Abstract
Gallbladder neuroendocrine carcinomas (GB-NECs) are a group of rare and heterogeneous neoplasms. There are few reports regarding laparoscopic surgery for GB-NEC cases diagnosed at advanced stage. Three patients, two females and one male, were admitted to our hospital. Two patients had the chief complaint of upper quadrant pain and one patient was found to have gallbladder occupation during a routine health checkup. No patient complained of jaundice, weight loss, or carcinoid syndrome–related symptoms including diarrhea, edema, flushing, and wheezing. Contrast-enhanced computed tomography (CT) examination showed local wall thickening of the gallbladder. In addition, one patient showed focal liver parenchymal invasion, and none of the three patients’ preoperative imaging examination revealed lymph node (LN) metastases. All three patients underwent laparoscopic radical cholecystectomy according to intraoperative frozen pathological examination, and they were diagnosed as GB-NEC based on postoperative pathology and immunohistochemistry. TNM stages of these patients were IIIA (T3N0M0), IIIB (T3N1M0), and IVB (T3N2M0), respectively. Chromogranin A (CgA) and synaptophysin (Syn) were positive in all cases. No patient encountered postoperative bleeding, bile leakage, abdominal abscess, gastrointestinal fistulas, or pulmonary complication. Two patients underwent postoperative chemotherapy with two cycles and seven cycles of etoposide plus cisplatin, respectively. Another patient did not receive postoperative chemotherapy due to his poor general condition. The overall survival time of the three patients was 4.6 months, 16.8 months, and 8.5 months, respectively. All three patients presented with liver and/or bile duct recurrence after surgery with a tumor-free survival time of 2.3 months, 3.3 months, and 3.0 months, respectively. Laparoscopic surgery may be considered a potential treatment for advanced GB-NEC in selected patients. However, further studies are needed to investigate the tumor-free survival benefit of laparoscopic surgery, and whether expanding the resection scope could reduce postoperative recurrence.
Highlights
Gallbladder neuroendocrine carcinomas (GB-NECs) are a group of rare and heterogeneous neoplasms
All three patients underwent laparoscopic radical cholecystectomy according to intraoperative frozen pathological examination, and they were diagnosed as GB-NEC based on postoperative pathology and immunohistochemistry
Laparoscopic surgery may be considered as a potential treatment for advanced GB-NEC in selected patients
Summary
Laparoscopic surgery may be considered a potential treatment for advanced GB-NEC in selected patients. Further studies are needed to investigate the tumor-free survival benefit of laparoscopic surgery, and whether expanding the resection scope could reduce postoperative recurrence. The sample size of our report is limited and more research with a larger sample size is needed, our experience will be very helpful for surgeons when they need to decide the surgical options for patients with advanced GB-NEC. Hongwu Chu and Jungang Zhang designed the study; Hongwu Chu drafted the manuscript; Ying Shi collected the clinical data; Changwei Dou, Fangqiang Wei and Chengwu Zhang performed the operation; Jungang Zhang and Dongsheng Huang reviewed the manuscript
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