Zeng Gerald, Teo Nan Zun, Goh Brian K P
Department of Hepatopancreatobiliary and Transplant Surgery, Duke-Nus Medical School, Singapore General Hospital, Singapore.
J Minim Access Surg. 2019 Apr-Jun;15(2):109-114. doi: 10.4103/jmas.JMAS_229_17.
Minimally invasive surgery (MIS) for gallbladder cancer (GBCa) has traditionally been discouraged, with limited studies reporting on its outcomes. The aim of this study was to evaluate the short-term outcomes of MIS for patients with GBCa or suspected GBCa.
A retrospective study of 8 consecutive patients who underwent MIS for GBCa by a single surgeon over a 22-month period between 2015 and 2017.
Three patients underwent robotic surgery, while five underwent conventional laparoscopic surgery. Four patients presented with histologically proven GbCa detected incidentally after cholecystectomy. All 4 patients underwent resection of Segment 4b/5. Of these, 3 underwent hilar lymphadenectomy and 1 underwent hilar lymph node sampling. Four patients presenting with suspected GBCa underwent upfront extended cholecystectomy. Two patients who had malignancy on frozen section underwent hilar lymphadenectomy. The median operation time was 242.5 (range, 165-530) min, and the median blood loss was 175 (range, 50-700) ml. The median post-operative hospital stay was 3.5 (range, 2-8) days. There were no open conversion, post-operative morbidities and mortalities. Six had histologically proven GBCa. Five were T3 and one had T2 cancers.
The results of the present study confirm the short-term safety and feasibility of MIS for patients with GBCa, as all eight patients underwent successful MIS with no major morbidity or mortality. Further studies with larger patient cohorts with long-term follow-up are needed to determine the oncologic outcomes and the definitive role of MIS in treating GBCa.
传统上不鼓励对胆囊癌(GBCa)进行微创手术(MIS),关于其结果的研究有限。本研究的目的是评估MIS治疗GBCa或疑似GBCa患者的短期结果。
对2015年至2017年期间一名外科医生在22个月内连续为8例GBCa患者实施MIS的情况进行回顾性研究。
3例患者接受了机器人手术,5例接受了传统腹腔镜手术。4例患者在胆囊切除术后经组织学证实为偶然发现的GBCa。所有4例患者均接受了4b/5段切除。其中,3例接受了肝门淋巴结清扫,1例接受了肝门淋巴结采样。4例疑似GBCa患者接受了前期扩大胆囊切除术。2例冷冻切片显示为恶性肿瘤的患者接受了肝门淋巴结清扫。中位手术时间为242.5(范围165 - 530)分钟,中位失血量为175(范围50 - 700)毫升。中位术后住院时间为3.5(范围2 - 8)天。无中转开腹、术后并发症及死亡病例。6例经组织学证实为GBCa。5例为T3期,1例为T2期癌症。
本研究结果证实了MIS治疗GBCa患者的短期安全性和可行性,因为所有8例患者均成功接受了MIS,无严重并发症或死亡。需要对更大患者队列进行长期随访的进一步研究,以确定肿瘤学结果以及MIS在治疗GBCa中的明确作用。