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Novel strategy for laparoscopic treatment of pT2 gallbladder carcinoma

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Abstract

Background

This study evaluated our new strategy for treating suspected T2 gallbladder carcinoma (GBC) using a laparoscopic approach.

Methods

We examined 19 patients with suspected T2 GBC who were treated laparoscopically (LS group) between December 2007 and December 2013; these patients were compared with 14 patients who underwent open surgery (OS group). Laparoscopic staging was initially performed to exclude factors making the patients ineligible for curative resection. Intraoperative pathological examination of the surgical margin of the cystic duct was performed prior to laparoscopic gallbladder bed resection, and pathological examination was again performed to confirm the presence of carcinoma and the depth of tumor invasion. Surgery was completed when the pathological findings indicated that the patient was cancer free. Lymph node dissection was performed according to the depth of tumor invasion.

Results

None of the patients required conversion to laparotomy. For three patients with benign lesions, only gallbladder bed resection was required. Additional regional lymph node dissection was performed in 16 patients in the LS group. The mean operative time (309 vs. 324 min, p = 0.755) and mean number of dissected lymph nodes (12.6 vs. 10.2, p = 0.361) were not significantly different between the LS and OS groups. The intraoperative blood loss was significantly lower (104 vs. 584 mL, p = 0.002) and the postoperative hospital stay was significantly shorter (9.1 vs. 21.6 days, p = 0.002) for LS patients than for those in the OS group. In the LS group, one patient developed postoperative pneumonia, but all patients survived without recurrence after a mean follow-up of 37 months.

Conclusion

Our strategy for suspected T2 gallbladder GBC is safe and useful, avoids unnecessary procedures, and is associated with similar oncologic outcomes as the open method.

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Disclosures

Drs. Osamu Itano, Go Oshima, Takuya Minagawa, Masahiro Shinoda, Minoru Kitago, Yuta Abe, Taizo Hibi, Hiroshi Yagi, Naruhiko Ikoma, Satoshi Aiko, Miho Kawaida, Yohei Masugi, Kaori Kameyama, Professor Michiie Sakamoto, and Professor Yuko Kitagawa have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Osamu Itano, Takuya Minagawa, Masahiro Shinoda, Minoru Kitago, Yuta Abe, Taizo Hibi, Hiroshi Yagi & Yuko Kitagawa

  2. Department of Surgery, Eiju General Hospital, Tokyo, Japan

    Go Oshima, Naruhiko Ikoma & Satoshi Aiko

  3. Department of Pathology, School of Medicine, Keio University, Tokyo, Japan

    Miho Kawaida, Yohei Masugi & Michiie Sakamoto

  4. Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan

    Kaori Kameyama

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  1. Osamu Itano
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  2. Go Oshima
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Correspondence to Osamu Itano.

Electronic supplementary material

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464_2015_4116_MOESM1_ESM.tiff

Supplementary table. Pathological findings of patients undergoing gallbladder bed resection and lymphadenectomy using the laparoscopic (LS) and open approaches (OS). (TIFF 2483 kb)

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Itano, O., Oshima, G., Minagawa, T. et al. Novel strategy for laparoscopic treatment of pT2 gallbladder carcinoma. Surg Endosc 29, 3600–3607 (2015). https://doi.org/10.1007/s00464-015-4116-y

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  • DOI: https://doi.org/10.1007/s00464-015-4116-y

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