Piccolo Gaetano, Piozzi Guglielmo Niccolò
Department of Surgery, University of Catania, Via S. Sofia 78, 95123 Catania, Italy.
Department of Surgery, Università Degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy.
Gastroenterol Res Pract. 2017;2017:8570502. doi: 10.1155/2017/8570502. Epub 2017 Jun 11.
To evaluate the technical feasibility and oncologic safety of laparoscopic radical cholecystectomy (LRC) for primary or incidental early gallbladder cancer (GBC) treatment.
Articles reporting LRC for GBC were reviewed from the first case reported in 2010 to 2015 (129 patients). 116 patients had a preoperative diagnosis of gallbladder cancer (primary GBC). 13 patients were incidental cases (IGBC) discovered during or after a laparoscopic cholecystectomy.
The majority of patients who underwent LRC were pT2 (62.7% GBC and 63.6% IGBC). Parenchyma-sparing operation with wedge resection of the gallbladder bed or resection of segments IVb-V were performed principally. Laparoscopic lymphadenectomy was carried out according to the reported depth of neoplasm invasion. Lymph node retrieved ranged from 3 to 21. Some authors performed routine sampling biopsy of the inter-aorto-caval lymph nodes (16b1 station) before the radical treatment. No postoperative mortality was documented. Discharge mean day was POD 5th. 16 patients had post operative morbidities. Bile leakage was the most frequent post-operative complication. 5 y-survival rate ranged from 68.75 to 90.7 months.
Laparoscopy can not be considered as a dogmatic contraindication to GBC but a primary approach for early case (pT1b and pT2) treatment.
评估腹腔镜根治性胆囊切除术（LRC）治疗原发性或意外早期胆囊癌（GBC）的技术可行性和肿瘤学安全性。
回顾2010年首例报道至2015年期间报道的LRC治疗GBC的文章（129例患者）。116例患者术前诊断为胆囊癌（原发性GBC）。13例为腹腔镜胆囊切除术期间或术后发现的意外病例（IGBC）。
接受LRC的大多数患者为pT2期（原发性GBC占62.7%，IGBC占63.6%）。主要采用保留实质的手术，即楔形切除胆囊床或切除IVb-V段。根据报道的肿瘤浸润深度进行腹腔镜淋巴结清扫。获取的淋巴结数量为3至21个。一些作者在根治性治疗前对主动脉腔间淋巴结（16b1站）进行常规抽样活检。无术后死亡记录。平均出院日为术后第5天。16例患者有术后并发症。胆漏是最常见的术后并发症。5年生存率为68.75至90.7个月。
腹腔镜检查不能被视为GBC的绝对禁忌证，而是早期病例（pT1b和pT2）治疗的主要方法。
