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Laparoscopic completion radical cholecystectomy for T2 gallbladder cancer
Andrew A Gumbs1, John P Hoffman
1Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue C-308, Philadelphia, PA 19111, USA. aagumbs@gmail.com
Surgical Endoscopy
|May 26, 2010
Summary
Minimally invasive surgery for gallbladder cancer is controversial but feasible. This study shows a laparoscopic approach for residual gallbladder bed resection and lymph node dissection is safe in early-stage cases.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Hepatobiliary Surgery
Background:
- The optimal surgical approach for gallbladder cancer, particularly after initial laparoscopic cholecystectomy, remains debated.
- Growing expertise in laparoscopic liver and pancreatic surgery has led to offering minimally invasive options for gallbladder cancer management.
Purpose of the Study:
- To evaluate the feasibility and safety of laparoscopic completion partial hepatectomy of the gallbladder bed and hepatoduodenal lymphadenectomy for gallbladder cancer.
- To demonstrate the surgical technique for laparoscopic resection of residual gallbladder bed, lymph nodes, and cystic duct stump.
Main Methods:
- Laparoscopic resection of the residual gallbladder bed, hepatoduodenal lymph nodes, and cystic duct stump was performed.
- The previous extraction site was utilized for specimen retrieval; port sites were excised if the site was unclear.
- Surgical steps included resection of skin and fascia around the prior extraction site.
Main Results:
- Three patients underwent laparoscopic radical cholecystectomy with hepatoduodenal lymph node dissection.
- Average lymph nodes retrieved: 3; average blood loss: 117 ml; average operative time: 227 minutes.
- Average hospital stay was 4 days with no observed morbidity or mortality within 90 days.
Conclusions:
- A minimally invasive approach for gallbladder cancer diagnosed post-cholecystectomy appears feasible and safe, even with prior hepatobiliary surgery.
- Further research with larger studies is necessary to confirm the benefits and identify potential drawbacks of this approach for early-stage gallbladder cancer.
