Risk factors and survival prediction model establishment for prognosis in patients with radical resection of gallbladder cancer.

The incidence of gallbladder cancer has been increasing. Radial resection is still the most promising curable treatment for patients with gallbladder cancer. Although the techniques required for laparoscopic radical resection of gallbladder cancer have matured, the number of reports is also on the rise, and laparoscopic radical resection of gallbladder cancer is still controversial. To standardize laparoscopic radical resection of gallbladder cancer, the Biliary Surgery Branch, Chinese Society of Surgery, Chinese Medical Association, together with the Chinese Medical Doctor Association in Chinese Committee of Biliary Surgeons, gathered experts to formulate recommendations and consensus on laparoscopic radical resection of gallbladder cancer. This consensus includes several parts: safety, preoperative evaluation, indications, surgical team, positioning of patient and trocars, intraoperative frozen examination, lymph node dissection, liver resection,bile duct resection, etc. Furthermore, suggestions on the principle of treatment, surgical procedures, and precautions were also provided for patients with delayed diagnoses of gallbladder cancer undergoing resection. This consensus aims to offer valuable suggestions for the standardization of laparoscopic radical resection of gallbladder cancer.

The use of robotic or laparoscopic surgery for gallbladder cancer (GBC) is increasing, with reported advantages over conventional open surgery. The purpose of this study was to compare the perioperative outcomes and postoperative overall survival (OS) associated with robotic radical resection (RRR) and laparoscopic radical resection (LRR) for GBC. A total of 109 patients with GBC who underwent radical resection with the same surgical team between January 2015 and December 2023 were enrolled, with 21 patients in the RRR group and 88 cases in the LRR group. A 1:1 propensity score matching (PSM) algorithm was used to compare the surgical outcomes and postoperative prognosis between the RRR and LRR groups. Logistic regression analysis was used to identify the risk factors of postoperative overall survival (OS) and complications of Clavien-Dindo (C-D) Grades III-IV. The median follow-up time was 46 (inter-quartile range, IQR 29-70) months for the LRR group and 16 (IQR 12-34) months for the RRR group. After PSM, the baseline characteristics of the RRR and LRR groups were generally well balanced, with 21 patients in each group. RRR was associated with significantly decreased intraoperative bleeding [100.00 (50.00, 200.00) mL vs 200.00 (100.00, 300.00) mL] and higher number of lymph nodes (LNs) yield [12.00 (9.00, 15.50) vs 8.00 (6.00, 12.00)]. The two groups showed comparable outcomes in terms of the incidence of biliary reconstruction, the range of liver resection, the length of operation, the incidence of postoperative morbidity, the incidence of C-D Grades III-IV complications, number of the days of drainage tubes indwelling and postoperative hospital stay, and mortality by postoperative days 30 and 90. After PSM, the 1-, 2-, and 3-year overall survival rates were 78, 70, and 37%, respectively, in the RRR group, and 71, 59, and 48%, respectively, in the LRR group (P = 0.593). Multivariate analysis showed that the preoperative TB level ≥ 72µmol/L and biliary reconstruction were found to be the independent risk factors of C-D Grades III-IV complications. T3 stage was identified to be the risk factor for postoperative OS. Compared with LRR, RRR showed comparable perioperative outcomes in terms of length of operation, and postoperative complications, recovery, and OS. In our case series, RRR of GBC can be accomplished safely and tends to show less intraoperative bleeding and higher LNs yield.

Clinicopathological features of long-term survivors after radical resection for gallbladder cancer

The use of radical resection for gallbladder cancer is controversial. This study evaluated results of resection for gallbladder cancer and analysed prognostic factors. A retrospective review of 135 patients who underwent surgical resection for gallbladder cancer between 1976 and 1998 was performed. Of these, 123 patients underwent radical resection and the remaining 12 had palliative resection. The resections included 32 hepatopancreatoduodenectomies and 57 with adjuvant radiotherapy. Twelve prognostic factors were analysed. A subset of 96 patients with stage IV disease was analysed separately with respect to residual tumour level and adjuvant radiotherapy. Surgical resection was associated with a 5-year survival rate of 36 per cent, with a mean follow-up time of 870 days. Twenty-two patients have survived more than 5 years including three with stage IV disease. Overall operative morbidity and mortality rates were 13 and 4 per cent respectively. The 5-year survival rate decreased with disease stage: 100, 78, 69 and 11 per cent for stages I (n = 13), II (n = 19), III (n = 7) and IV (n = 96) respectively. Performance status, jaundice, histopathological type and grade, primary tumour, lymph node, distant metastasis, stage grouping, residual tumour level and adjuvant radiotherapy were significant prognostic factors. With careful patient selection, radical resection for gallbladder cancer improves the prognosis with acceptable operative mortality and morbidity rates, even for stage IV disease, provided that complete gross tumour resection is combined with radiotherapy.

