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Ahmed SH, Usmani SUR, Mushtaq R, Samad S, Abid M, Moeed A, Atif AR, Farhan SA, Saif A. Role of laparoscopic surgery in the management of gallbladder cancer: Systematic review & meta-analysis. Am J Surg 2023; 225:975-987. [PMID: 36693774 DOI: 10.1016/j.amjsurg.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/26/2022] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND This meta-analysis evaluates the safety and short-term oncological outcomes of laparoscopic vs. open surgery for gallbladder carcinoma(GBC). METHODS Meta-analysis was performed on laparoscopic(LG) and open group(OG) studies. Data for survival outcomes were extracted from Kaplan-Meier curves and combined with Tierney's method to estimate hazard ratios(HRs) and 95% CIs. RESULTS There was no significant difference in overall survival(HR: 1.01), disease-free survival(HR: 0.84), 30-day mortality(RR:1.10), overall recurrence(RR:0.93), intraoperative gallbladder violation(RR:1.17), operative time(WMD:8.32), number of patients receiving adjuvant chemotherapy(RR:1.06) and blood transfusion(RR: 0.81). A significant difference was seen in survival of T3 subgroup(HR:0.77) and number of lymph node dissections (LND)(WMD: 0.63) favoring OG, along with a decrease in postoperative complications(RR:0.65), greater incidence of R0 resections(RR:1.04), lower volume of intraoperative blood loss(WMD: 128.62), lower time in removing drainage tube(WMD: 1.35), shorter diet recovery time(WMD: 1.88), shorter hospital stay(WMD: 3.51), lower incidence of 90-day mortality(RR:0.49) favoring LG. A higher incidence of port-site recurrence(RR:1.99) was reported in LG. CONCLUSION Laparoscopic surgery is non-inferior to the open approach in terms of oncological outcomes and has an improved rate of postoperative complications.
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Affiliation(s)
- Syeda Hoorulain Ahmed
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan.
| | - Shajie Ur Rehman Usmani
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Rabeea Mushtaq
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Saba Samad
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Minaam Abid
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Abdul Moeed
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Abdul Raafe Atif
- Department of Surgery, Dow University of Health Sciences, Baba-e-Urdu Rd, Karachi, 74200, Pakistan
| | - Syed Ali Farhan
- Department of Surgery, Virginia Commonwealth University Health, 1200 E Marshall St, Richmond, VA, 23219, United States
| | - Areeba Saif
- Department of Surgery, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, United States
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Adverse Outcomes After Bile Spillage in Incidental Gallbladder Cancers: A Population-based Study. Ann Surg 2021; 273:139-144. [PMID: 30998534 DOI: 10.1097/sla.0000000000003325] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the effect of bile spillage during cholecystectomy on oncological outcomes in incidental gallbladder cancers. BACKGROUND Gallbladder cancer (GBC) is rare, but lethal. Achieving complete resection offers the best chance of survival. About 30% of GBCs are discovered incidentally after cholecystectomy for benign pathology. There is an anecdotal association between peritoneal dissemination and bile spillage during the index cholecystectomy. However, no population-based studies are available that measure the consequences of bile spillage on patient outcomes. METHODS We conducted a retrospective cohort comparison of patients with incidental GBC. All cholecystectomies and cases of GBC in Alberta, Canada, from 2001 to 2015, were identified. GBCs discovered incidentally were included. Operative events leading to bile spillage were reviewed. Patient outcomes were compared between cases of bile spillage versus no contamination. RESULTS In all, 115,484 cholecystectomies were performed, and a detailed analysis was possible in 82 incidental GBC cases. In 55 cases (67%), there was bile spillage during the index cholecystectomy. Peritoneal carcinomatosis occurred more frequently in those with bile spillage (24% vs 4%; P = 0.0287). Patients with bile spillage were less likely to undergo a radical re-resection (25% vs 56%; P = 0.0131) and were less likely to achieve an R0 resection margin [odds ratio 0.19, 95% confidence interval (CI) 0.06-0.55]. On Cox regression modeling, bile spillage was an independent predictor of shorter disease-free survival (hazard ratio 1.99, 95% CI 1.07-3.67). CONCLUSION For incidentally discovered GBC, bile spillage at the time of index cholecystectomy has measureable adverse consequences on patient outcomes. Early involvement of a hepatobiliary specialist is recommended where concerning features for GBC exist.
