The technique of laparoscopic hepatic bisegmentectomy with regional lymphadenectomy for gallbladder cancer

Abstract

Background:Laparoscopic hepatic bisegmentectomy (s4b and s5) with regional lymphadenectomy (LHBRL) for patients with gallbladder cancer (GBC) is rarely reported.Aims:The aim of the study was to describe the technique of LHBRL in patients with GBC and to present our initial experience.Patients and Methods:This retrospective study was conducted on twenty patients with GBC who were considered for LHBRL by the described technique. These patients either had a suspicion of GBC (SGBC) or had an incidental diagnosis of GBC (IGBC). Appropriate statistical methods were applied.Results:Twelve patients (60%) had SGBC and eight patients (40%) had IGBC. Eighteen patients (90%) were females and median age was 50 (range: 28–70) years. Median (range) surgical blood loss was 120 ml (80–400), operation time was 300 (200–480) min and hospital stay was 5.5 (2–10) days. No patient had iatrogenic complication during LHBRL. Five (25%) patients required conversion to open method. Four patients (20%) who developed complications were managed conservatively. All but three patients (25%) with SGBC had a benign disease on final biopsy. TNM stage of 17 patients (85%) with adenocarcinoma was T1bN0 in 3 (17.6%), T2N0 in 6 (35.3%), T3N0 in 2 (11.7%) and T1-3N1 in 6 (35.3%). The median lymph node count was 10 (range: 4–24) and resection margins were negative (R0) in all. The overall survival was 82.3%. During a median follow-up of 22 months, two patients died due to disease recurrence and one patient died due to myocardial infarction.Conclusion:The described technique of LHBRL is safe and feasible for patients with GBC without extrahepatic involvement.

Systematic review of management of incidental gallbladder cancer after cholecystectomy

“…One concern is that laparoscopic access has been associated with a reduced lymph node yield. Open or laparoscopic access for resection appears to have no effect on outcome in early gallbladder cancers, whereas data on the minimally invasive approach in more advanced cancers (T2 or above) are based on small series and not established as a standard approach.…”

Effects of Cystic Duct Margin Involvement on the Survival Rates of Patients With Gallbladder Cancer: A Propensity Score-Matched Case-Control Study

“…If resectable, radical cholecystectomy was performed, including en bloc cholecystectomy with either anatomical segment 4b and 5 resection or non-anatomical 2 cm wedge resection and lymphadenectomy (involving stations 8, 12, and 13). Resections were performed laparoscopically whenever feasible, as described by Nag et al [ 15 , 16 ]. Conversion to open laparotomy was performed whenever required (e.g., technical difficulty, intraoperative bleeding, and multi-visceral resection).…”

Bi-segmentectomy versus wedge hepatic resection in extended cholecystectomy for T2 and T3 gallbladder cancer: A matched case-control study

“…EC was abandoned in patients with confirmed N2 and M1 metastasis. Laparoscopic ECB was performed as described by Nag et al [ 14 ]. Any involvement of adjacent organs such as common bile duct (CBD), stomach, duodenum, and colon were dealt with CBD resection, distal gastrectomy, duodenal sleeve resection, and colonic resection, respectively.…”