Objective To explore the application value of nano carbon lymph tracing technique in the radical resection of gallbladder cancer. Methods The prospective study was conducted. The clinical data of 120 patients with gallbladder cancer who were admitted to the Henan Provincial People′s Hospital between January 2010 and December 2014 were collected. All the patients were allocated into the experimental group and control group by random number table. For the experimental group, a total of 0.1 mL carbon nanoparticles were injected at 4-6 locations subserously around the cancerous site, radical resection of gallbladder cancer were performed at 15 minutes after injection, and intraoperative stained lymph nodes were used as markers to guide lymphadenectomy. Patients in the control group underwent regular radical resection of gallbladder cancer. Observation indicators: (1) intra- and post- operative situations; (2) number of lymph node sorting; (3) follow-up situations. Follow-up using telephone interview was performed to detect survival of patients up to January 2016. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were described as M(P25, P75), and comparison between groups was analyzed by the Mann-whitney rank-sum test. Comparisons of count data were analyzed using the chi-square test. Comparison of ordinal data were analyzed by the nonparametric test. The survival curve was drawn by the Kaplan-Meier method. Survival analysis was done using the Log-rank test. Results One hundred and twenty patients were screened for eligibility, and were allocated into the experimental group and control group, 60 in each group. (1) Intra- and postoperative situations: operation time, volume of intraoperative blood loss and duration of postoperative hospital stay were respectively (164±51)minutes, (200±98)mL, (13±4)days in the experimental group and (178±52)minutes, (225±98)mL, (14±5)days in the control group, with no statistically significant difference between groups (t=-1.50, -1.42, -1.03, P>0.05). (2) Comparison of lymph node sorting: overall number of lymph node sorting, overall number of positive lymph node sorting, number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 13.0 (12.0, 15.0), 8.0 (5.0, 9.0), 7.0 (5.0, 8.0), 3.0 (2.0, 4.0) in the experimental group and 10.0 (8.0, 12.0), 5.0 (4.0, 6.0), 5.0 (3.0, 5.0), 1.0 (1.0, 2.0) in the control group, with statistically significant differences between groups (Z=-5.51, -4.37, -6.24, -6.18, P 0.05). Overall number of lymph node sorting, overall number of positive lymph node sorting, number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 5.0 (4.8, 6.3), 0(0, 0.8), 2.0 (1.0, 3.3), 0(0, 0.5) in patients with stage Ⅱ of the experimental group and 3.0 (2.0, 4.3), 0 (0, 0), 0 (0, 1.3), 0(0, 0) in patients with stage Ⅱ of the control group, with statistically significant differences between groups (Z=-2.96, -2.02, -2.38, -2.01, P 0.05). Overall number of lymph node sorting, overall number of positive lymph node sorting, number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 13.0 (12.0, 15.0), 7.0 (5.0, 8.0), 7.0 (5.0, 8.0), 3.0 (2.0, 4.0) in patients with stage Ⅲ of the experimental group and 10.0 (9.0, 12.0), 5.0 (4.0, 6.0), 5.0 (4.0, 5.0), 2.0 (1.0, 2.0) in patients with stage Ⅲ of the control group, with statistically significant differences between groups (Z=-4.80, -3.43, -5.25, -4.76, P 0.05). Overall number of lymph node sorting, overall number of positive lymph node sorting, number of N2 station lymph node sorting and number of positive N2 station lymph node sorting were respectively 14.0 (13.0, 15.0), 9.0 (8.0, 10.0), 8.0 (7.5, 8.0), 4.0 (4.0, 5.0) in patients with stage Ⅳa of the experimental group and 11.0 (10.0, 13.0), 6.0 (4.0, 8.0), 5.0 (5.0, 6.0), 2.0 (1.0, 2.0) in patients with stage Ⅳa of the control group, with statistically significant differences between groups (Z=-3.47, -3.25, -4.02, -3.92, P 0.05). (3) Follow-up situations: 120 patients were followed up for 12-60 months, with a median time of 28 months. The postoperative overall survival time was (45.7±2.3)months in the experimental group and (36.5±2.4)months in the control group, with a statistically significant difference between groups (χ2=8.32, P 0.05). The postoperative overall survival time was (42.2±2.7)months in patients with stage Ⅲ of the experimental group and (35.0±3.0)months in patients with stage Ⅲ of the control group, with a statistically significant difference between groups (χ2=4.12, P<0.05). The postoperative overall survival time was (37.7±2.5)months in patients with stage Ⅳa of the experimental group and (27.0±3.1)months in patients with stage Ⅳa of the control group, with a statistically significant difference between groups (χ2=4.14, P<0.05). Conclusion The nano carbon lymph tracing technique in the radical resection of gallbladder cancer can guide precise operation, increase the numbers of overall and positive lymph nodes sorting, and extend postoperative overall survival time. Key words: Bile tract neoplasms; Radical resection; Nano carbon; Lymphatic tracer technology; Lymph node dissection; Prospective study

