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Comparison of Laparoscopic and Open Approach in Treating Gallbladder Cancer
Changzhou First People’s Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
Radical gallbladder surgery
Background: Preliminary study on the feasibility and efficacy of laparoscopic cholecystec-tomy and radical cholecystectomy in stage Tis-T3 gallbladder cancer (GBC).
Methods: Retrospective analysis of the clinical data of 102 patients with GBC from August 2008 to August 2017 in the Department of Hepatopancreatobiliary Surgery at the Third Affiliated Hospital of Soochow University. The clinical and pathological data of laparo-scopic surgery and open surgery were compared.
Results: Of 102 patients with GBC, 41 underwent laparoscopic treatment, 12 of whom un-derwent laparoscopic cholecystectomy, and the others underwent laparoscopic radical cholecystectomy/extended radical cholecystectomy. Sixty-one patients underwent radical cholecystectomy/extended radical cholecystectomy. Based on the individual patient’s condition, excision of the extrahepatic biliary tract and cholangioenterostomy were per-formed. There were no perioperative deaths. There was no significant difference in the operative blood loss (P ¼ 0.732), operative time (P ¼ 0.058), postoperative complications (P ¼ 0.933), R0 margins (P ¼ 0.679), and tumor-related death (P ¼ 0.396) between the lapa-roscopic group and the laparotomy group. The postoperative activity time (P < 0.001), postoperative eating time (P < 0.001), drainage tube removal time (P < 0.001), and post-operative hospital discharge time (P < 0.001) in the laparoscopic group were all earlier than those in the laparotomy group, and the difference was statistically significant. The number of Veratridine nodes resected in the laparoscopic group and the laparotomy group was 1-17, average (5 3) and 1-13 average (5 3), respectively, with no statistically significant dif-ference (P ¼ 0.973). The 1-, 3-, and 5-y survival rates in the laparoscopic group were 97.1%, 69.4%, and 51.9%, respectively, and those in the laparotomy group were 94.7%, 64.9%, and
* Corresponding author. Changzhou First People’s Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China. Tel./fax: 13809079991.
** Corresponding author. Changzhou First People’s Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China. Tel./fax: 13961466346.
Conclusions: Laparoscopic treatment of stage Tis-T3 GBC is feasible. Laparoscopic treatment of GBC does not increase the incision metastasis rate on the basis of the intact gallbladder wall. The same survival rates can be achieved with laparoscopic treatment as with open treatment of GBC. In terms of postoperative rehabilitation, laparoscopic treatment has more advantages.
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Gallbladder cancer (GBC) is the most common bile duct tumor, the sixth most common type of digestive tract tumor and the ninth most deadly type of gastrointestinal tumor. The inci-dence is approximately 0.8%-1.2%; due to a lack of specific clinical manifestations, preoperative definite diagnosis is difficult.1 Compared with other gastrointestinal organs, the gallbladder lacks a submucosal layer, and the muscles of the serous layer are relatively thin, allowing invasion of cancer cells to other organs. The 5-y survival rates of patients with GBC (all stages) are approximately 5%. Radical cholecystec-tomy is curative but is possible in only 10% to 30% of patients.2
Although laparoscopic cholecystectomy (LC) has been introduced in the era of endoscopic surgery and prevented some patients from undergoing laparotomy, there is still some controversy about laparoscopic treatment of GBC. The rea-sons for the debate mainly concern the difficulty of radical cholecystectomy, the seeding of malignant cells, and the high recurrence rate after surgery. With the development of endoscopic techniques and the improvement in surgical technique, it has been reported that laparoscopic treatment of GBC can achieve the same outcomes as laparotomy.3,4 How-ever, the majority of these series included either a small number of patients or patients with early GBC. This article summarizes the clinical data of 102 patients with GBC treated in our department and discusses the feasibility and curative effects of laparoscopic treatment for GBC.
Materials and methods
The clinical data of 132 patients with GBC treated in our hospital from August 2008 to August 2017 were retrospectively reviewed. Among them, there were 41 males and 91 females with an age ranging from 29 to 90 y with a median age of 67 y. The preoperative diagnoses were as follows: 49 cases of cholecystolithiasis associated with cholecystitis, which include one case of calculous ileus, three cases of atrophic cholecystitis, and one case of obstructive jaundice; 12 cases of gallbladder polyps; 40 cases of gallbladder space-occupying lesions, which include one case with a space-occupying lesion of the common bile duct; 31 cases of GBC, which include one case with hepatic space-occupying lesion and two cases of obstructive jaundice. The follow-up period ended on December 31, 2017. Twenty patients were lost to follow-up due to change in their contact address or other reasons. The follow-up program included clinical examinations, abdominal ultrasounds, and measurement of serum tumor marker levels