Comparison of Laparoscopic and Open Approach in Treating Gallbladder Cancer.
BACKGROUND
Preliminary study on the feasibility and efficacy of laparoscopic cholecystectomy and radical cholecystectomy in stage Tis-T3 gallbladder cancer (GBC).


METHODS
Retrospective analysis of the clinical data of 102 patients with GBC from August 2008 to August 2017 in the Department of Hepatopancreatobiliary Surgery at the Third Affiliated Hospital of Soochow University. The clinical and pathological data of laparoscopic surgery and open surgery were compared.


RESULTS
Of 102 patients with GBC, 41 underwent laparoscopic treatment, 12 of whom underwent laparoscopic cholecystectomy, and the others underwent laparoscopic radical cholecystectomy/extended radical cholecystectomy. Sixty-one patients underwent radical cholecystectomy/extended radical cholecystectomy. Based on the individual patient's condition, excision of the extrahepatic biliary tract and cholangioenterostomy were performed. There were no perioperative deaths. There was no significant difference in the operative blood loss (P = 0.732), operative time (P = 0.058), postoperative complications (P = 0.933), R0 margins (P = 0.679), and tumor-related death (P = 0.396) between the laparoscopic group and the laparotomy group. The postoperative activity time (P < 0.001), postoperative eating time (P < 0.001), drainage tube removal time (P < 0.001), and postoperative hospital discharge time (P < 0.001) in the laparoscopic group were all earlier than those in the laparotomy group, and the difference was statistically significant. The number of lymph nodes resected in the laparoscopic group and the laparotomy group was 1-17, average (5 ± 3) and 1-13 average (5 ± 3), respectively, with no statistically significant difference (P = 0.973). The 1-, 3-, and 5-y survival rates in the laparoscopic group were 97.1%, 69.4%, and 51.9%, respectively, and those in the laparotomy group were 94.7%, 64.9%, and 55.7%, respectively; there were no significant difference between the two groups (P = 0.453). In terms of different pathologic T stages, the 5-y survival rates of patients with stage Tis (9 cases), T1a (2 cases), T1b (8 cases), T2 (14 cases), and T3 (8 cases) disease in the laparoscopic group were 100%, 100%, 75%, 48.1%, and 12.5%, respectively, and the 5-y survival rates in patients with stage Tis (4 cases), T1b (9 cases), T2 (32 cases), and T3 (16 cases) disease in the laparotomy group were 100%, 87.5%, 64.7%, and 16%, respectively; there were no significant differences between the two groups.


CONCLUSIONS
Laparoscopic treatment of stage Tis-T3 GBC is feasible. Laparoscopic treatment of GBC does not increase the incision metastasis rate on the basis of the intact gallbladder wall. The same survival rates can be achieved with laparoscopic treatment as with open treatment of GBC. In terms of postoperative rehabilitation, laparoscopic treatment has more advantages.
['Feng|Jia-Wei|JW|', 'Yang|Xing-Hai|XH|', 'Liu|Chi-Wen|CW|', 'Wu|Bao-Qiang|BQ|', 'Sun|Dong-Lin|DL|', 'Chen|Xue-Min|XM|', 'Jiang|Yong|Y|', 'Qu|Zhen|Z|']
D000230:Adenocarcinoma D000236:Adenoma D000328:Adult D000368:Aged D000369:Aged, 80 and over D002294:Carcinoma, Squamous Cell D002763:Cholecystectomy D005240:Feasibility Studies D005260:Female D005500:Follow-Up Studies D005706:Gallbladder Neoplasms D006801:Humans D010535:Laparoscopy D008297:Male D008875:Middle Aged D009367:Neoplasm Staging D011183:Postoperative Complications D012189:Retrospective Studies D016019:Survival Analysis D016896:Treatment Outcome
Gallbladder cancer Laparoscopy Prognosis Radical gallbladder surgery