Objective To investigate the safety and feasibility of totally laparoscopic radical resection of gallbladder cancer. Methods The retrospective cross-sectional descriptive study was adopted. The clinical data of 30 patients who underwent laparoscopic radical resection of gallbladder cancer at the Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2013 to August 2015 were collected. The patients received synchronous hepatic segmental or extrahepatic bile duct resection according to the conditions of patients, and choledochojejunostomy was applied to patients undergoing extrahepatic bile duct resection. The patients accepted postoperative adjuvant chemotherapy according to the results of postoperative pathological examination. Observation indicators included (1) operation situations, including surgical procedures, operation time, volume of intraoperative blood loss and number of lymph node dissected, (2) postoperative situations, including time for out-off-bed activity, time for diet intake, time of drainage tube removal, occurrence of complications and duration of hospital stay, (3) results of postoperative pathological examination, including tumor stage and surgical margin, (4) postoperative adjuvant treatment, (5) follow-up situation including the survival of patients, tumor recurrence and metastasis. The follow-up using outpatient examination and telephone interview was performed to detect the survival of patients and tumor recurrence and metastasis up to December 2015. Count data were represented as average (range). Results All the 30 patients underwent successful laparoscopic radical resection of gallbladder cancer combined with hepatic S4b and S5 resection+ lymph node dissection at N1 region. Six patients with obstructive jaundice caused by tumor invaded to extrahepatic bile duct underwent combined laparoscopic extrahepatic bile duct resection+ Roux-en-Y hepaticojejunostomy, without perioperative death.The average operation time, average volume of intraoperative blood loss and average number of intraoperative lymph node dissected were 238 minutes (range, 178-430 minutes), 250 mL (range, 200-600 mL) and 7 (range, 4-15), respectively. (2) The patients got out-off-bed activity and normal diet intake at postoperative day 2, with a average time of drainage tube removal of 3 days (range, 0-25 days) and an average duration of hospital stay of 5 days (range, 3-28 days). Two patients with complications were cured by symptomatic treatment. (3) Results of postoperative pathological examination showed that all the patients received R0 resection, and pathological stage showed that 12 patients were detected inⅠB stage, 10 inⅡstage, 7 in ⅢA stage and 1 in ⅢB stage. (4) One patient in ⅢB stage (pT3N1M0 stage ) received gemcitabine+ cisplatin chemotherapy and other patients didn't receive the adjuvant treatment. (5) All the patients were followed up for a median time of 16 months (range, 4-32 months), without tumor recurrence and metastasis at Trocar puncture site. There were 25 patients with tumor-free survival and 5 patiens died of tumor recurrence. Conclusion Laparoscopic radical resection of gallbladder cancer is technically safe and feasible, with a satisfactory short-term outcome. Key words: Gallbladder neoplasms; Radical resection; Laparoscopy

