title: Laparoscopic radical cholecystectomy for suspected early gall bladder carcinoma: thinking beyond convention.
abstract: Gall bladder cancer (GBC) is the most common and aggressive malignancy of the biliary tract with extremely poor prognosis. Radical resection remains the only potential curative treatment for operable lesions. Although laparoscopic approach is now considered as standard of care for many gastrointestinal malignancies, surgical community is still reluctant to use this approach for GBC probably because of fear of tumor dissemination, inadequate lymphadenectomy and overall nihilistic approach. Aim of this study was to share our initial experience of laparoscopic radical cholecystectomy (LRC) for suspected early GBC.
  
  
  
  From 2008 to 2013, 91 patients were evaluated for suspected GBC, of which, 14 patients had early disease and underwent LRC.
  
  
  
  Mean age of the cohort was 61.14 ± 4.20 years with male/female ratio of 1:1.33. Mean operating time was 212.9 ± 26.73 min with mean blood loss of 196.4 ± 63.44 ml. Mean hospital stay was 5.14 ± 0.86 days without any 30-day mortality. Bile leak occurred in two patients. Out of 14 patients, 12 had adenocarcinoma, one had xanthogranulomatous cholecystitis and another had adenomyomatosis of gall bladder as final pathology. Resected margins were free in all (>1 cm). Median number of lymph nodes resected was 8 (4-14). Pathological stage of disease was pT2N0 in eight, pT2N1 in three and pT3N0 in one patient. Median follow-up was 51 (14-70) months with 5-year survival 68.75 %.
  
  
  
  Laparoscopic radical cholecystectomy with lymphadenectomy can be a viable alternative for management of early GBC in terms of technical feasibility and oncological clearance along with offering the conventional advantages of minimal access approach.
authors.affiliation: Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India. senthilnathan94@gmail.com.
authors.forename: Senthilnathan
authors.initials: S
authors.lastname: Palanisamy
authors.affiliation: Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India.
authors.forename: Nikunj
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sabnis
authors.affiliation: Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India.
authors.forename: Nalankilli
authors.initials: N
authors.lastname: Palanisamy
authors.affiliation: Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India.
authors.forename: Anand
authors.initials: A
authors.lastname: Vijay
authors.affiliation: Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India.
authors.forename: Praveenraj
authors.initials: P
authors.lastname: Palanivelu
authors.affiliation: Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India.
authors.forename: R
authors.initials: R
authors.lastname: Parthasarthi
authors.affiliation: Department of HPB Surgery, Gem Hospital and Research Centre, 45, Pankaja Mills Road, Ramanathapuram, Coimbatore, Tamil Nadu, 641045, India.
authors.forename: Palanivelu
authors.initials: P
authors.lastname: Chinnusamy
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D018194:Adenomyoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D001660:Biliary Tract Diseases / Q000601:surgery; D016063:Blood Loss, Surgical; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D012189:Retrospective Studies; D014973:Xanthomatosis / Q000601:surgery*
keywords: Cancer of biliary tract; Gall bladder carcinoma; Laparoscopic radical cholecystectomy; Laparoscopic surgery; Radical cholecystectomy