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Isetani et al. Laparoscopic surgery for gallbladder carcinoma

or GB bed with limited LN dissection and no bile to patients with proven T2 GBC in our institute.
duct resection for treatment of GBC is thought to
have similar advantages, although such a procedure Itano et al. reported that the disease-free and
[8]
also has potential disadvantages (risk of tumor cell overall survival rates of patients with T2 GBC tended
dissemination and port site recurrence). [11] to be superior, although not significantly so, among
patients who underwent laparoscopic than open
Liver resection for treatment of T1b/T2 GBC involves surgery. However, they also mentioned that this
PR of the anterolateral segments, where laparoscopic observation may have been due to selection bias
approaches are easily applied, [4,5] and the techniques because their study was a semi-historical control
for LN dissection have also been applied in other study (the period for the laparoscopic group was
established procedures. [15,18] Although dissection of the from December 2007 to December 2013, and that for
posterosuperior pancreatic and peri-splenic vein LNs the control open group was from June 2003 to May
is difficult, this dissection can reportedly be easier with 2011), and patients with more advanced disease
the Kocher maneuver. [8,9] However, bile duct resection might have been selected for the open surgery
and reconstruction is still a demanding technique group before the advent of precise endoscopic
with limited reports. [9,16,19,20] It is often required for bile ultrasonography examination. They still concluded
duct invasion by the tumor in patients with T3 GBC that the laparoscopic approach for suspected T2
or GBC in the neck. Therefore, in the present series, GBC was at least comparable with open surgery in
only patients with GBTs suspected to be T1b/T2 GBC terms of both the surgical and oncological outcomes.
in the body/fundus were selected for laparoscopic
surgeries with intraoperative pathological examination The sample size of the present study was too
for confirmation of negative cystic duct tumor small to perform a definitive statistical analysis of
invasion. No cases of mismatch of the intraoperative the short-term outcomes, and concerns regarding
and postoperative pathological results of cystic duct tumor dissemination and port site recurrence are
tumor invasion were encountered. Furthermore, an still valid when performing laparoscopic procedures
accurate preoperative diagnosis of the tumor depth with restricted manipulation and instruments. Further
(T stages 1a, 1b, 2, and 3 [12] ) is needed for application studies of laparoscopic surgery for GBC are needed.
of this technique. Itano et al. reported that precise Nevertheless, this technique could be a good
[8]
preoperative endoscopic ultrasonography led to treatment option for GBTs suspected to be T1b/T2
no underestimation of the preoperative diagnosis GBC in the GB body/fundus without invasion of the
regarding tumor invasion into the muscular or cystic duct.
subserosal layer in their patients with T1/T2 cancer.
We also attempted to avoid underestimation, which DECLARATIONS
leads to the need for a second operation and/or
carcinoma recurrence, rather than overestimation in Authors’ contributions
our series. We observed no cases of underestimation; Performed the treatments and wrote this manuscript:
however, 2 patients had benign (overestimated) M. Isetani
lesions, including 1 xanthogranuloma. Overestimation Planned and performed the treatments: Z. Morise
and overapplication of this procedure for benign or Supervised planning and writing this manuscript: Z.
Tis/T1a GBC is also a potential problem. However, Morise, A. Horiguchi
the drawbacks of laparoscopic cholecystectomy for
Tis/T1a GBC include the risk of GB wall perforation Acknowledgments
and bile leakage contaminated with tumor cells, We thank Angela Morben, DVM, ELS, from Edanz
which may lead to port site recurrence and peritoneal Group (www.edanzediting.com/ac) for editing a draft of
dissemination. [21] These risks could be overcome by this manuscript.
combined GB bed resection. Given the fact that this
procedure was performed with short-term outcomes Financial support and sponsorship
comparable with those of laparoscopic LLS or PR, None.
overestimation and overapplication of this procedure
might be justified. However, LLR of S4b+5+6a with Conflicts of interest
regional LN dissection, which we applied to the There are no conflicts of interest.
patients with T2 GBC, is a more complicated and
demanding procedure and was associated with a Patient consent
longer OT and larger BL volume comparable with AR. Patients were fully involved in the treatment decision-
The application of this procedure is currently limited making process. Informed consent was obtained
176 Hepatoma Research ¦ Volume 3 ¦ August 09, 2017