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Recurrence of gallbladder carcinoma 12 years after laparoscopic cholecystectomy. Clin Res Hepatol Gastroenterol 2019; 43:e1-e3. [PMID: 30174266 DOI: 10.1016/j.clinre.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/01/2018] [Indexed: 02/04/2023]
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Berger-Richardson D, Chesney TR, Englesakis M, Govindarajan A, Cleary SP, Swallow CJ. Trends in port-site metastasis after laparoscopic resection of incidental gallbladder cancer: A systematic review. Surgery 2016; 161:618-627. [PMID: 27743715 DOI: 10.1016/j.surg.2016.08.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 07/07/2016] [Accepted: 08/05/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The risk of port-site metastasis after laparoscopic removal of incidental gallbladder cancer was previously estimated to be 14-30%. The present study was designed to determine the incidence of port-site metastasis in incidental gallbladder cancer in the modern era (2000-2014) versus the historic era (1991-1999). We also investigated the site of port-site metastasis. METHODS Using PRISMA, a systematic review was conducted to identify papers that addressed the development of port-site metastasis after laparoscopic resection of incidental gallbladder cancer. Studies that described cancer-specific outcomes in ≥5 patients were included. A validated quality appraisal tool was used, and a weighted estimate of the incidence of port-site metastasis was calculated. RESULTS Based on data extracted from 27 papers that met inclusion criteria, the incidence of port-site metastasis in incidental gallbladder cancer has decreased from 18.6% prior to 2000 (95% confidence interval 15.3-21.9%, n = 7) to 10.3% since then (95% confidence interval 7.9-12.7%, n = 20) (P < .001). The extraction site is at significantly higher risk than nonextraction sites. CONCLUSION The incidence of port-site metastasis in incidental gallbladder cancer has decreased but remains high relative to other primary tumors. Any preoperative finding that raises the suspicion of gallbladder cancer should prompt further investigation and referral to a hepato-pancreato-biliary specialist.
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Affiliation(s)
- David Berger-Richardson
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Tyler R Chesney
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Anand Govindarajan
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sean P Cleary
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Carol J Swallow
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Lai QY, Wang DS. Surgical treatment of gallbladder cancer: Strategy and optimization. Shijie Huaren Xiaohua Zazhi 2015; 23:1865-1872. [DOI: 10.11569/wcjd.v23.i12.1865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gallbladder cancer is the most common malignant tumor of the biliary tract. It is difficult to diagnose early due to the lack of special symptoms and physical signs. Most cases are diagnosed in advanced stages and the response to traditional chemotherapy and radiotherapy is extremely limited, with modest impact on overall survival. Despite improvements in outcome associated with extended resections, selection of patients for such extensive surgery remains controversial. In this article, we analyze and discuss the key issues about the surgical management of gallbladder cancer, with the hope of a more comprehensive recognition of this malignancy.
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Xu XQ, Liu W, Li BL, Hong T, Zheng CJ, Wang C, Zhao YP. Unsuspected gallbladder cancer during or after laparoscopic cholecystectomy. ACTA ACUST UNITED AC 2013; 28:102-6. [PMID: 23806373 DOI: 10.1016/s1001-9294(13)60030-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To summarize the clinical features and outcomes of unsupected gallbladder carcinoma ( UGC) detected during or after laparoscopic cholecystectomy. METHODS Medical records of 8005 patients, who underwent laparoscopic cholecystectomy in Peking Union Medical College Hospital between June 1993 and June 2011, were reviewed. Patients that pathologically diagnosed as UGC were retrospectively studied in terms of clinical features, preoperative and postoperative diagnosis, surviving period, and complications. RESULTS In the 8005 patients who received laparoscopic cholecystectomy, 36 (0.45%) were diagnosed as UGC during (25 patients) or after (11 patients) laparoscopic cholecystectomy. The gallbladder cancer was staged as T1 in 16 patients, T2 in 11 patients, and T3 in 9 patients. The 1-, 3-, and 5-year survival rates of all the patients were 88.9% (32/36), 63.9% (23/36), and 58.3% (21/36). The 5-year survival rates in T1 stage, T2 stage, and T3 stage patients were 100%, 75.0%, and 0.0%, respectively. CONCLUSIONS The survival rate of UGC is associated with tumor stage, not with operation approaches. Laparoscopic cholecystectomy is appropriate for T1 patients.