BackgroundAlthough laparoscopic radical resection (LRR) has long been contraindicated in gallbladder cancer (GBC), recent studies have demonstrated laparoscopic surgery did not adversely affect the perioperative and survival outcomes of GBC patients. However, these literatures are mainly focused on GBC of relatively early stages or incidental GBC. This study aimed to investigate the perioperative and long-term outcomes of LRR versus open radical resection (ORR) for GBCs in T2 and T3 stages. MethodsA retrospective study was conducted on 99 patients with GBC of T2 and T3 stages who underwent radical resection at Zhejiang Provincial People’s Hospital from January 2010 to December 2020. A 1:1 propensity score matching (PSM), which is widely used to reduce selection bias, was performed to compare the surgical outcomes and long-term prognosis between LRR and ORR. A logistic regression analysis was implemented to identify the predictive risk factors of postoperative overall survival. ResultsBy using PSM, the baseline characteristics of two groups (with 30 patients in each group) were generally well balanced. In the LRR group, the length of operation was significantly longer than the ORR group, but the intraoperative bleeding and postoperative days of hospital stay were significantly decreased compared to the ORR group. The two groups showed comparable outcomes regarding the incidence of biliary reconstruction, lymph node yield, the incidence of postoperative morbidities, the incidence of Clavien–Dindo (C–D) grades III–IV, the days of drainage tubes indwelling, mortality at 30 postoperative days and 90 postoperative days, and the incidence of port-site metastasis. The 1-, 2-, and 3-year overall survival rates were 61.2, 40.1, and 30.1%, respectively, in the LRR group, and 53.3, 40.1, and 40.1%, respectively, in the OLR group (P = 0.644). On multivariate analysis, T stage, vascular invasion, and tumor differentiation were found to be the independent risk factors for overall survival of GBC in T2 and T3 stages. ConclusionsFor GBC in T2 and T3 stages, LRR can achieve comparable perioperative outcomes and similar long-term survival benefit compared to ORR. LRR tends to show advantages over ORR regarding intraoperative bleeding and postoperative days of hospital stay.

Objective: To compare the short-term efficacy and long-term prognosis of laparoscopic and laparotomy radical resection for gallbladder cancer(GBC). Methods: From January 2010 to December 2020,the clinical data and survival information for 133 patients who underwent radical resection of GBC at the Department of Hepatopancreatobiliary Surgery,Zhejiang Provincial People's Hospital,were retrospectively collected. Eighty patients(23 males and 57 females) underwent laparoscopic radical resection and had a median age(M(IQR)) of 66.0(12.8)years(range:28.0 to 82.0 years). Fifty-three patients(45 males and 8 females) who received laparotomy were 63.0(6.0)years old(range:45.0 to 80.0 years old). There were no significant differences in age,gender,body mass index,preoperative albumin,preoperative total bilirubin,N stages,vascular invasion,peri-neural invasion or tumor differentiation between the laparoscopic and laparotomy group(all P>0.05). But there were significant differences in preoperative CA19-9(Z=-2.955, P=0.003), preoperative ALT level(Z=-2.801,P=0.031) and T stage (χ2=19.110,P=0.007) between the two groups. A non-parametric test was used for quantitative data. χ2 test or Fisher exact probability method was used for count data. Results: Patients in the laparoscopic group did not differ from those in the laparotomy group in terms of length of operation,number of lymph node yield,number of positive lymph nodes,the incidence of intraoperative gallbladder rupture,incidence of postoperative bile leakage,abdominal bleeding or abdominal infection,30-day mortality,90-day mortality, the incidence of incision implantation or peritoneal cavity metastasis(all P>0.05). Patients in the laparoscopic group showed less intraoperative bleeding(100.0(200.0)ml vs. 400.0(250.0)ml)(Z=-5.260,P<0.01),fewer days with drainage tube indwelling(6.0(3.8)days vs. 7.0(4.0)days)(Z=-3.351, P=0.001), and fewer postoperative days in hospital(8.0(5.0)days vs. 14.0(7.5)days)(Z=-6.079,P<0.01) than those in the laparotomy group. Patients in the laparoscopic group displayed better overall survival (P<0.01) and progression-free survival (P<0.01). Subgroup analysis for GBC of T1b-T2 and T3 stages revealed comparable overall survival and progression-free survival between the laparoscopic and laparotomy groups (P>0.05). Conclusions: Laparoscopic radical resection can achieve long-term survival for GBC comparable to that with open surgery. Laparoscopic radical resection has advantages over open surgery regarding surgical trauma and postoperative recovery.

