Park Yeshong, Choi Sae Byeol, Lee Boram, Han Ho-Seong, Jeong Chi-Young, Kang Chang Moo, Hwang Dae Wook, Kim Wan-Joon, Yoon Yoo-Seok
From the Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Korea (Park, Lee, Han).
Department of Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea (Choi).
J Am Coll Surg. 2025 Mar 1;240(3):235-244. doi: 10.1097/XCS.0000000000001252. Epub 2025 Feb 14.
Although T2 gallbladder cancer (GBC) incidentally diagnosed after cholecystectomy requires additional resection, the surgical approaches are technically difficult due to inflammatory adhesion or fibrosis around the hepatoduodenal ligament and gallbladder bed. In this study, we sought to compare the surgical and oncologic outcomes of open and minimally invasive reoperation for postoperatively diagnosed T2 GBC.
Patients who underwent open (110) and laparoscopic (38) reoperation for T2 GBC between November 2004 and October 2022 at 5 tertiary referral centers were included in this multicenter retrospective cohort study. The short- and long-term outcomes were compared between the 2 groups.
There were no differences in clinicopathologic characteristics between the open and laparoscopic groups. Liver resection was more frequent in the open group (101 [91.8%] vs 21 [55.3%], p < 0.001). Compared with open operation, laparoscopic reoperation was associated with shorter postoperative hospital stay (9.0 [8.0 to 10.0] vs 6.0 [3.8 to 8.3] days, p < 0.001) and a lower postoperative complication rate (24 [21.8%] vs 1 [2.6%], p = 0.013). Among patients who underwent liver resection, the postoperative hospital stay was shorter in the laparoscopic group (9.0 [8.0 to 10.0] vs 6.0 [4.0 to 9.0] days, p = 0.004). The 5-year disease-free survival (66.7% vs 76.1%, p = 0.749) and overall survival (75.2% vs 73.7%, p = 0.789) rates were not significantly different between the 2 groups.
The results indicate that laparoscopic reoperation for postoperatively diagnosed T2 GBC has favorable postoperative outcomes and similar oncologic safety compared with open operation.
尽管胆囊切除术后偶然诊断出的T2期胆囊癌（GBC）需要进一步切除，但由于肝十二指肠韧带和胆囊床周围的炎症粘连或纤维化，手术入路在技术上具有挑战性。在本研究中，我们旨在比较开放性和微创性再次手术治疗术后诊断为T2期GBC的手术和肿瘤学结局。
本多中心回顾性队列研究纳入了2004年11月至2022年10月期间在5家三级转诊中心接受T2期GBC开放性再次手术（110例）和腹腔镜再次手术（38例）的患者。比较两组的短期和长期结局。
开放性手术组和腹腔镜手术组的临床病理特征无差异。开放性手术组肝切除更为常见（101例[91.8%] vs 21例[55.3%]，p < 0.001）。与开放性手术相比，腹腔镜再次手术的术后住院时间更短（9.0[8.0至10.0]天 vs 6.0[3.8至8.3]天，p < 0.001），术后并发症发生率更低（24例[21.8%] vs 1例[2.6%]，p = 0.013）。在接受肝切除的患者中，腹腔镜手术组的术后住院时间更短（9.0[8.0至10.0]天 vs 6.0[4.0至9.0]天，p = 0.004）。两组的5年无病生存率（66.7% vs 76.1%，p = 0.749）和总生存率（75.2% vs 73.7%，p = 0.789）无显著差异。
结果表明，与开放性手术相比，腹腔镜再次手术治疗术后诊断为T2期GBC具有良好的术后结局和相似的肿瘤学安全性。
