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

• Published in: Journal of minimal access surgery Vol. 14; no. 2; pp. 124 - 129
• Main Authors: Nag, Hirdaya, Raj, Prithivi, Sisodia, Kshitij
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01-04-2018; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd; Wolters Kluwer Medknow Publications
• Subjects: Abdomen; Antigens; Biopsy; Bisegmentectomy; Cancer; Care and treatment; Cholecystectomy; Diagnosis; Dissection; Endoscopy; extended; Gallbladder; Gallbladder cancer; Gastrointestinal surgery; Health education; Laparoscopy; Medical prognosis; Metastasis; Methods; Original; Patients; Prognosis; radical; Surgeons; Surgical outcomes; Ultrasonic imaging; Germany; India; laparoscopy; gallbladder cancer; Bisegmentectomy; cholecystectomy; radical; extended
• ISSN: 0972-9941; 1998-3921
• DOI: 10.4103/jmas.JMAS_181_16

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.