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Laparoscopic segment 4b+5 liver resection for stage T3 gallbladder cancer

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Abstract

Background

There is still controversy over whether to perform laparoscopic surgery for T3 stage gallbladder cancer. In addition, the necessity of segment 4b+5 liver resection for stage T3 gallbladder has not been reported. This article aims to explore the safety, effectiveness, and short-term prognosis of laparoscopic segment 4b+5 liver resection for T3 stage gallbladder cancer.

Methods

This is a retrospective multicenter propensity score-matched study. Disease-free survival, perioperative complications, and intraoperative safety were analyzed to evaluate safety and effectiveness.

Results

There was no significant difference in the incidence of intraoperative bleeding, number of lymph nodes obtained, postoperative complications, or disease-free survival (DFS) between the open group (OG) and laparoscopic group (LG) (P > 0.05). The DFS time of the S4b+5 resection group (S4b5) was longer than that of the wedge group (P = 0.016). Cox regression showed that positive margins (HR, 5.32; 95% CI 1.03–27.63; P = 0.047), lymph node metastasis (HR, 2.70; 95% CI 1.31–5.53; P = 0.007), and liver S4b+5 resection (HR, 0.30; 95% CI 0.14–0.66; P = 0.003) were independent risk factors for DFS. The operative time of indocyanine green (ICG) fluorescence-guided liver S4b5 segment resection was shorter than that of traditional laparoscopic S4b+5 resection guided by hepatic veins (P ≤ 0.001).

Conclusion

Laparoscopic liver S4b+5 resection for T3 stage gallbladder cancer is safe and feasible and can prolong DFS. ICG fluorescence-guided negative staining may reduce the difficulty of the operation.

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Funding

This work was supported by Fujian Research and Training Grants for Young and Middle-aged Leaders in Healthcare.

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Authors and Affiliations

  1. Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, No. 134 East Street, Fuzhou, 350001, China

    Long Huang, Chenjun Zhang, Yifeng Tian, Chengyu Liao, Maolin Yan, Funan Qiu, Songqiang Zhou, Zhide Lai, Yaodong Wang & Shi Chen

  2. Department of Hepatobiliary and pancreatic Surgery, Fujian Provincial Hospital, Fujian Medical University, No. 134 East Street, Fuzhou, 350001, China

    Long Huang, Chenjun Zhang, Yifeng Tian, Chengyu Liao, Maolin Yan, Funan Qiu, Songqiang Zhou, Zhide Lai, Yaodong Wang & Shi Chen

  3. Department of General Surgery, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, China

    Ye Lin

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  1. Long Huang
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Correspondence to Ye Lin or Shi Chen.

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Disclosures

Drs. Long Huang, Chenjun Zhang, Yifeng Tian, Chengyu Liao, Maolin Yan, MD, Funan Qiu, Songqiang Zhou, Zhide Lai, Yaodong Wang, Ye Lin, and Shi Chen have no conflicts of interest or financial ties to disclose. Long Huang, Chenjun Zhang and Yifeng Tian contributed equally to this work and should be considered first authors. Shi Chen and Ye Lin also contributed equally, and both should be considered co-corresponding authors. The authors have no conflicts of interest.

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Huang, L., Zhang, C., Tian, Y. et al. Laparoscopic segment 4b+5 liver resection for stage T3 gallbladder cancer. Surg Endosc 36, 8893–8907 (2022). https://doi.org/10.1007/s00464-022-09325-4

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  • DOI: https://doi.org/10.1007/s00464-022-09325-4

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