[Analysis of safety and efficacy of laparoscopic surgery for gallbladder carcinoma]

Objective: To examine the efficacy and safety of laparoscopic surgery for gallbladder carcinoma. Methods: Data from 197 gallbladder carcinoma patients admitted to Peking Union Medical College Hospital between January 2012 and September 2022 were analyzed retrospectively. There were 86 males and 111 females,with an age of (64.4±9.8)years(range: 35 to 89 years). The patients were divided into laparoscopic group(n=53) and open group(n=144) according to different surgical methods. The general information of the two groups was matched by propensity score matching,and the clinical data and the prognosis were compared between the two groups. Categorical variables were analyzed using χ² test or Fisher's exact test,as appropriate. Continuous variables with and without normal distribution were analyzed using the t-test and the Mann-Whitney U test,respectively. Kaplan-Meier curves with Log-rank test were used to analyze the cumulative survival rates. Results: Forty-eight pairs of patients were matched successfully. There were no differences in general information,cholecystolithiasis,partial hepatectomy,and tumor stage between the two groups(all P>0.05). The laparoscopic group had a shorter operation time(t=-3.987,P<0.01),less bleeding(Z=-4.862,P<0.01),a shorter total(Z=-5.009,P<0.01) and postoperative(Z=-5.412,P<0.01) hospital stay. Seventeen patients had postoperative complications. According to the Clavien-Dindo system,there were 4,11,1,and 1 patient with grade Ⅰ,Ⅱ,Ⅲa,and Ⅲb,respectively. All complications improved after active treatment. After a follow-up(M(IQR)) of 24(36) months(range: 3 to 130 months),56 patients(58.3%) survived without tumor,7 patients(7.3%) survived with tumor,and 33 patients(34.4%) died. According to the Kaplan-Meier curves,there was no significant difference between the laparoscopic and open groups in disease free(χ²=0.399,P=0.528) and overall(χ²=0.672,P=0.412) survival rates. Conclusions: Laparoscopic surgery is safe and effective in selected patients with gallbladder carcinoma. It can reduce surgical trauma and improve patient recovery without increasing complication. Its prognosis is similar to that of open surgery.