Laparoscopic Management of Suspected Gallbladder Cancer: Risk Stratified Approach in Thick-Walled Gallbladder and...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Hepatobiliary Surgery

Background:

• Thick-walled gallbladder (TWGB) and gallbladder polyps (GBP) can harbor malignancy, posing diagnostic challenges.
• Current diagnostic methods and predictive models have limitations in differentiating benign from malignant lesions.
• Standard surgical approaches like simple or radical cholecystectomy risk either incomplete cancer removal or overtreatment.

Purpose of the Study:

• To evaluate the safety and efficacy of a risk-stratified laparoscopic approach for managing TWGB and GBP with suspected malignancy.
• To determine if a tailored surgical strategy can balance oncological safety with the avoidance of overtreatment.

Main Methods:

• A retrospective study of 39 patients with TWGB or GBP suspicious for malignancy.
• Patients were stratified into very low-risk and low-risk groups based on clinical, radiological, and intraoperative findings.
• Very low-risk patients underwent laparoscopic cystic plate cholecystectomy (LCPC); low-risk patients underwent laparoscopic anticipatory extended cholecystectomy (LAEC). Frozen section analysis guided further surgical decisions.

Main Results:

• Twenty-five patients underwent LAEC, ten underwent LCPC, and four had simple cholecystectomies.
• Eight patients (20.5%) were diagnosed with cancer via frozen section and proceeded to completion surgery.
• Mean operative time was 3.34 ± 1.77 hours, mean hospital stay was 3.66 ± 1.72 days, with Clavien-Dindo ≥3 morbidity in 10.2% of patients.

Conclusions:

• A risk-stratified laparoscopic approach, incorporating frozen section analysis, is a safe and effective strategy for managing TWGB and GBP with suspected cancer.
• This approach allows for tailored surgical intervention, optimizing oncological outcomes while minimizing overtreatment.