Piccolo Gaetano, Ratti Francesca, Cipriani Federica, Catena Marco, Paganelli Michele, Aldrighetti Luca
1 Department of Surgery, University of Catania, Catania, Italy.
2 Hepatobiliary Surgery Division, Ospedale San Raffaele, Milano, Italy.
J Laparoendosc Adv Surg Tech A. 2019 Jun;29(6):741-746. doi: 10.1089/lap.2019.0227. Epub 2019 May 10.
Primary laparoscopic approach for the treatment of cancers of the biliary tract is not popular in the surgical community. The aim of this study is to report the short-term data of patients who underwent total laparoscopic radical cholecystectomy for gallbladder cancer (GBC) at a single center of specialized hepatobiliary surgery. From November 2016 to January 2019, we routinely performed a laparoscopic approach for two groups of patients: (1) patients with primary GBC (diagnosed preoperatively) and (2) patients with incidental GBC (IGBC) discovered after cholecystectomy. Our retrospective study included 18 patients (7 primary GBCs, 11 IGBCs). Conversion rate from laparoscopy to laparotomy was 28.6% and 9.1%, respectively, for the two groups, but this difference was not statistically significant ( = .28). Only 3 patients had liver recurrence (27.3%) and 1 had liver invasion (14.3%). A more advanced T category and TNM stage were presented in the preoperative suspicion cases (T3-T4 18.2% versus 57.1%, = .06, stage IVA-B 9.1% versus 71.4%, = .017). Regional lymphadenectomy was performed in 15 patients, in 73.3% the total number of lymph nodes (total LNs) retrieved was more than 7 (7-12 LNs in 66.7% of patients and >12 LNs in 6.6% of patients). The mean postoperative long stay was 8 days excluding for cases who developed complication. Laparoscopy can be considered a safe treatment for IGBC or primary GBC. The T3 stage with only liver involvement was not a contraindication. The real reasons that lead to convert the laparoscopic procedure were due to oncological concerns, unrelated to the liver infiltration.
原发性腹腔镜手术治疗胆道癌在外科领域并不流行。本研究旨在报告在一家专业肝胆外科中心接受全腹腔镜根治性胆囊切除术治疗胆囊癌（GBC）患者的短期数据。2016年11月至2019年1月，我们对两组患者常规采用腹腔镜手术方法：（1）原发性GBC患者（术前诊断）和（2）胆囊切除术后发现的意外性GBC（IGBC）患者。我们的回顾性研究纳入了18例患者（7例原发性GBC，11例IGBC）。两组患者从腹腔镜手术转为开腹手术的比例分别为28.6%和9.1%，但这种差异无统计学意义（P = 0.28）。仅3例患者发生肝转移（27.3%），1例有肝侵犯（14.3%）。术前疑似病例中T分期和TNM分期更高（T3 - T4期：18.2%对57.1%，P = 0.06；IVA - B期：9.1%对71.4%，P = 0.017）。15例患者进行了区域淋巴结清扫，73.3%的患者获取的淋巴结总数（总LN）超过7个（66.7%的患者为7 - 12个LN，6.6%的患者>12个LN）。排除发生并发症的病例后，术后平均住院时间为8天。腹腔镜手术可被认为是治疗IGBC或原发性GBC的安全方法。仅伴有肝脏受累的T3期并非禁忌证。导致腹腔镜手术转为开腹手术的真正原因是出于肿瘤学方面的考虑，与肝脏浸润无关。
