Cao Jiasheng, Wang Yong, Zhang Bin, Hu Jiahao, Topatana Win, Li Shijie, Juengpanich Sarun, Lu Ziyi, Cai Xiujun, Chen Mingyu
Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China.
Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China.
Front Oncol. 2021 Oct 28;11:758319. doi: 10.3389/fonc.2021.758319. eCollection 2021.
The primary laparoscopic approach (PLA) for T1b/T2 gallbladder cancer (GBC) remains contradicted. We aimed to compare the perioperative and long-term outcomes after PLA versus open approach (OA) for T1b/T2 GBC.
Patients with resected T1b/T2 GBC were selected from our hospital between January 2011 and August 2018. Overall survival (OS), disease-free survival (DFS), and several secondary outcomes were used to evaluate safety and effectiveness. Subgroup analyses were performed to identify significant risk factors for OS/DFS in GBC patients undergoing PLA/OA.
A total of 114 patients who underwent OA (n = 61) or PLA (n = 53) were included in the study. The percent of PLA cases was increased over time from 40.0% in 2011 to 70.0% in 2018 ( < 0.05). There was no significant difference in OS [hazard ratio (HR), 1.572; 95% confidence interval (CI), 0.866-2.855; = 0.13] and DFS (HR, 1.225; 95% CI, 0.677-2.218; = 0.49). No significance was found for intraoperative drainage placement ( = 0.253), intraoperative blood loss ( = 0.497), operation time ( = 0.105), postoperative hospitalization ( = 0.797), positive LNs ( = 0.494), total harvested LNs ( = 0.067), and recurrence rates ( = 0.334). Subgroup analyses demonstrated no significance of conversion rates after PLA (all > 0.05). Patients undergoing PLA with good/poor OS would have similar recurrence rates ( = 0.402). Positive LNs ( = 0.032) and tumor differentiation ( = 0.048) were identified as risk factors for OS after PLA, while positive LNs ( = 0.005) was identified for OS after OA. Moreover, age ( = 0.013), gallbladder stone ( = 0.008), tumor size ( = 0.028), and positive LNs ( = 0.044) were potential risk factors for DFS after OA.
PLA for T1b/T2 GBC was comparable to OA in terms of perioperative and long-term outcomes. Less positive LNs and well-differentiated tumors were independent predictors for better OS after PLA, and less positive LNs were also identified for better OS after OA. Additionally, younger age, without gallbladder stone, smaller tumor size, and less positive LNs were potential risk factors for better DFS after OA.
T1b/T2期胆囊癌（GBC）的主要腹腔镜手术方式（PLA）仍存在争议。我们旨在比较PLA与开放手术（OA）治疗T1b/T2期GBC的围手术期和长期结局。
选取2011年1月至2018年8月我院行T1b/T2期GBC切除术的患者。采用总生存期（OS）、无病生存期（DFS）及其他几个次要结局指标评估安全性和有效性。进行亚组分析以确定接受PLA/OA的GBC患者OS/DFS的显著危险因素。
本研究共纳入114例行OA（n = 61）或PLA（n = 53）的患者。PLA病例的比例随时间从2011年的40.0%增至2018年的70.0%（P < 0.05）。OS[风险比（HR），1.572；95%置信区间（CI），0.866 - 2.855；P = 0.13]和DFS（HR，1.225；95%CI，0.677 - 2.218；P = 0.49）无显著差异。术中引流管放置（P = 0.253）、术中失血量（P = 0.497）、手术时间（P = 0.105）、术后住院时间（P = 0.797）、阳性淋巴结（P = 0.494）、总切除淋巴结数（P = 0.067）和复发率（P = 0.334）均无显著差异。亚组分析显示PLA术后的中转率无显著差异（均P > 0.05）。OS良好/较差的接受PLA治疗的患者复发率相似（P = 0.402）。阳性淋巴结（P = 0.032）和肿瘤分化程度（P = 0.048）被确定为PLA术后OS的危险因素，而阳性淋巴结（P = 0.005）被确定为OA术后OS的危险因素。此外，年龄（P = 0.013）、胆囊结石（P = 0.008）、肿瘤大小（P = 0.028）和阳性淋巴结（P = 0.044）是OA术后DFS的潜在危险因素。
PLA治疗T1b/T2期GBC在围手术期和长期结局方面与OA相当。较少的阳性淋巴结和高分化肿瘤是PLA术后OS更好的独立预测因素，较少的阳性淋巴结也是OA术后OS更好的预测因素。此外，年龄较小、无胆囊结石、肿瘤较小和阳性淋巴结较少是OA术后DFS更好的潜在危险因素。
