Does laparoscopic surgery have a role in the treatment of gallbladder cancer?
Eung Kook Kim1, Sang Kuon Lee, Won Woo Kim
1Department of Surgery, St. Mary's Hospital, The Catholic University of Korea, 62 Youido-dong, Youngdeungpo-ku, Seoul 150-713, Korea.
Background/Purpose:
This study was conducted to evaluate the role of laparoscopic surgery in the treatment of gallbladder cancer.
Methods:
A retrospective study was performed on 31 patients with a postoperative diagnosis of gallbladder cancer. The laparoscopic approach was initially applied to all of them.
Results:
Ten patients had a pT1a cancer, and all underwent laparoscopic cholecystectomy without recurrence. Nine patients had pT1b lesions, and three had to be converted to an open operation. There were two recurrences. In one of the converted patients the cystic node was invaded. Seven patients had a pT2 lesion, and in four of them the operation was converted to an open procedure. Recurrences were noted in three patients. In two patients with pT3 cancer, the opera-tions were converted; both cancers recurred. Only diagnostic laparoscopy or a palliative laparoscopic procedure was performed for pT4 cancers. The median follow-up time was 17.0 months. The 5-years survival rate was 100% for patients with stage pT1a, 100% for pT1b, and 68% for pT2 lesions.
Conclusions:
We suggest that when a polypoid lesion of the gallbladder is found on preoperative evaluation, laparoscopic surgery may be attempted initially. During the procedure it is important to open all specimens when a polypoid lesion is present and perform a frozen section biopsy. When a pT1a lesion is found, laparoscopic cholecystectomy is sufficient; however, when a pT1b or more advanced lesion is found, the operation might be converted to a radical cholecystectomy.