Laparoscopic Radical Cholecystectomy for Primary or Incidental Early Gallbladder Cancer: The New Rules Governing the Treatment of Gallbladder Cancer.

Gaetano Piccolo,Guglielmo Niccolò Piozzi

doi:10.1155/2017/8570502

Gaetano Piccolo, Guglielmo Niccolò Piozzi

Open Access

https://doi.org/10.1155/2017/8570502

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Abstract

Aim To evaluate the technical feasibility and oncologic safety of laparoscopic radical cholecystectomy (LRC) for primary or incidental early gallbladder cancer (GBC) treatment. Methods Articles reporting LRC for GBC were reviewed from the first case reported in 2010 to 2015 (129 patients). 116 patients had a preoperative diagnosis of gallbladder cancer (primary GBC). 13 patients were incidental cases (IGBC) discovered during or after a laparoscopic cholecystectomy. Results The majority of patients who underwent LRC were pT2 (62.7% GBC and 63.6% IGBC). Parenchyma-sparing operation with wedge resection of the gallbladder bed or resection of segments IVb-V were performed principally. Laparoscopic lymphadenectomy was carried out according to the reported depth of neoplasm invasion. Lymph node retrieved ranged from 3 to 21. Some authors performed routine sampling biopsy of the inter-aorto-caval lymph nodes (16b1 station) before the radical treatment. No postoperative mortality was documented. Discharge mean day was POD 5th. 16 patients had post operative morbidities. Bile leakage was the most frequent post-operative complication. 5 y-survival rate ranged from 68.75 to 90.7 months. Conclusion Laparoscopy can not be considered as a dogmatic contraindication to GBC but a primary approach for early case (pT1b and pT2) treatment.

Highlights

Gallbladder cancer (GBC) is the most frequent neoplasm of the biliary tract [1]
The titles of the 110 retrieved papers were examined by two authors (GP and GNP) who excluded nonpertinent papers. 38 articles were suggestive for our aim, but only 9 articles reported a total laparoscopic approach for primary or incidental gallbladder cancer (GBC) treatment (Figure 1)
Our study is subjected to a number of limitations, the most important of which is the relatively small group of patients with primary or incidental GBC treated with a total laparoscopic approach

Summary

Introduction

Gallbladder cancer (GBC) is the most frequent neoplasm of the biliary tract [1]. GBC has a great worldwide incidence variability in correlation with both geographic and ethnic features.Higher rates of GBC are observed in South America (especially Chile), Indian subcontinent, Japan, and Korea [2] and, in many cases, this is due to a higher incidence of S. typhi/paratyphi infection in these countries [3,4,5].Nowadays, thanks to the widespread use of ultrasound and laparoscopic cholecystectomy, GBC is diagnosed at an earlier stage with a consequent change in patients’ management and outcome.According to literature, the occurrence of IGBC ranges between 0.19 and 2.8% [6] with almost half of these cases detected after laparoscopic cholecystectomy for benign diseases (polyps, gallstones, and cholecystitis) [7]. Higher rates of GBC are observed in South America (especially Chile), Indian subcontinent, Japan, and Korea [2] and, in many cases, this is due to a higher incidence of S. typhi/paratyphi infection in these countries [3,4,5]. Thanks to the widespread use of ultrasound and laparoscopic cholecystectomy, GBC is diagnosed at an earlier stage with a consequent change in patients’ management and outcome. The occurrence of IGBC ranges between 0.19 and 2.8% [6] with almost half of these cases detected after laparoscopic cholecystectomy for benign diseases (polyps, gallstones, and cholecystitis) [7]. IGBC are usually at an earlier pathological stage with consequent increased long-term survival [8, 9]

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