Laparoscopic cholecystectomy: its effect on the prognosis of patients with gallbladder cancer.
Numerous reports suggest more recurrences and a worse prognosis after laparoscopic cholecystectomy (LC) than after open cholecystectomy (OC). The objective of this study was to compare the survival rate of patients undergoing a laparoscopic procedure versus those undergoing an open operation. A series of 24 patients with gallbladder cancer detected after LC were compared with 40 consecutive patients with gallbladder cancer detected after OC. Patients were matched by wall invasion, age, and whether they underwent a reoperation or only cholecystectomy. The series included 2 patients with in situ tumors, 2 with mucosal tumors, 1 with muscular invasion, 13 with subserosal invasion, and 6 with serosal invasion. Recurrences were observed in 4 of the 10 patients with subserosal compromise who underwent reoperation. In contrast, in the OC group of 26 patients with subserosal invasion, 20 of whom were reoperated, only 2 had a recurrence. Of the six patients with serosal infiltration, three in the LC underwent reoperation, all of whom had recurrences that precluded resection. Of the 12 patients in the OC group who presented with serosal invasion, 6 were reoperated and 4 had a recurrence. Overall survival curves did not show differences when patients were compared according to the type of procedure performed. Similarly, the analysis of patients according to the level of wall invasion indicated that there was no significant difference in survival. Although multiple reports have shown a worse prognosis for patients with gallbladder cancer undergoing LC, this study did not show a significant survival difference between the two methods. Although there is a higher but insignificant recurrence rate among the patients who underwent LC, this is not translated into survival.
de Aretxabala
Xabier A
XA
Department of Surgery, Universidad de la Frontera, German Clinic Temuco, PO Box 54-D Temuco 4781176, Chile. aretxaba@ufro.cl
Roa
Ivan S
IS
Mora
Javier P
JP
Orellana
Juan J
JJ
Riedeman
Juan P
JP
Burgos
Luis A
LA
Silva
Veronica P
VP
Cuadra
Alvaro J
AJ
Wanebo
Harold J
HJ
D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D016016:Proportional Hazards Models; D012704:Serous Membrane / Q000473:pathology