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Affiliation(s)
- Xie-qun Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
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Ekblad L, Lindgren G, Persson E, Kjellén E, Wennerberg J. Cell-line-specific stimulation of tumor cell aggressiveness by wound healing factors - a central role for STAT3. BMC Cancer 2013; 13:33. [PMID: 23351302 PMCID: PMC3585883 DOI: 10.1186/1471-2407-13-33] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 01/23/2013] [Indexed: 12/14/2022] Open
Abstract
Background Local recurrence is a major factor affecting survival after treatment for head and neck squamous cell carcinoma (HNSCC). It is possible that the normal processes involved in wound healing after surgical removal of a primary tumor can boost the regrowth of residual cancer cells, thereby contributing to the recurrent growth. In this work, we collected human wound fluids and used them to investigate the effect of wound healing factors on HNSCC cell lines in vitro. Methods Wound fluids were collected from thyroidectomized patients diagnosed with benign disease and were included in assays of cell proliferation, migration, cell scattering, and invasion. The involvement of intracellular signaling pathways and membrane receptors were investigated by western blotting and the inclusion of specific inhibitors. Results One out of four cell lines was greatly stimulated in proliferation, migration, cell scattering, and invasion by the addition of wound fluid as compared with addition of fetal bovine or human serum. These effects were accompanied by a sharp increase in activation of signal transducer and activator of transcription 3 (STAT3). Inhibition of STAT3 activation abolished the wound fluid response, showing that STAT3 plays an important role in the wound healing response. Several of the observed phenotypic changes were epithelial-to-mesenchymal transition (EMT)-like, but the appropriate changes were not seen in any of the EMT markers investigated. The involvement of c-Met or epidermal growth factor receptor family members was excluded, while the interleukin-6 receptor was found to be partly responsible for the activation of STAT3. Conclusions In conclusion, we found cell-line-specific effects of wound healing factors on HNSCC, setting the stage for therapy development and predictive opportunities.
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Affiliation(s)
- Lars Ekblad
- Department of Oncology, Lund University, Lund, Sweden.
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Lee JM, Kim BW, Kim WH, Wang HJ, Kim MW. Clinical Implication of Bile Spillage in Patients Undergoing Laparoscopic Cholecystectomy for Gallbladder Cancer. Am Surg 2011. [DOI: 10.1177/000313481107700623] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We determined the influence of bile spillage on recurrence and survival during laparoscopic cholecystectomy (LC) for gallbladder (GB) cancer. Among the 136 patients with GB cancer treated at Ajou University Hospital between 1994 and 2007, 28 underwent LC alone. We compared patients without bile spillage (bile spillage [-] group, n = 16) with patients who had bile spillage (bile spillage [+] group, n = 12). There was no statistical difference in stage between the groups. In the bile spillage (-) group, all patients underwent curative resection and there were two patients with locoregional recurrences and three patients with systemic recurrences. In the bile spillage (+) group, five patients underwent R1 resection and one patient underwent R2 resection and all eight recurrent patients had systemic recurrences. The disease-free survival and overall survival were shorter in the bile spillage (+) group (disease-free survival, 71.4 vs 20.9 months; P = 0.028; overall survival, 72.6 vs 25.8 months; P = 0.014). Bile spillage is likely to be an association with an incomplete resection and systemic recurrences. When GB cancer is suspected during LC, conversion to open surgery for preventing bile spillage and achieving curative resection should be considered.
