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Isetani et al. Laparoscopic surgery for gallbladder carcinoma

treatments for gallbladder carcinoma (GBC); [7-9] for suspected GBC from November 2011 to June
however, many studies of occult GBC revealed high 2015, 10 patients with GBTs suspected to be T1b/T2
incidences of port site recurrence and peritoneal GBC in the GB fundus/body underwent LLR and LN
dissemination after laparoscopic cholecystectomy. [10,11] dissection. The other patients underwent laparoscopic
The treatment of T1b/T2 GBC, which is not in the full-thickness cholecystectomy for suspected T1a GBC
[12]
early stage of intramucosal layer but without serosal or open surgery for suspected ≥ T3 GBC or possible
invasion, involves a combination of liver resection, bile duct resection based on preoperative assessment.
lymph node (LN) dissection, and bile duct resection and
reconstruction in cases of invasion. [13,14] Laparoscopic Three patients with T2 GBC underwent LLR of
procedures have been less commonly adapted to S4b+5+6a with regional LN dissection, and the other
GBC treatment mainly because of concerns regarding seven patients underwent LLR of the GB bed liver with
the aggressive features of the malignancy and the peri-cystic duct LN and peri-bile duct LN dissection.
technically demanding surgical procedure. [7-9] However, The patients’ data are shown in Table 1.
the liver resection technique performed for treatment
of T1b/T2 GBC involves resection of either the GB bed In total, 124 patients underwent LLR for liver tumors
or S4b+5+6a, both of which require resection of the (80 hepatocellular carcinomas, 35 metastatic tumors,
anterolateral segments. LN dissection has also been and 9 others). These 124 LLR procedures included
applied to other more popular procedures. Because 79 PRs, 11 LLSs, 25 anatomical resections (ARs)
[15]
bile duct resection and reconstruction is not necessary (resection of one or more segments, excluding LLS),
during surgical treatment of T1b/T2 GBC of the body/ and 9 small ARs (SARs) (resection of less than a full
fundus without cystic duct invasion, the operation is a segment and sometimes combined resection of those).
simple combination of anterolateral LLR and limited
LN dissection. Furthermore, tumor dissemination and The conversion, morbidity, and mortality rates were
port site recurrence are thought to occur mainly due compared between the GBT and various LLR groups.
to bile leakage from intraoperative GB perforation. [9,11] The perioperative short-term results [operation time
Theoretically, combined resection of the GB bed (OT), intraoperative blood loss (BL), and postoperative
liver could prevent these events. [10,11,16,17] Therefore, LOS] of the 10 patients with GBTs were compared with
we have employed a laparoscopic procedure for those of the patients who underwent various types of
treatment of GB tumors (GBTs) suspected to be T1b/ LLR (PR, LLS, AR, and SAR).
T2 GBC located in the GB body/fundus without cystic
duct invasion. Patients were fully involved in the treatment
decision-making process. Informed consent was
In this study, to determine whether laparoscopic obtained from each patient for both treatment and
treatment of T1b/T2 GBC is a feasible treatment use of data in the study. The data obtained through
option, we compared the short-term results of patients the medical record review were managed according
who underwent this procedure and those of patients to the privacy policy and ethics code of our institute.
who underwent various types of LLR. The surgeries were performed with the permission of
our hospital review board.
METHODS
Statistical analysis
Among 28 patients who underwent GB resection Results are expressed as median (range) and mean ±

Table 1: Characteristics of the 10 patients who underwent laparoscopic surgery for suspected T1b/T2 GBC
Gender Age Child-Pugh T-stage T-stage Ope Resection OT BL LOS Comp
(years) (clinical) (pathologic) margin (min) (mL) (days)
Female 57 A T1b Benign GB bed R0 248 50 10
Male 63 A T1b Benign GB bed R0 296 250 15
Female 72 A T1b T1b GB bed R0 340 150 105 Bile
leakage
Female 38 A T1b T1b GB bed R0 186 10 11
Male 82 A T1b T1b GB bed R0 201 50 17
Female 39 A T1b T1b GB bed R0 307 50 8
Female 63 A T1b T1b GB bed R0 197 75 10
Male 65 A T2 T2 S4b+5+6a R0 300 500 17
Male 69 A T2 T2 S4b+5+6a R0 442 200 34
Male 72 A T2 T2 S4b+5+6a R0 488 143 24
GBC: gallbladder carcinoma; LLR: laparoscopic liver resection; Ope: performed operation; OT: operation time; BL: intraoperative blood
loss; LOS: postoperative length of hospital stay; Comp: complication; GB bed: LLR of GB bed liver with peri-cystic lymph node and peri-bile
duct lymph node dissections; S4b+5+6a: LLR of S4b+5+6a with regional lymph node dissection
Hepatoma Research ¦ Volume 3 ¦ August 09, 2017 171