Gallbladder cancer (GBC) is a common malignant tumor often diagnosed in advanced stages. Surgery is among the most important treatments for GBC. Radical resection of GBC involves removal of the gallbladder and the gallbladder bed [liver segments (S) 4b and 5], and hepatoduodenal ligament regional lymphadenectomy. The main GBC metastasis modes are blood and lymph node metastases. The scope of resection/wedge resection or regular S4b and S5 hepatectomy for blood metastasis is a matter of debate. A variety of hepatectomy methods have been proposed for T2 stage GBC, but no consensus has been reached regarding the scope of radical resection. Currently, the liver resection range is determined by branches of the portal vein. S4b and S5 hepatectomy is determined according to the liver portal vein branch perfusion area, but the rationale for liver resection for GBC is to eliminate potential metastasis from the cystic vein reflux area to the liver. In the case described herein, we used a novel technique and theoretical framework to conduct laparoscopic radical resection of gallbladder cancer (LRRGC) facilitated by staining of the liver draining area with an indocyanine green (ICG) injection into the cholecystic artery.

Purpose: To determine the efficacy of dexmedetomidine (DEX) plus either isoflurane or sevoflurane, in elderly gallbladder cancer patients given radical resection. Methods: A total of 278 elderly patients assessed for eligibility and scheduled for radical gallbladder cancer resection in Hunan Cancer Hospital, Changsha, China were recruited. They were randomly assigned at a ratio of 1:1 to receive either DEX plus isoflurane or DEX plus sevoflurane. These two groups were compared with respect to immune functions (CD3+, CD 4+, CD 8+, and CD4+/CD8+ T cells); inflammatory factors, and cognitive function scores.Results: The sevoflurane cohort had higher immune function indices, lower levels of inflammatorycytokines, and better oxidative stress indices, than the isoflurane cohort (p &lt; 0.05). Postoperatively,cognitive function scores in both cohorts were reduced. At postoperative 12 and 24 h, sevofluranecohort had higher scores than the isoflurane group. Sevoflurane was more effective in stabilizinghemodynamic indices than isoflurane.Conclusion: DEX plus sevoflurane produces more significant improvements in the cognitive function ofelderly patients undergoing radical resection for gallbladder cancer, with milder immune functionimpairment, milder inflammatory response, and lower degree of oxidative stress, than isoflurane

Objective To investigate the treatment strategies and factors influencing the prognosis of patients with primary gallbladder carcinoma.Methods The clinical data of 135 patients with primary gallbladder cancer who were admitted to the Cancer Hospital of Tianjin Medical University from January 2000 to December 2009 were retrospectively analyzed.The survival curve was drawn by the Kaplan-Meier method,and the survival rates were analyzed by using the Log-rank test.Factors which may have influences on the prognosis were analyzed by univariate analysis and COX multivariate analysis.Results The overall 1-,3-,5-year survival rates of the 135 patients were 46.7％,10.4％ and 5.2％,respectively.The 1-,3-,5-year survival rates of 74 patients who received radical resection of gallbladder cancer were 68.9％,18.9％ and 9.5％,respectively.The 1-,3-,5-year survival rates of 50 patients who received palliative treatment were 24.0％,0 and 0,respectively.The 1-,3-,5-year survival rates of 11 patients who received conservative treatment were 0,0 and 0,respectively.There was no significant difference in the survival rates among patients who received different treatment methods (x2 =5.642,P ＜ 0.05 ). Of the 9 patients with gallbladder cancer who received reoperation after laparoscopic choledochotomy,the survival time of 1 patient in stage Ⅰ and 1 of the 3 patients in stage Ⅱ who received radical surgery exceeded 5 years,while the survival time of 5 patients in stage Ⅱ who received palliative treatment was shorter than 5 years.There was a significant difference in the survival time among the 3 groups of patients ( x2 =5.642,P＜0.05).Under the condition of same TNM stages ( Ⅱ,ⅢA,ⅢB,ⅣA,ⅣB),the survival rates of patients who received radical resection of gallbladder cancer were significantly higher than those who received palliative or conservative treatment ( x2 =8.971,21.250,44.153,6.696,21.722,P ＜ 0.05 ).The results of univariate analysis showed that age,CA19-9,TNM stages and treatment methods were risk factors influencing the median survival time ( x2 =8.466,3.977,9.837,5.642,P ＜ 0.05 ).The results of multivariate analysis showed that age,TNM stages and treatment methods were the independent risk factors influencing the median survival time ( Wald=5.779,14.724,11.640,P＜0.05).Conclusion The prognosis of primary gallbladder cancer is poor.Age,TNM stages and treatment methods are the independent factors influencing the prognosis of patients with gallbladder cancer,and patients who receive radical resection have relatively good prognosis. Key words: Gallbladder neoplasms,primary; Prognosis; Surgical treatment

The only potentially curative option for patients with gallbladder cancer is radical resection. This is the first report that describes the successful application of a minimally invasive, robot-assisted radical resection, including lymphadenectomy, in five gallbladder cancer patients. Medical records of patients who underwent radical resection of gallbladder cancer via the da Vinci robotic surgical system in the Hepato-Bilio-Pancreatic Surgical Department of the Shanghai Ruijin Hospital, China, between March 2010 and July 2011 were reviewed and analyzed. Robot-assisted radical resection was successful in all five patients. The mean number of excised lymph nodes was 9 (range = 3-11), mean operative time was 200 min (range = 120-300 min), mean intraoperative blood loss was 210 ml (range = 50-400 ml), and mean length of hospital stay was 7.4 days (range = 7-8 days). All patients were discharged with no reported complications. Mean postoperative follow-up was 11 months (range = 1-17 months). One patient died due to tumor recurrence 10 months postsurgically, but there was no recurrence in the remaining four patients during the follow-up period. Robot-assisted radical resection for gallbladder cancer is both feasible and safe. Compared to laparoscopic surgery, the robotic surgery system is better suited for subtle dissection in a narrow, deep space. This is advantageous for both the removal of lymph nodes near the pancreas and hepatoduodenal ligament and the skeletonization of the hepatoduodenal ligament, the hepatic artery, and the celiac axis. The long-term outcome and direct comparisons to laparotomy in a larger patient cohort are needed to provide more clinical data supporting the superiority of this approach.

Lymph node evaluation is associated with improved survival after surgery for early stage gallbladder cancer

The role of radical resection for gallbladder cancer is an ongoing area of debate. In this review, we present our experience managing gallbladder cancer at a tertiary center by using an aggressive surgical approach for T2 or greater disease, reserving simple cholecystectomy only for T1 lesions. Seventy-six patients with histologically confirmed gallbladder cancer were identified from our cancer registry. Estimated survival distributions were calculated by the Kaplan-Meier method, and comparisons were made by using the log-rank test. The Cox proportional hazards model was used to determine the effect on survival of T stage, nodal status, age, and margins. Sixty-four patients were assessable for this study. Simple cholecystectomy was the only procedure performed in 10 T2 and 15 T3 cases. Radical cholecystectomy was performed as the primary procedure in two T2, two T3, and six T4 cases. Radical re-resection was accomplished in seven T2 and two T3 cases. Excluding the T4 group, there was a significant survival advantage (P = .007) for the radical resection group (n = 13; median survival not yet reached) compared with the simple cholecystectomy group (n = 25; median survival, 17 months; 95% confidence interval, 7-27 months). Analysis of the 13 T2 and T3 patients who underwent radical resections revealed that the radical re-resection group (n = 9) had an overall survival similar to that of the primarily resected group (n = 4). All T2N(+) and T3N(-) patients are still alive and disease free after 5 years of follow-up, whereas none of the T3N(+) or T4 patients survived beyond 24 months. Increasing T stage and age (>65 years) were independent predictors of a poor prognosis. Radical resection for T2 and T3 disease resulted in a significant survival advantage compared with simple cholecystectomy. Patients who undergo radical re-resection after an incidentally discovered gallbladder cancer experience the same survival benefit as primarily resected patients. Radical resection for T2N(-), T2N(+), and T3N0 cases can achieve long-term survival. Conversely, the prognosis for T3N(+) and T4 patients is poor, and improved outcome for this group will likely depend on the development of multi-institutional neoadjuvant clinical trials that can identify effective systemic regimens.

Surgery is the mainstay of treatment for resectable gallbladder cancer. Near-infrared fluorescence (NIRF) imaging using ICG is an innovation in laparoscopic surgery, which can provide real-time navigation during the whole operation. In this article, we present a 56-year older woman with gallbladder cancer, in which we evaluated the applicability of NIRF imaging using ICG for tumor and biliary tree visualization during the operative procedure of gallbladder cancer. The tumor and biliary tree were clearly visualized by utilizing a green fluorescence dye. The patient was successfully operated radical resection of gallbladder cancer under fluorescence laparoscope, without any complications. According to this case, the utilization of ICG based NIRF imaging is feasible and beneficial in identifying tumors and the biliary tree during radical resection. It can assist in the achievement of a negative margin and lymphatic clearance around the biliary tree. However, further studies are needed to corroborate the results of this case.