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Affiliation(s)
- Jae-Myeong Lee
- Division of Critical Care Medicine for Surgical Patients, Department of Anesthesiology and Pain Medicine
| | - Bong-Wan Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Wook Hwan Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hee-Jung Wang
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Myung Wook Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Abstract
INTRODUCTION Accidental intraoperative gallbladder perforation is a problem in laparoscopic surgery, especially in cases with incidental gallbladder carcinoma (IGBC). The question is whether intraoperative gallbladder perforation has a prognostic disadvantage or a retrieval bag provides protection against tumor dissemination. METHODS A standardized questionnaire was sent to all German surgical clinics based on the central register of "incidental gallbladder carcinoma" of the German Society of Surgery founded in 1997. RESULTS In 592 IGBC-registered cases, there were 330 laparoscopies, 154 open surgeries, and intraoperative conversion was performed in 106 cases. Of laparoscopic surgeries (n = 330), the recurrence rate was 30%. The recurrence rate for cases with (174/330) and without (156/330) the use of retrieval bag was 32.2% and 27%, respectively. In laparoscopies with intraoperative gallbladder perforation (73/330 cases), the recurrence rate was 38.4%. Of these cases the recurrence rate with (51/73) and without (22/73) the use of retrieval bags was 39.2% and 36.4%, respectively. In 257 cases without intraoperative perforation, tumor recurrence rate was 27.2%, and it was 29.3% or 25.4% with (123/257) and without (134/257) the use of retrieval bags. CONCLUSIONS According to the registry data, the intraoperative gallbladder perforation results in significant (P = 0.047) prognostic disadvantage and in these cases retrieval bags were used more often (P = 0.001). However, in IGBC cases if intraoperative gallbladder perforation has already happened, the use of retrieval bags had no protective effects.
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Hardiman KM, Sheppard BC. What to do when the pathology from last week's laparoscopic cholecystectomy is malignant and T1 or T2. J Gastrointest Surg 2009; 13:2037-9. [PMID: 19219515 DOI: 10.1007/s11605-009-0809-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/12/2009] [Indexed: 01/31/2023]
Affiliation(s)
- K M Hardiman
- Department of Surgery, Oregon Health and Science University, Portland, OR, USA
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Xu XQ, Liu W, Li BL, Hong T, Zheng CJ, He XD, Liao Q, Zhao YP. Unsuspected gallbladder cancer management during or after laparoscopic cholecystectomy. Shijie Huaren Xiaohua Zazhi 2009; 17:1312-1317. [DOI: 10.11569/wcjd.v17.i13.1312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the effectiveness of surgeons in determining the unsuspected gallbladder carcinoma (UGC) at laparoscopic cholecystectomy (LC) and the management of UGC.
METHODS: A total of 6429 patients with gallbladder disease were included in this study who underwent LC during June, 1989 and November, 2008. Patients with UGC were reviewed retrospectively to assess preoperative diagnosis, intraoperative findings and outcomes.
RESULTS: Of the total patients, 27 in 6429 (0.4%) were histopathologically diagnosed as UGC during (17) or after (10) LC. The tumor stages of the 27 diagnosed were pT1 (9), pT2 (9), and pT3 (91), each with 9 cases. The survival rates of all the UCG patients in one-year, three-year and five-year were 74.1%, 63% and 59.3%, respectively. The five-year survival rates of pT1 stage, pT2 stage and pT3 stage were 100%, 66.7% and 0.0%, respectively, not significantly affected by whether the patients had been diagnosed with UGC during or after LC (P < 0.05).
CONCLUSION: The survival rate from UGC is associated with tumor stage and it is confirmed that a carefully performed LC is adequate treatment for pT1 stage cancer. If a suspicious lesion is found, intraoperative frozen section is performed for pathological examination. However, radical operation is recommended for T2 patients and effective measures should be taken to avoid tumor implant and metastasis.
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Gourgiotis S, Kocher HM, Solaini L, Yarollahi A, Tsiambas E, Salemis NS. Gallbladder cancer. Am J Surg 2008; 196:252-64. [PMID: 18466866 DOI: 10.1016/j.amjsurg.2007.11.011] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 11/02/2007] [Accepted: 11/02/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gallbladder cancer (GC) is a relatively rare but highly lethal neoplasm. We review the epidemiology, etiology, pathology, symptoms, diagnosis, staging, treatment, and prognosis of GC. METHOD A Pubmed database search between 1971 and February 2007 was performed. All abstracts were reviewed and articles with GC obtained; further references were extracted by hand-searching the bibliography. The database search was done in the English language. RESULTS The accurate etiology of GC remains unclear, while the symptoms associated with primary GC are not specific. Treatment with radical cholecystectomy is curative but possible in only 10% to 30% of patients. For patients whose cancer is an incidental finding on pathologic review, re-resection is indicated, where feasible, for all disease except T1a. Patients with advanced disease should receive palliative treatment. Laparoscopic cholecystectomy is contraindicated in the presence of GC. CONCLUSION Prognosis generally is extremely poor. Improvements in the outcome of surgical resection have caused this approach to be re-evaluated, while the role of chemotherapy and radiotherapy remains controversial.
