Role of laparoscopic surgery in the management of gallbladder cancer: Systematic review &amp; meta-analysis

Ahmed, Syeda Hoorulain; Usmani, Shajie Ur Rehman; Mushtaq, Rabeea; Samad, Saba; Abid, Minaam; Moeed, Abdul; Atif, Abdul Raafe; Farhan, Syed Ali; Saif, Areeba

doi:10.1016/j.amjsurg.2023.01.008

Cited by 3 publications

(1 citation statement)

References 47 publications

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“…According to applicable guidelines of the National Comprehensive Cancer Network, the European Society of Medical Oncology, the Japanese Society of Hepato-Biliary-Pancreatic Surgery, and the Chinese Surgical Society and Chinese Committee of Biliary Surgeons, open surgery is recommended as a rule and laparoscopic surgery only in selected cases and for research purposes[ 115 - 118 ]. This recommendation has been based on the fears and reservations regarding intraperitoneal cancer cell dissemination in cases of GB perforation and bile spillage, as well as the doubtful achievement of laparoscopic radicality and adequate lymphadenectomy mainly around the hepatoduodenal ligament and hepatic artery[ 39 , 86 , 119 - 121 ]. However, despite these uncertainties, by improving equipment and operative skills, advances in laparoscopic techniques[ 122 - 126 ] or even robotic management[ 38 , 127 ] can overcome the disadvantages and difficulties of laparoscopic procedures.…”

Section: Managementmentioning

confidence: 99%

New trends in diagnosis and management of gallbladder carcinoma

Pavlidis,

Galanis,

Pavlidis

2024

World J Gastrointest Oncol

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Gallbladder (GB) carcinoma, although relatively rare, is the most common biliary tree cholangiocarcinoma with aggressiveness and poor prognosis. It is closely associated with cholelithiasis and long-standing large (> 3 cm) gallstones in up to 90% of cases. The other main predisposing factors for GB carcinoma include molecular factors such as mutated genes, GB wall calcification (porcelain) or mainly mucosal microcalcifications, and GB polyps ≥ 1 cm in size. Diagnosis is made by ultrasound, computed tomography (CT), and, more precisely, magnetic resonance imaging (MRI). Preoperative staging is of great importance in decision-making regarding therapeutic management. Preoperative staging is based on MRI findings, the leading technique for liver metastasis imaging, enhanced three-phase CT angiography, or magnetic resonance angiography for major vessel assessment. It is also necessary to use positron emission tomography (PET)-CT or 18F-FDG PET-MRI to more accurately detect metastases and any other occult deposits with active metabolic uptake. Staging laparoscopy may detect dissemination not otherwise found in 20%-28.6% of cases. Multimodality treatment is needed, including surgical resection, targeted therapy by biological agents according to molecular testing gene mapping, chemotherapy, radiation therapy, and immunotherapy. It is of great importance to understand the updated guidelines and current treatment options. The extent of surgical intervention depends on the disease stage, ranging from simple cholecystectomy (T1a) to extended resections and including extended cholecystectomy (T1b), with wide lymph node resection in every case or IV-V segmentectomy (T2), hepatic trisegmentectomy or major hepatectomy accompanied by hepaticojejunostomy Roux-Y, and adjacent organ resection if necessary (T3). Laparoscopic or robotic surgery shows fewer postoperative complications and equivalent oncological outcomes when compared to open surgery, but much attention must be paid to avoiding injuries. In addition to surgery, novel targeted treatment along with immunotherapy and recent improvements in radiotherapy and chemotherapy (neoadjuvant-adjuvant capecitabine, cisplatin, gemcitabine) have yielded promising results even in inoperable cases calling for palliation (T4). Thus, individualized treatment must be applied.

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