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Laparoscopic segment 4b+5 liver resection for stage T3 gallbladder cancer
Long Huang1,2, Chenjun Zhang1,2, Yifeng Tian1,2
1Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, No. 134 East Street, Fuzhou, 350001, China.
Surgical Endoscopy
|July 29, 2022
Summary
Laparoscopic liver resection for T3 gallbladder cancer is safe and effective, showing similar outcomes to open surgery. Segment 4b+5 resection in this group improved disease-free survival (DFS) and was aided by indocyanine green (ICG) fluorescence guidance.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Minimally invasive surgery
Background:
- Controversy exists regarding laparoscopic surgery for T3 stage gallbladder cancer.
- The necessity of segment 4b+5 liver resection for T3 gallbladder cancer remains under-explored.
Purpose of the Study:
- To explore the safety and effectiveness of laparoscopic segment 4b+5 liver resection for T3 stage gallbladder cancer.
- To evaluate the short-term prognosis of this surgical approach.
Main Methods:
- Retrospective, multicenter, propensity score-matched study.
- Analysis of disease-free survival (DFS), perioperative complications, and intraoperative safety.
- Comparison between laparoscopic and open surgery groups, and between different liver resection techniques.
Main Results:
- No significant difference in intraoperative bleeding, lymph node yield, postoperative complications, or DFS between laparoscopic and open surgery groups.
- Segment 4b+5 liver resection demonstrated longer DFS compared to wedge resection (P=0.016).
- Positive margins, lymph node metastasis, and liver segment 4b+5 resection were independent risk factors for DFS. Operative time was reduced with ICG fluorescence guidance.
Conclusions:
- Laparoscopic segment 4b+5 liver resection is a safe and feasible option for T3 stage gallbladder cancer, potentially prolonging DFS.
- Indocyanine green (ICG) fluorescence-guided resection may simplify the procedure.
