Zimmitti Giuseppe, Manzoni Alberto, Guerini Francesca, Ramera Marco, Bertocchi Paola, Aroldi Francesca, Zaniboni Alberto, Rosso Edoardo
Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Via Bissolati n 57, Brescia, Italy.
Department of Oncology, Istituto Ospedaliero Fondazione Poliambulanza, Via Bissolati n 57, Brescia, Italy.
Gastroenterol Res Pract. 2016;2016:7684915. doi: 10.1155/2016/7684915. Epub 2016 Nov 3.
. For Tis and T1a gallbladder cancer (GbC), laparoscopic cholecystectomy can provide similar survival outcomes compared to open cholecystectomy. However, for patients affected by resectable T1b or more advanced GbC, open approach radical cholecystectomy (RC), consisting in gallbladder liver bed resection or segment 4b-5 bisegmentectomy, with locoregional lymphadenectomy, is considered the gold standard while minimally invasive RC (MiRC) is skeptically considered. . To analyze current literature on perioperative and oncologic outcomes of MiRC for patients affected by GbC. . A Medline review of published articles until June 2016 concerning MiRC for GbC was performed. . Data relevant for this review were presented in 13 articles, including 152 patients undergoing an attempt of MiRC for GbC. No randomized clinical trial was found. The approach was laparoscopic in 147 patients and robotic in five. Conversion was required in 15 (10%) patients. Postoperative complications rate was 10% with no mortality. Long-term survival outcomes were reported by 11 studies, two of them showing similar oncologic results when comparing MiRC with matched open RC. . Although randomized clinical trials are still lacking and only descriptive studies reporting on limited number of patients are available, current literature seems suggesting that when performed at highly specialized centers, MiRC for GbC is safe and feasible and has oncologic outcomes comparable to open RC.
对于Tis和T1a期胆囊癌(GbC),与开腹胆囊切除术相比,腹腔镜胆囊切除术可提供相似的生存结果。然而,对于可切除的T1b期或更晚期GbC患者,开腹根治性胆囊切除术(RC),包括胆囊肝床切除术或4b-5段双段切除术,并进行局部区域淋巴结清扫,被认为是金标准,而微创RC(MiRC)则受到怀疑。分析目前关于MiRC治疗GbC患者围手术期和肿瘤学结果的文献。对截至2016年6月发表的有关MiRC治疗GbC的文章进行了Medline综述。本综述相关数据在13篇文章中呈现,包括152例尝试进行MiRC治疗GbC的患者。未发现随机临床试验。147例患者采用腹腔镜手术,5例采用机器人手术。15例(10%)患者需要中转手术。术后并发症发生率为10%,无死亡病例。11项研究报告了长期生存结果,其中两项研究显示,将MiRC与匹配的开腹RC进行比较时,肿瘤学结果相似。虽然仍然缺乏随机临床试验,且仅有报告有限数量患者的描述性研究,但目前的文献似乎表明,在高度专业化的中心进行时,MiRC治疗GbC是安全可行的,且肿瘤学结果与开腹RC相当。