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Laparoscopic versus open oncological extended re-resection for incidental gallbladder adenocarcinoma: we can do more than T1/2

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Abstract

Background

The laparoscopic and open approaches have comparable safety and oncological efficacy to treat early (T1b or T2) stage incidental gallbladder cancer (IGBC). However, their effects on T3 stage or above tumors unclear.

Methods

Data of IGBC patients who underwent radical re-resection were retrospectively analyzed. Demographic characteristics, surgical variables, and tumor characteristics were evaluated for association with survival.

Results

We analyzed retrospectively 201 patients (72 men, 129 women; median age 63 years; range, 36–85 years). 84 underwent laparoscopic re-resection and 117 underwent open surgery. The 5-year OS post-resection was 74.7%, with a median survival of 74.52 months. The median OS (73.92 months vs. 77.04 months, P = 0.67), and disease-free survival (72.60 months vs. 71.09 months, P = 0.18) were comparable between the laparoscopic re-resection and open surgery groups. The survival of patients with T1/T2 (median: 85.50 months vs. 80.14 months; P = 0.67) and T3 (median: 68.56 months vs. 58.85 months; P = 0.36) disease were comparable between the open re-resection and laparoscopic re-resection groups even after PS matching. Open surgery group lost significantly more blood, while laparoscopic surgery took longer. The postsurgical stay in the laparoscopic re-resection group was significantly shorter. Combined extrahepatic bile duct resection, gallbladder perforation, pT, pStage, histological grade, microscopic liver invasion, status of the resected margin, and adjuvant therapy comprised significant independent prognostic indicators for IGBC.

Conclusions

Laparoscopic and open surgery can achieve similar short and long-term outcomes for T3 IGBC; however, careful surgical manipulation is necessary to avoid secondary injuries.

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Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to institutional policy but are available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Elixigen (www.elixigen.com.cn) for English language editing.

Funding

This work was supported by the Young Scientists Fund of National Natural Science Foundation of China (82203650), Sichuan Science and Technology Program (2021YJ0132), Science and Technology Bureau of Sichuan Province (2020YFS0099), Natural Science Foundation of Sichuan Province (2022NSFSC0806), 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYJC18014, ZYJC21046), 1.3.5 project for disciplines of excellence-Clinical Research Incubation Project, West China Hospital, Sichuan University (2021HXFH001), and Sichuan University-Zigong School-local Cooperation project (2021CDZG-23).

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Authors and Affiliations

  1. Department of Biliary Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People’s Republic of China

    Yan-Wen Jin, Wen-Jie Ma, Fu-Yu Li & Nan-sheng Cheng

  2. Department of Biliary Disease Research Center, West China Hospital of Sichuan University, Chengdu, China

    Yan-Wen Jin, Wen-Jie Ma, Fu-Yu Li & Nan-sheng Cheng

  3. Health Management Center, West China Hospital, Sichuan University, Chengdu, China

    Wei Gao

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Contributions

Y-WJ and W-JM contributed equally to the study. Y-WJ and W-JM performed the majority of manuscript. WG provided the collection of all the material and were also involved in editing the manuscript. N-SC and F-YL revised the manuscript critically and gave the final approval of the version to be published.

Corresponding authors

Correspondence to Fu-Yu Li or Nan-sheng Cheng.

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Disclosures

Yan-Wen Jin, Wen-Jie Ma, Wei Gao, Fu-Yu Li, Nan-Sheng Cheng have no conflicts of interest or financial ties to disclose.

Ethical approval

This study was performed in accordance with the Declaration of Helsinki, and it complied with the study protocol and the Ethical Guidelines for Medical and Health Research Involving Human Subjects. This study was approved by the institutional review committee of West China Hospital, Sichuan University (approval code 2021–445). The protocol summary was described on the hospital website.

Informed consent

Since this was a retrospective study, the requirement for informed consent was waived by ethics committee of West China Hospital, Sichuan University.

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All authors have read and approved this manuscript. All authors consent to the publication of this article.

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Supplementary file1 (DOCX 27 kb)

464_2022_9839_MOESM2_ESM.eps

Supplementary file2 (EPS 170 kb) Related to Figure 4. Overall survival for sixty-three T2 and thirty-six T3 patients with IGBC treated with laparoscopic and open approaches after PS matching.

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Jin, YW., Ma, WJ., Gao, W. et al. Laparoscopic versus open oncological extended re-resection for incidental gallbladder adenocarcinoma: we can do more than T1/2. Surg Endosc 37, 3642–3656 (2023). https://doi.org/10.1007/s00464-022-09839-x

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