Researchers from Natori, Japan, determined the long-term prognosis of patients with gallbladder carcinoma who had undergone laparoscopic cholecystectomy (LC).
The clinical courses and outcomes of 498 patients with laparoscopically removed gallbladder carcinoma registered in a nationwide survey were examined.
Written questionnaires were sent to members of the Japanese Society of Biliary Surgery. These included questions on preoperative diagnosis, timing and methods to obtain final diagnosis, depth of invasion, second surgical procedure, prognosis of patients, and type of recurrence, if any.
The 5-year survival rates of patients after LC according to the depth of invasion were calculated.
They were as follows: 99% in those with pT1a (limited to the mucosa), 95% in those with pT1b (muscularis), 70% in those with pT2 (subserosa), 20% in those with pT3 (serosa), and 0% in those with pT4 (serosa with invasion to adjacent organs).
In addition, perforation of the gallbladder during LC occurred in 20% of the patients.
Patients with gallbladders perforated during the procedure showed a significantly lower survival rate than did those without perforated gallbladders.
|5-year survival after LC for gallbladder carcinoma:|
| Journal of Hepato-Biliary-Pancreatic Surgery |
Additional excision during or after LC was carried out in 48% of the patients. The authors found that the frequency of additional excision increased in accordance with the depth of invasion.
Compared with patients who underwent LC only, additional excision resulted in better survival in patients with pT2 or pT3 tumors.
However, this difference was not found in patients with pT1 or pT4 tumors.
Kiyoaki Ouchi, of the Miyagi Cancer Center Hospital, Natori, said on behalf of colleagues, "LC is not likely to worsen the survival rate of patients with gallbladder carcinoma, compared with the survival rate of patients undergoing a standard open radical procedure.
"However, this is only as long as additional excision is conducted for patients with laparoscopically removed pT2 or pT3 gallbladder carcinomas."
"Special attention should be paid to prevention of bile spillage during LC," it was concluded.