Novel strategy for laparoscopic treatment of pT2 gallbladder carcinoma.
BACKGROUND
This study evaluated our new strategy for treating suspected T2 gallbladder carcinoma (GBC) using a laparoscopic approach.


METHODS
We examined 19 patients with suspected T2 GBC who were treated laparoscopically (LS group) between December 2007 and December 2013; these patients were compared with 14 patients who underwent open surgery (OS group). Laparoscopic staging was initially performed to exclude factors making the patients ineligible for curative resection. Intraoperative pathological examination of the surgical margin of the cystic duct was performed prior to laparoscopic gallbladder bed resection, and pathological examination was again performed to confirm the presence of carcinoma and the depth of tumor invasion. Surgery was completed when the pathological findings indicated that the patient was cancer free. Lymph node dissection was performed according to the depth of tumor invasion.


RESULTS
None of the patients required conversion to laparotomy. For three patients with benign lesions, only gallbladder bed resection was required. Additional regional lymph node dissection was performed in 16 patients in the LS group. The mean operative time (309 vs. 324 min, p = 0.755) and mean number of dissected lymph nodes (12.6 vs. 10.2, p = 0.361) were not significantly different between the LS and OS groups. The intraoperative blood loss was significantly lower (104 vs. 584 mL, p = 0.002) and the postoperative hospital stay was significantly shorter (9.1 vs. 21.6 days, p = 0.002) for LS patients than for those in the OS group. In the LS group, one patient developed postoperative pneumonia, but all patients survived without recurrence after a mean follow-up of 37 months.


CONCLUSIONS
Our strategy for suspected T2 gallbladder GBC is safe and useful, avoids unnecessary procedures, and is associated with similar oncologic outcomes as the open method.
Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. itano@z8.keio.jp.
Osamu
O
Itano
Department of Surgery, Eiju General Hospital, Tokyo, Japan.
Go
G
Oshima
Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Takuya
T
Minagawa
Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Masahiro
M
Shinoda
Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Minoru
M
Kitago
Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Yuta
Y
Abe
Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Taizo
T
Hibi
Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Hiroshi
H
Yagi
Department of Surgery, Eiju General Hospital, Tokyo, Japan.
Naruhiko
N
Ikoma
Department of Surgery, Eiju General Hospital, Tokyo, Japan.
Satoshi
S
Aiko
Department of Pathology, School of Medicine, Keio University, Tokyo, Japan.
Miho
M
Kawaida
Department of Pathology, School of Medicine, Keio University, Tokyo, Japan.
Yohei
Y
Masugi
Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan.
Kaori
K
Kameyama
Department of Pathology, School of Medicine, Keio University, Tokyo, Japan.
Michiie
M
Sakamoto
Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Yuko
Y
Kitagawa
D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods / Q000592:standards*; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
EUS; Gallbladder bed resection; Gallbladder carcinoma; Laparoscopic resection; Lymphadenectomy