Minimally invasive versus the conventional open surgical approach of a radical cholecystectomy for gallbladder cancer: a retrospective comparative study.
BACKGROUND
Laparoscopic surgery has traditionally been contraindicated for the management of gall bladder cancer (GBC). This study was undertaken to determine the safety and feasibility of a laparoscopic radical cholecystectomy (LRC) for GBC and compare it with an open radical cholecystectomy (ORC).


METHODS
Retrospective analysis of primary GBC patients (with limited liver infiltration) and incidental GBC (IGBC) patients (detected after a laparoscopic cholecystectomy) who underwent LRC between June 2011 and October 2013. Patients who fulfilled the study criteria and underwent ORC during the same period formed the control group.


RESULTS
During the study period, 147 patients with GBC underwent a radical cholecystectomy. Of these, 24 patients (primary GBC- 20, IGBC - 4) who underwent a LRC formed the study group (Group A). Of the remaining 123 patients who underwent ORC, 46 matched patients formed the control group (Group B). The median operating time was higher in Group A (270 versus 240 mins, P = 0.021) and the median blood loss (ml) was lower (200 versus 275 ml, P = 0.034). The post-operative morbidity and mortality were similar (P = 1.0). The pathological stage of the tumour in Group A was T1b (n = 1), T2 (n = 11) and T3 (n = 8), respectively. The median lymph node yield was 10 (4-31) and was comparable between the two groups (P = 0.642). During a median follow-up of 18 (6-34) months, 1 patient in Group A and 3 in Group B developed recurrence. No patient developed a recurrence at a port site.


CONCLUSIONS
LRC is safe and feasible in selected patients with GBC, and the results were comparable to ORC in this retrospective comparison.
Department of Gastrointestinal Surgery, GB Pant Hospital & MAM College, Delhi University, New Delhi, India.
Anil K
AK
Agarwal
Department of Gastrointestinal Surgery, GB Pant Hospital & MAM College, Delhi University, New Delhi, India.
Amit
A
Javed
Department of Gastrointestinal Surgery, GB Pant Hospital & MAM College, Delhi University, New Delhi, India.
Raja
R
Kalayarasan
Department of Pathology, GB Pant Hospital & MAM College, Delhi University, New Delhi, India.
Puja
P
Sakhuja
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002763:Cholecystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult