Radical Cholecystectomy Research Articles

Approach to Resectable Biliary Cancers.

Biliary malignancies, although rare, can be some of the most challenging to manage surgically. Intrahepatic cholangiocarcinomas are resectable if there is no evidence of metastatic disease. These tumors are managed with anatomic resection and portal lymphadenectomy when centrally located or multiple in a single lobe. Non-anatomic resection can be performed for solitary peripheral tumors with minimally invasive techniques. It is not our practice to routinely employ neoadjuvant chemotherapy prior to resection of these tumors. Hepatic arterial infusion chemotherapy is utilized at our institution in highly selected patients in the context of an ongoing clinical trial for unresectable tumors. Hilar cholangiocarcinomas, when resectable (i.e., ipsilateral arterial involvement or lack of vascular involvement), are managed with right or left (extended) hepatectomy, caudate resection, and portal lymphadenectomy. Distal cholangiocarcinomas are managed with pancreaticoduodenectomy. Neoadjuvant chemotherapy is not routinely used in our treatment algorithm of extrahepatic cholangiocarcinomas. Nodal involvement and positive margin (R1) resection necessitates adjuvant chemotherapy. Finally, gallbladder carcinoma is managed with radical cholecystectomy, anatomic segment IVb/V resection, and portal lymphadenectomy. Adjuvant chemotherapy is employed routinely amongst patients with T2 or higher tumors and those with positive lymph nodes.

Minimally Invasive Surgery For Gallbladder Cancer Needing Adjacent Viscera Resection

Background: The minimally invasive surgery (MIS) in GBC is being increasingly performed with superior short term results and non-inferior oncological outcomes. Most of the studies on minimally invasive radical cholecystectomy (MIRC) included patients with GBC limited to the gall bladder. Bile duct or adjacent viscera has been resected only in a very few studies. One of the reasons perhaps for not imbibing MIS in advanced GBC is the innate complexity of resection of the involved adjacent organs and need performing a bilioenteric anastomosis. Aim of this study is to assess safety, feasibility and short-term outcomes of locally advanced GBC patients who underwent MIRC with adjacent bile duct or viscera resection.

Does timing of completion radical cholecystectomy determine the survival outcome in incidental carcinoma gallbladder: A single center retrospective analysis

Incidental discovery of gallbladder cancer (GBC) on postoperative histopathology or intra-operative suspicion is becoming increasingly frequent, since laparoscopic cholecystectomy became the standard of care for gall stone disease. Incidental GBC (IGBC) portends a better survival than primarily detected GBC. Various factors affect the outcome of re-resection with timing of re-intervention an important determinant of survival. All patients of IGBC who underwent curative resection from January 2009 to December 2018 were considered for analysis. Details of demographic profile, index surgery, primary histopathology, operative findings on re-resection, final histopathology and follow-up data were retrieved from the prospectively maintained database. Patients were evaluated in three groups based on the interval between index cholecystectomy and re-intervention (early [< 4weeks], intermediate [4-12 weeks], and late [> 12 weeks]) using appropriate statistical tests. Forty eight patients underwent re-resection with curative intent. Median age of presentation was 55 years. Mean and median follow-up was 51.6 and 40.6 months respectively (range, 1.2-130.6 months). The overall survival and disease free survival among the three groups was the best in 'early' group (104 & 102 months) as compared to the 'Intermediate' (84 & 83 months) and 'late' groups (75 & 73 months), though the difference was not statistically significant (p = 0.588 and p = 0.581). On Multivariate analysis, poor differentiation was the only independent factor affecting survival. Other attributes which were associated with poor outcome, but could not reach statistical significance were node metastasis, delay in re-resection, residual tumor, need for CBD excision and lymphovascular invasion. Grade of tumor is the most important determinant of survival in IGBC. Early surgery, preferably within 4 weeks possibly entails better survival.

Development and Validation of a Prognostic Nomogram Based on the Systemic Immune-Inflammation Index for Resectable Gallbladder Cancer to Predict Survival and Chemotherapy Benefit.

ObjectivesTo investigate the prognostic significance of the systemic immune-inflammation index (SII) in patients after radical cholecystectomy for gallbladder cancer (GBC) using overall survival (OS) as the primary outcome measure.MethodsBased on data from a multi-institutional registry of patients with GBC, significant prognostic factors after radical cholecystectomy were identified by multivariate Cox proportional hazards model. A novel staging system was established, visualized as a nomogram. The response to adjuvant chemotherapy was compared between patients in different subgroups according to the novel staging system.ResultsOf the 1072 GBC patients enrolled, 691 was randomly selected in the discovery cohort and 381 in the validation cohort. SII>510 was found to be an independent predictor of OS (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.42-2.54). Carbohydrate antigen 199(CA19-9), tumor differentiation, T stage, N stage, margin status and SII were involved in the nomogram. The nomogram showed a superior prediction compared with models without SII (1-, 3-, 5-year integrated discrimination improvement (IDI):2.4%, 4.1%, 5.4%, P<0.001), and compared to TNM staging system (1-, 3-, 5-year integrated discrimination improvement (IDI):5.9%, 10.4%, 12.2%, P<0.001). The C-index of the nomogram in predicting OS was 0.735 (95% CI 0.683-0.766). The novel staging system based on the nomogram showed good discriminative ability for patients with T2 or T3 staging and with negative lymph nodes after R0 resection. Adjuvant chemotherapy offered significant survival benefits to these patients with poor prognosis.ConclusionsSII was an independent predictor of OS in patients after radical cholecystectomy for GBC. The new staging system identified subgroups of patients with T2 or T3 GBC with negative lymph nodes who benefited from adjuvant chemotherapy.Clinical Trial Registration ClinicalTrials.gov, identifier (NCT04140552).

Lymph Node Ratio is an Important Prognostic Factor in Curatively Resected Gallbladder Carcinoma, Especially in Node-positive Patients: An Experience from Endemic Region in a Developing Country

BackgroundMetastasis to lymph nodes is a bad prognostic factor in patients with gallbladder carcinoma who undergo radical cholecystectomy. During the past decade, studies have brought focus on lymph node ratio (LNR) as an additional valuable prognostic factor in these cases.Our research studied the factors that predicted the recurrence of disease and survival of patients with gallbladder carcinoma who were treated with surgical resection, concentrating especially on the lymph nodal status as a prognostic factor and LNR in node-positive T1–T3 cases.MethodsIn our hospital, Mahavir Cancer Institute and Research Centre, we reviewed retrospective data, from 2009 to 2014, of 60 patients who had undergone radical cholecystectomy for gallbladder carcinoma. We staged the patients as per the AJCC eight edition. Predictive factors that affect disease-free survival (DFS), like age, gender, postoperative complications, lymphovascular invasion (LVI) and perineural invasion (PVI), lymph node dissection, differentiation, T stage, N stage, number of lymph nodes involved, and LNR, were examined statistically.ResultsLymph nodal involvement was found to be a principal predictive factor in cases in whom radical cholecystectomy was done. The number of lymph nodes dissected determined the prognosis in N0 cases. LNR was a strong prognostic factor for DFS in cases of curatively resected gallbladder cancer.ConclusionLNR is a strong predictive factor in radically resected gallbladder carcinoma cases.How to cite this articleNaveed S, Qari H, Thau CM, et al. Lymph Node Ratio is an Important Prognostic Factor in Curatively Resected Gallbladder Carcinoma, Especially in Node-positive Patients: An Experience from Endemic Region in a Developing Country. Euroasian J Hepato-Gastroenterol 2021;11(1):1–5.

Laparoscopic Surgery for Gallbladder Neuroendocrine Carcinoma: a Case Series and Literature Review

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.

Robotic Completion Radical Cholecystectomy with Fluorescence Guidance.

The application of minimally invasive surgery (MIS) techniques in the treatment of hepatobiliary malignancies offers advantages of shorter length of stay, quicker functional recovery, and decreased need for postoperative opioids. However, MIS completion radical cholecystectomy for incidentally diagnosed gallbladder cancer can be challenging due to a reoperative field and lack of tactile feedback. This video demonstrates the utility of the robotic platform and highlights the ways in which it assists surgeons in overcoming these limitations. These include (1) versatile wristed instruments and excellent visualization that facilitate a thorough regional lymphadenectomy; and (2) built-in fluorescence imaging technology that can be used with intravenous indocyanine green (ICG) to confirm porta hepatis anatomy in a reoperative field. ICG pharmacokinetics enable fluorescence angiography 15-20s after ICG injection and fluorescence cholangiography 15-20min after ICG injection as the dye accumulates in the biliary system. Systematic and intentional application of these techniques allows for the safe performance of robotic completion radical cholecystectomy following sound oncologic principles, with excellent perioperative outcomes.

The giant resectable carcinoma of gall bladder\u2014a case report

BackgroundGall bladder cancer (GBC) is the fifth most common malignancy in the gastrointestinal system and the most common malignancy of the biliary system. GBC is a very aggressive malignancy having a 5 year survival rate of 19%. Giant Gall Bladder (GGB) is an uncommon condition that can result from cholelithiasis or chronic cholecystitis and rarely with malignancy.Case reportA 65 year old lady presented with vague abdominal pain for 12 years and right abdominal lump of size 20 × 8 cms was found on examination. CT scan showed a circumferentially irregularly thickened wall (2.5 cm) of gall bladder indicative of malignancy. Per-operatively a GB of size 24 × 9 cm was noted and patient underwent radical cholecystectomy. It was surprise to find such a giant malignant GB with preserved planes. Histopathology, it was well differentiated adenocarcinoma of gall bladder of Stage II (T2a N0 M0).DiscussionIt is known that mucocoele of GB can attain large size, however chronic cholecystitis will lead to a shrunken gall bladder rather than an enlarged one. A malignant GB of such size and resectable is rare without any lymph node involvement or liver infiltration. Few cases of giant benign gall bladder have been reported in literature, however this appears to be the largest resectable gall bladder carcinoma reported till date as per indexed literature.ConclusionGiant GB is an uncommon finding. They are mostly benign, however malignant cases can occur. Radiological findings may suggest features of malignancy and define extent of disease. Prognosis depends on stage of disease and resectability, irrespective of size.

Gallbladder carcinoma outcomes in an Australian tertiary referral hospital.

This study aimed to examine the presentation, treatment, and long-term outcomes of patients with gallbladder carcinoma (GBC) managed in a surgical unit of an Australian tertiary referral hospital of a 19-year period. A retrospective review of prospectively collected data of patients with GBC managed in the Royal North Shore Upper GI Surgical department from October 1999 to March 2018. A total of 104 patients with GBC were identified: 36 patients underwent palliative treatment, 61 patients with gallbladder adenocarcinoma underwent resection with curative intent. Seven patients were excluded. 'Simple cholecystectomy' was undertaken in eight patients, 'standard radical cholecystectomy' in 37 and 'extended radical resection' in 16. The median survival in these patients was 35 months (95% confidence interval (CI) 21.29-55.10), with a median follow up of 60 months (95% CI 38.18-78.39). This compares with an overall median survival of only 4.00 months (95% CI 2.79-6.24) in patients who did not undergo a potentially curative resection. Independent predictors of poor long-term survival included an elevated preoperative serum tumour marker, advanced tumour stage (T3/T4) or node positive disease (N1/N2). The biology and stage of GBC at presentation are major factors in determining patient outcome. There is a need for better pre- and post-operative predictors to improve risk stratification, and these are likely to be in the form of molecular markers. Although the focus of surgery should be to ensure an R0 resection, patients with advanced stage disease need to be carefully selected for surgical intervention, and ideally should be managed by a multidisciplinary team in a specialist centre.

EVALUATION OF RADICAL CHOLECYSTECTOMY FOR INCIDENTAL GALLBLADDER CARCINOMA DIAGNOSED AFTER CHOLECYSTECTOMY, SINGLE CENTER EXPERIENCE

Objective: To evaluate the procedure of radical cholecystectomy for incidental gallbladder carcinoma diagnosed after cholecystectomy at a tertiary care teaching hospital of Pakistan.&#x0D; Study Design: Observational study (case series).&#x0D; Place and Duration of Study: Army Liver Transplant Unit, Pak Emirates Military Hospital, Rawalpindi, from Jun2018 to Apr 2019.&#x0D; Methodology: A prospective study was conducted on 11 patients who underwent routine cholecystectomy either open or laparoscopic for a possibly benign condition but were found with a malignancy on histopathology, were included in the study. Detailed assessment regarding all the side effects was done immediately after the procedure, at 48 hours, at time of discharge and two weeks after the procedure was done on all the participants.&#x0D; Results: Out of 11patients included in the final analysis, 06 were male and 05 were female. Mean age of patients put who underwent cholecystectomy and had incidental finding of cancer was 44.23 ± 3.621. Mean duration of hospital stay after the surgery was 5.13 ± 2.175. Most of the patients had well differentiated tumor. Post-operative pain was the commonest complication among the target population followed by biliary complication.&#x0D; Cholecystectomy,Conclusion: Gallbladder carcinoma may be missed on routine clinical screening and radiological modalities.Surgeon should be careful enough and suspect unusual finding of malignancy in routine surgeries. Radicalsurgery of the incidental gallbladder cancer emerged as an effective management modality among the patientsmanaged in our set up during this study period.

Robotic radical cholecystectomy for gallbladder adenocarcinoma experience from a single tertiary referral center

Presenter: Tara Hughes MD | University of Mississippi Medical Center Background: The scope of abdominal surgical procedures performed with utilization of robotic systems has expanded substantially in the past several years. There is little available data regarding the safety and adequacy of a robotic radical cholecystectomy. Gallbaldder adenocarcinoma is most commonly diagnosed at an advanced age, and a minimally invasive approach has the potential to significantly improve the morbidity associated with an open operation. We sought to evaluate the surgical outcomes of our experience with robotic resection at our institution. Methods: A retrospective chart review was performed for 5 patients who underwent a robotic radical cholecystectomy at our institution between the dates of January 1, 2018 through December 31, 2020. All patients were incidentally found to have gallbladder adenocarcinoma after undergoing laparoscopic cholecystectomy. We examined surgical outcomes for these patients including operative times, hospital length of stay, estimated blood loss, the number of lymph nodes resected, margins, and complications. Results: All patients successfully underwent a robotic assisted radical cholecystectomy and no patients required conversion to an open procedure. The median length of stay for our patients was 1 day. Operative times were on average 250 minutes. All resections were completed as R0 resections and a median number of 5 lymph nodes were harvested on portal dissection. The average estimated blood loss was 240 ml. There were no complications for any of these patients. Our median follow up post operatively was 3 months. There was one patient diagnosed with local recurrence a year after resection. Conclusion: Our case series demonstrates that robotic radical cholecystectomy is a safe and feasible option for resection of gallbladder adenocarcinoma. The experience at our institution indicates that a robotic approach may lead to a shorter length of stay and reduced morbidity relative to an open approach. Further investigation is warranted to clearly establish adequacy of robotic portal lypmadenectomy and oncologic outcomes.

An overview on diagnosis and surgical management of gallbladder cancer

Gallbladder cancer is among the most deadly cancers, and it continues to present surgeons with numerous challenges. Cholelithiasis, an abnormal pancreaticobiliary junction, and focal mucosal microcalcifications are all known risk factors for gallbladder carcinoma. The most common histologic type in most patients is adenocarcinoma, which is frequently associated with Kras and p53 mutations. Endoscopic ultrasonography, magnetic resonance cholangiopancreatography, as well as helical computed tomography, as well as radiologic or endoscopic improvements in endoscopic ultrasonography as well as magnetic resonance cholangialpancratia, have improved preoperative staging. Cholecystectomy (subsegmental surgical excision of segments IVB but instead V plus a hepatoduodenal ligament lymphadenectomy) for advanced disease without indications of distant metastasis (T2–4/N0-N2) or a radical cholecystectomy (subsegmental resection of segments IVB as well as V plus a hepatoduodenal musculotendinous lymphadenectomy) for severe stages without indications of distant metastasis More extensive hepatic resection, such as extended right hepatectomy or central segmentectomy with caudate lobectomy, has been recommended by certain surgeons. Patients who underwent a pancreaticoduodenectomy to enhance distal ductal margins as well as lymphadenectomy for T3 or T4 malignancies were studied by Japanese surgeons. These patients had a reduced incidence of tumor recurrence but no benefit in terms of survival. Adjuvant treatment options are still restricted. The most frequent postoperative treatment is radiation therapy with fluorouracil radio sensitization. Capecitabine, oxaliplatin, & bevacizumab are now being studied in the treatment of gallbladder cancer in clinical studies.

Radical Cholecystectomy for GB Tuberculosis Mimicking GB Neck Carcinoma with Obstructive Jaundice

Introduction: Isolated Hepatic-pancreato-biliary tuberculosis is a very rare condition and gall bladder tuberculosis is still rarer. Majority of patients with GB tuberculosis diagnosed in symptomatic gall stone disease, post cholecystectomy and only a few cases reported with GB neck involvement causing obstructing jaundice. We report a rate case of gall bladder tuberculosis presented as suspected GB neck carcinoma with obstructive jaundice. Methods: 55 year male presented with complaints of painful progressive jaundice since 2 month. H/o loss of appetite and significant loss of weight over last 2month. CECT abdomen and MRCP was s/o circumferential soft tissue thickening with high grade stenosis at gall bladder neck, CHD and superiorly extending upto confluence. EUS showed mass in GB neck extending to CHD around 2.5cm and EUS guided FNAC inconclusive. His total serum bilirubin was 6.9 and CA 19.9 was 271.9. Results: In view of ? carcinoma GB neck with obstructive jaundice he we underwent radical cholecystectomy with CBD excision. Intra operatively there is 3x3 cm mass present at GB neck and CHD reaching upto confluence. Post-operative period was grossly uneventful and patient was discharged on POD 7. Final histopathology was s/o Necrotizing granulomatous inflammation, consistent with tubercular cholecystitis. Proximal CHD also showing Necrotizing granulomatous inflammation. ZN stain shows an occasional bacilli. Following biopsy he was started on ATT and now at 6 months follow up he is totally asymptomatic. Conclusion: Gall bladder tuberculosis can present as carcinoma GB with obstructive jaundice and very difficult to diagnose preoperatively.

Lateral Approach toward Hepatoduodenal Ligament during Laparoscopic Radical Cholecystectomy for GB Cancer

Introduction: Lymph node dissection (LND) during laparoscopic radical cholecystectomy (LRC) is usually approached through an anterior approach, mimicking and with similar view than in open surgery. However, safe and complete isolation of the post-pancreatic node or retro-portal node are sometimes more difficult in laparoscopic surgery because the dorsal structures of hepatoduodenal ligament are embedded and might be difficult to expose.

Rare Presentation of the Type I Choledochal Cyst in a Young Adult

Introduction: Incidence of malignancy in choledochal cyst is 7.5%. Most Common malignancy is cholangiocarcinoma (70%), Gall bladder adenocarcinoma (20%), rest others. It is more common in females, and as the age increases the incidence of malignancy increases, the mean age of presentation is 32 years. Although Type I choledochal cysts are more common, the incidence of malignancy is higher in type IV choledochal cysts. Japanese and Koreans have seen High Incidence of Gall bladder cancer in Pancreatico biliary maljuction(PBM). Case report: We present a rare primary presentation of choledochal cyst in 34yrs/male who presented with complaints of vague right upper quadrant Pain for 4 months. On further evaluation with imaging studies he was diagnosed to have Type I Choledochal cyst with Gall bladder malignancy along with pancreatico biliary maljunction. Patient underwent Radical cholecystectomy with cyst excision and hepaticojejunostomy. Conclusion: Adult Choledochal cyst presentation is usually in form of complication - Cystolithiasis, Infection, Pancreatitis, portal HTN, biliary cirrhosis, and malignancy. Mere Primary presentation of GB cancer along with Choledochal Cyst is quite unusual. We present this case as it is quite rare presentation.

Development and Evolution of Laparoscopic Radical Cholecystectomy for Incidental and Non-incidental Gallbladder Cancer

Development and Evolution of Laparoscopic Radical Cholecystectomy for Incidental and Non-incidental Gallbladder Cancer

T2a gallbladder cancers have better overall survival and lower recurrence than T2b: a systematic review and meta-analysis

Presenter: Wasfi Alrawashdeh MD, PhD | Newcastle Freeman Hospital Background: Radical cholecystectomy including some form of liver resection and lymphadenectomy is the most widely accepted surgical treatment for T2 gallbladder cancer. However, the re classification of T2 into T2a (peritoneal side) and T2b (hepatic side) in the 8th edition of the AJCC TNM staging triggered further debate regarding the optimal treatment of these tumours. Some advocate liver resection only for T2b tumours based on survival data but studies have reported conflicting results in terms of survival and recurrence in T2a and b tumours. We aimed to perform a systematic review and meta-analysis to investigate the long-term survival and recurrence for T2a and T2b gallbladder cancers. Methods: Literature search of Medline, Web of science, Embase and Cochrane databases up to Sept 2020 was performed. Search criteria included T2 gallbladder cancer as well as T2a, T2b, peritoneal side and hepatic side tumours. Data was extracted including study characteristics, survival and recurrence. Where available, patient data were extracted from published Kaplan Meier curves for individual patient meta-analysis. The Meta-analysis was performed using random effect model. Results: The systematic review identified 15 retrospective studies that met the inclusion criteria including 2531 patients. There was no randomised controlled trail. In standard meta-analysis. overall survival was significantly worse in T2b compared to T2a tumours (HR 2.18, 95% CI 1.67-2.86, p <0.0001). Individual patient data meta-analysis showed similar results (629 patients, HR 1.92, 95%CI 1,43-2.58, p<.00001). T2b tumours had higher risk of disease recurrence compared to T2a (OR 3.19, 95% CI 1.40-7.28, p= 0.006) and were more likely to receive adjuvant chemotherapy (OR 1.76, 95% CI 1.12-2.84, p 0.014). All studies had moderate to high risk of bias. Conclusion: T2a gallbladder tumours have better overall survival and reduced risk of recurrence when compared to T2b tumours. The data is however derived from retrospective studies and there is no consistent evidence to support specific surgical strategy for each stage. Further better controlled and larger scale studies are required to generate better quality data.

The utility of screening ultrasound in early diagnosis of gall bladder cancer among high-risk population

Background: Screening has led to reduction in mortality for cancers of the cervix, prostate, and colon. Advanced gall bladder carcinoma (GBC) have a poor prognosis, compared to early-stage GBC. The aim of this study was early detection of GBC by ultrasound screening, in a high-risk population. Data were analyzed to look at the impact of screening on staging, operability, and survival. Materials and Methods: In this prospective study spanning 4 years, 978 high-risk individuals as per defined criteria, were screened by ultrasound of the abdomen. The clinical profile of patients with screened GBC (S-GBC) and clinically evident GBC (C-GBC) was studied in terms of stage of detection, operability, and median overall survival (mOS). Results: Six cases of GBC were detected as S-GBC. These were compared with a control population of 119 GBC cases presenting to the cancer outpatient department (C-GBC) in the same period. It was found that S-GBC patients compared to C-GBC, had early stages of diagnosis (P = 0.001) and all underwent curative radical cholecystectomy compared to only 18.8% in C-GBC cases (P = 0.004). At 2 years follow-up, mOS was not reached for S-GBC patients as all patients were alive, compared to 9 months mOS in C-GBC cases (P

Laparoscopic hepatopancreatoduodenectomy for locally advanced gall bladder cancer.

Hepatopancreatoduodenectomy (HPD) can offer a survival advantage in selected patients with locally advanced gall bladder cancer (GBC). While the safety and feasibility of minimally invasive radical cholecystectomy have been recently documented, laparoscopic HPD for GBC has not been previously reported. A 73-year-old male with GBC infiltrating the bile duct underwent laparoscopic HPD to achieve R0 resection. The patient had an uneventful post-operative course except for delayed gastric emptying that improved with conservative management. The feasibility of laparoscopic HPD for locally advanced GBC reported in the present case needs to be documented in a large case series.

Safety of laparoscopic cholecystectomy for gallbladder cancer: a meta-analysis

Objective: To evaluate the effect and safety of laparoscopic cholecystectomy (LC) on the treatment of patients with gallbladder cancer (GBC), compared with patients undergoing open cholecystectomy (OC). Methods: PubMed, EMBASE, Web of Science, CNKI, CQVIP and WANFANG DATA and the Cochrane Library were searched for all Chinese and English literatures of randomized or non-randomized concurrent controlled trials of OC and LC treatment of GBC from the database establishment to March 2020. Two reviewers selected the studies according to inclusion and exclusion criteria, extracted the data, and then a meta-analysis was subsequently performed by the RevMan 5.3 software provided by the Cochrane Library. Results: A total of 15 studies (1 074 patients) including 14 retrospective studies and 1 prospective study met the inclusion criteria. The meta-analysis showed that compared with OC, LC has significant short-term efficacy in the treatment of patients with gallbladder cancer, including shorter operation time (mean difference (MD) =-18.78, 95% confidence interval (CI) : -36.68-0.88; P=0.04), less intraoperative blood loss (MD=-166.57, 95%CI: -248.51--84.63; P<0.000 1), shorter post-operative hospital stays (MD=-5.00, 95%CI: -6.43--3.57; P<0.000 1), less complication rate (OR=0.47, 95%CI: 0.28-0.79; P=0.004), but there was no significant difference on the aspects of recurrence rate (OR=0.48, 95%CI: 0.21-1.11; P=0.09), 5-year overall survival (HR=0.93, 95%CI: 0.54-1.61, I2=33.5%, P=0.198) and long-term survival. Conclusion: Whether it is radical cholecystectomy (RC) or simple cholecystectomy (SC), the short-term efficacy of LC is more significant than that of OC, and the long-term survival rate has no significant statistical difference. Limited by the quality of literature and experiments, the above conclusions still need to be supported by higher quality research.