Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patients

Abstract

The long-term effects of initial laparoscopic cholecystectomy on the prognosis of patients with GBC remain unknown because of the limited numbers of patients reported from single institutions. This study was designed to determine the long-term prognosis of patients with gallbladder carcinoma (GBC) who had undergone laparoscopic cholecystectomy (LC), and to clarify the role of LC for the treatment of GBC and the benefit of aggressive additional excision. The clinical courses and outcomes of 498 patients with laparoscopically removed GBC registered in a nationwide survey were examined. Written questionnaires sent to members of the Japanese Society of Biliary Surgery included questions on Preoperative diagnosis, timing and methods to obtain final diagnosis, depth of invasion, second surgical procedure, prognosis of patients, and type of recurrence, if any. The 5-year survival rates of patients after LC according to the depth of invasion were as follows: 99% in those with pT1a (limited to the mucosa), 95% in those with pT1b (muscularis), 70% in those with pT2 (subserosa), 20% in those with pT3 (serosa), and 0% in those with pT4 (serosa with invasion to adjacent organs). Perforation of the gallbladder during LC was found in 20% of the patients. Patients with gallbladders perforated during LC showed a significantly lower survival rate than did those without perforated gallbladders ( P < 0.01). Additional excision during or after LC was carried out in 48% of the patients, and the frequency of additional excision increased in accordance with the depth of invasion. Compared with patients who underwent LC only, additional excision resulted in better survival in patients with pT2 or pT3 tumors ( P = 0.051 and P < 0.05, respectively), but this difference was not found in patients with pT1 or pT4 tumors. LC is not likely to worsen the survival rate of patients with GBC compared with the survival rate of patients undergoing a standard open radical procedure, as long as additional excision is conducted for patients with laparoscopically removed pT2 or pT3 GBCs. Special attention should be paid to prevention of bile spillage during LC.