as the open procedure. Therefore, laparoscopy should be considered a valid alternative in the management of IGBC.
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References
Stinton LM, Shaffer EA (2012) Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 6:172–187
Wistuba II, Gaazdar AF (2004) Gallbladder cancer: lessons from a rare tumor. Nat Rev Cancer 4:695–706
De Aretxabala X, Roa I, Burgos L, Losada H, Roa JC, Mora J, Hepp J, Leon J, Maluenda F (2006) Gallbladder cancer: an analysis of a series of 139 patients with invasion restricted to the subserosal layer. J Gastrointest Surg 10:186–192
Tantia O, Jain M, Khanna S, Sen B (2009) Incidental carcinoma of the gallbladder during laparoscopic cholecystectomy for symptomatic gallstone disease. Surg Endosc 23:2021–20126
Hueman MT, Vollmer CM Jr, Pawlik TM (2009) Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol 16:2101–2115
Barlett DL, Fong Y, Fortner JG, Brennan MF, Blumgart LH (1996) Long term results after resection for gallbladder cancer. Implications for staging and management Ann Surg 224:639–646
Lee JM, Kim BW, Kim WH, Wang HJ, Kim MW (2011) Clinical implications of bile spillage in patients undergoing cholecystectomy for gallbladder cancer. Am Surg 7:697–701
Ahmad J, Mayne AI, Loughrey MB, Kelly P, Taylor M (2014) Spilled gallstones during laparoscopic cholecystectomy. Ann R Coll Surg Engl 96:18–20
Honda M, Hiki N, Kinoshita T, Yabusaki H, Abe T, Nunobe S, Terada M, Matsuki A, Sunagawa H, Aizawa M, Healy MA, Iwasaki M, Furukawa TA (2016) Long term outcomes of laparoscopic versus open surgery for clinical stage I gastric cancer: the LOC-1 Study. Ann Surg 264:214–222
Jiang JB, Jiang K, Dai Y, Wang RX, Wu WZ, Wang JJ, Xie FB, Li XM (2015) Laparoscopic versus open surgery for mid-low rectal cancer: a systematic review and meta-analysis on short and long term outcomes. J Gastrointest Surg 19:1497–1512
Deijen CL, Vasmel JE, de lange-deKlerk ES, Cuesta MA, Coene PLO. Lange JF, Meijerink WJHJ., Jakimowicz JJ, Jeekel J, Kazemier G, Janssen IM, Pahlman L, Haglind E, Bojer HJ, Color (Colon cancer laparoscopic or open Resection) study group (2017) Ten year outcomes of randomised trial of laparoscopic versus open surgery for colon cancer. Surg Endosc 31:2607–2615
Kondo S, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Nagino M, Furuse J, Saito H, Tsuyuguchi T, Yamamoto M, Kayahara M, Kimura F, Yoshitomi H, Nozawa S, Yoshoda M, Wada K, Hirano S, Amano H, Miura F (2008) Japanese Association of Biliary Surgery, Japanese Society of Clinical Oncology Guidelines for the management of biliary tract and ampullary carcinoma: surgical treatment. J Hepatobiliary Pancreat Surg 15:41–54
Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474
Dindo DN, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
de Aretxabala X, Leon J, Hepp J, Maluenda F, Roa I (2010) Gallbladder cancer: role of laparoscopy in the management of potentially resectable tumors. Surg Endosc 24:2192–2196
Gumbs AA, Hofmann JP (2010) Laparoscopic completion radical cholecystectomy for T2 gallbladder cancer. Surg Endosc 24:3221–3322
Agarwal AK, Javed A, Kalayarasan R, Sakhuja P (2015) Minimally invasive versus the conventional open surgical approach of a radical cholecystectomy for gallbladder cancer, a retrospective comparative study. HPB 17:536–541
Itano O, Oshima G. Minagawa T. Shinoda M, Kitago M, Abe Y, Hibi T, Yagi H, Ikoma N, Aiko S, Kawaida M, Musugi Y, Kameyama K, Sakamoto M, Kitagawa Y (2015) Novel strategy for treatment of T2 gallbladder carcinoma. Surg Endosc 29:3600–3607
Palanisamy S, Patel N, Sabnis S, Palanisamy N, Vijay A, Palanivelu P, Parthasarthi R, PChinnusamy (2016) Laparoscopic radical cholecystectomy for suspected gallbladder carcinoma: thinking beyond convention. Surg Endosc 30:2442–2448
Piccolo G, Piozzi GN (2017) Laparoscopic radical cholecystectomy for primary or incidental early gallbladder cancer. The new rules governing the treatment of gallbladder cancer. Gastroenterol Res Pract. https://doi.org/10.1155/2017/8570502
Qadan M, Kingham P (2016) Technical aspects of gallbladder cancer surgery. Surg Clin N Am 96:229–245
Shindoh J, de Aretxabala X, Aloia TA, Roa JC, Roa I, Zimmitti G, JAvle M. Conrad C, Maru DM, Aoki T, Vigano L, Ribero D, Kokudo N, Capusotti L, Vauthey JN (2015) Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer. Ann Surg 261:733–739
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Xabier de Aretxabala, Federico Oppliger, Nicolas Solano, Guillermo Rencoret, Marcelo Vivanco, Daniel Carvajal, Juan Hepp, and Ivan Roa have no conflicts of interest or financial ties to disclose.
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de Aretxabala, X., Oppliger, F., Solano, N. et al. Laparoscopic management of incidental gallbladder cancer. Surg Endosc 32, 4251–4255 (2018). https://doi.org/10.1007/s00464-018-6173-5
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DOI: https://doi.org/10.1007/s00464-018-6173-5