Page 56 - Read Online

Page 4 of 10 Lee et al. Mini-invasive Surg 2021;5:57 https://dx.doi.org/10.20517/2574-1225.2021.139

Additionally, when dividing small vessels, we prefer using a vessel sealing energy device rather than
applying hemoclips. This technique shortens the operation time and can provide a cleaner operative field.

LONG-TERM OUTCOMES
In 2015, we published our long-term outcomes after laparoscopic approach for early GBC . During a ten-
[8]
year period, 83 patients with suspected early GBC were enrolled in our prospective laparoscopic surgery
protocol. Among these 83 patients, 45 patients had a pathologic diagnosis of GBC. The pathologic
characteristics of the 45 patients are shown in Table 1. After a median follow-up period of 60 months for 45
patients, the overall survival rate was 90.7%, and the disease-specific 5-year survival rate was 94.2%
[Figure 3]. There were no cases with local recurrence at the lymphadenectomy site or the gallbladder bed.
From these results, we concluded that MIS for GBC is an oncologically safe operation.

After accumulating 13 years of experience of laparoscopic extended cholecystectomy, we analyzed the
[9]
oncologic outcomes of open vs. laparoscopic surgery for T2 GBC . During the period of 2004 to 2017, 247
patients with GBC were treated were at our hospital. Among these patients, 151 patients had T2 cancer.
After exclusion, a total of 99 patients were analyzed. The types of operations performed on the open surgery
(OS) group and the laparoscopic surgery (LS) group are shown in Table 2. The OS group had more liver
wedge resections than the LS group. The overall survival rates of the two groups are shown in Figure 4;
there was no statistical difference between the two groups in overall survival rate. The entire group was
subdivided into T2N0 group and T2N1 group to compare the overall survival according to nodal status.
There was no significant difference between the OS group and LS group, in both the T2N0 subgroup and
T2N1 subgroup. This outcomes show that laparoscopic surgery is compatible with open surgery even in T2
stage GBC.

For more advanced lesions, such as more than T3, further comparative studies are necessary to evaluate the
oncologic safety of the laparoscopic approach.

LAPAROSCOPIC SURGERY FOR GALLBLADDER CANCER: AN EXPERT CONSENSUS
STATEMENT
Despite these encouraging results, and an increasing number of reports on the feasibility of the laparoscopic
approach for the treatment of GBC, there was no consensus among experts. In September 10th, 2016, a
consensus meeting was held in Seoul, Korea, and the expert consensus statement on laparoscopic surgery
[10]
for GBC was established . Specific issues of this procedure were discussed among experts, such as concerns
regarding laparoscopic surgery for GBC, application of laparoscopic surgery for GBC, laparoscopic
extended cholecystectomy for GBC, and laparoscopic reoperation for postoperatively diagnosed GBC. The
experts concluded that laparoscopic surgery does not worsen the prognosis of patients with early stage GBC,
and that the postoperative and survival outcomes of highly selected patients were favorable.

Before this meeting was held, an international survey was undertaken of expert surgeons in the field of GBC
surgery, and the results were published along with a review of the literature on the outcomes of laparoscopic
[11]
surgery for GBC . The majority of surgeons agreed that laparoscopic surgery has an acceptable role for
suspicious or early GBC, and that laparoscopic extended cholecystectomy has a value comparable to that of
open surgery in selected patients with GBC. But the selection criteria for laparoscopic surgery for overt
GBC, and the detailed techniques varied among surgeons.