Castro César Muñoz, Santibañez Sergio Pacheco, Rivas Tomás Contreras, Cassis Nicolás Jarufe
Digestive Surgery, Hospital Regional de Talca, 1 North #1951, Talca, Chile.
Medicine School, Universidad Católica del Maule, Talca, Chile.
World J Surg. 2018 Aug;42(8):2592-2598. doi: 10.1007/s00268-018-4490-4.
Gallbladder cancer (GBC) is a rare tumor in developed countries. Chile has one of the highest incidences worldwide. For patients affected by resectable T1b or more advanced GBC, radical cholecystectomy (RC) is considered the standard therapy. Our aim is to describe the surgical technique and clinical-pathological results of patients undergoing totally laparoscopic radical resection of GBC.
Patients undergo laparoscopic radical resection for primary and incidental GBC, between the years 2009 and 2016 in two centers from Chile. Patients in whom suspected bile duct invasion, frozen biopsy did not confirm cancer and para-aortic lymph node sampling was positive were excluded.
Eighteen patients were operated, 77.8% were female with median age of 60.5 year, and 16 patients had previous cholecystectomy with incidental cancer finding. The median operative time was 490 min (400-550). No conversion to open surgery occurred. All patients achieved a R0 resection. Postoperative complications occurred in 2 patients (11.1%), and there was not mortality. After a median follow-up of 59 months, the 5-year survival was 80.7%.
This study shows the technical feasibility of the totally laparoscopic approach for radical resection of GBC with the same principles of classical open surgery. It appears that long-term oncological findings would also be similar at least in less advanced lesions.
胆囊癌（GBC）在发达国家是一种罕见肿瘤。智利是全球发病率最高的国家之一。对于可切除的T1b期或更晚期GBC患者，根治性胆囊切除术（RC）被视为标准治疗方法。我们的目的是描述接受完全腹腔镜下GBC根治性切除术患者的手术技术和临床病理结果。
2009年至2016年期间，来自智利两个中心的患者接受了原发性和偶然性GBC的腹腔镜根治性切除术。排除疑似胆管侵犯、冰冻活检未确诊癌症且主动脉旁淋巴结取样阳性的患者。
18例患者接受了手术，77.8%为女性，中位年龄60.5岁，16例患者既往有胆囊切除术且偶然发现癌症。中位手术时间为490分钟（400 - 550分钟）。未发生转为开放手术的情况。所有患者均实现R0切除。2例患者（11.1%）发生术后并发症，无死亡病例。中位随访59个月后，5年生存率为80.7%。
本研究表明，完全腹腔镜下GBC根治性切除术具有技术可行性，其遵循与传统开放手术相同的原则。至少在病情不太严重的病变中，长期肿瘤学结果似乎也相似。