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Affiliation(s)
- Stavros Gourgiotis
- Second Surgical Department, 401 General Army Hospital of Athens, Athens, Greece.
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Kwon AH, Imamura A, Kitade H, Kamiyama Y. Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy. J Surg Oncol 2008; 97:241-5. [PMID: 18095299 DOI: 10.1002/jso.20944] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The long-term prognosis of laparoscopic cholecystectomy (LC) for patients with unsuspected gallbladder carcinoma (GBC) remains unclear. We investigated retrospectively the role of examination of frozen sections and the prognosis of patients with unsuspected GBC detected during or after LC. METHODS LC was performed on 1,793 consecutive patients. If a suspicious lesion was found, intraoperative frozen section examination was performed. RESULTS Of all these patients, 38 (2.1%) were histopathologically diagnosed as having a GBC during (28) or after LC (10). The tumor stages of the 28 diagnosed during LC were: pT1a (17), pT1b (2), pT2 (8), and pT3 (1). The sensitivity and specificity of intraoperative frozen section examination were 90 and 100%, respectively. On the other hand, those 10 cases diagnosed after LC had pT1a (1) and pT2 (9) tumors. Survival rates were not significantly affected by whether the patient was diagnosed with GBC during or after LC. CONCLUSIONS The survival with unsuspected GBC was related to stage and it was confirmed that a carefully performed LC is adequate treatment for Stage 1A and B cancer. The LC procedure does not adversely affect the prognosis of unsuspected GBC, regardless of whether it is detected during or after LC.
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Affiliation(s)
- A-Hon Kwon
- Department of Surgery, Kansai Medical University, Osaka, Japan.
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Cleary SP, Dawson LA, Knox JJ, Gallinger S. Cancer of the gallbladder and extrahepatic bile ducts. Curr Probl Surg 2007; 44:396-482. [PMID: 17693325 DOI: 10.1067/j.cpsurg.2007.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sean P Cleary
- Department of Surgery, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
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Sikora SS, Singh RK. Surgical strategies in patients with gallbladder cancer: nihilism to optimism. J Surg Oncol 2006; 93:670-81. [PMID: 16724356 DOI: 10.1002/jso.20535] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Gallbladder cancer is an aggressive disease with dismal results of surgical treatment and a poor prognosis. However, over the last few decades selected groups have reported improved results with aggressive surgery for gallbladder cancer. METHODS Review of recent world literature was done to provide an update on the current concepts of surgical treatment of this disease. RESULTS Long-term survival is possible in early stage gallbladder carcinoma. Tis and T1a gallbladder carcinoma can be treated with simple cholecystectomy only. However, in T1b and beyond cancers, aggressive surgery (extended cholecystectomy) is important in improving the long-term prognosis. Laparoscopic cholecystectomy should not be performed where there is a high index of suspicion of malignancy due to the frequent association with factors (such as gallbladder perforation and bile spill) which may lead to implantation of cancer cells and dissemination. Surgical resection for advanced carcinoma gallbladder is recommended only if a potentially curative R0 resection is possible. Aggressive surgery with vascular and multivisceral resection has been shown to be feasible albeit with an increase in mortality and morbidity. However, the true benefit of these radical resections is yet to be realized, as the actual number of long-term survivors of advanced gallbladder carcinoma is few. CONCLUSIONS Surgery for gallbladder carcinoma, like other malignancies, has the potential to be curative only in local or regional disease. Pattern of loco-regional spread of disease dictates the surgical procedure. Radical surgery improves survival in early gallbladder carcinoma. The long-term benefit of aggressive surgery for advanced disease is unclear and may be offset by the high mortality and morbidity.
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Affiliation(s)
- Sadiq S Sikora
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Steinert R, Nestler G, Sagynaliev E, Müller J, Lippert H, Reymond MA. Laparoscopic cholecystectomy and gallbladder cancer. J Surg Oncol 2006; 93:682-9. [PMID: 16724350 DOI: 10.1002/jso.20536] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Heightened awareness of the possible presence of gallbladder cancer (GBC) and the knowledge of appropriate management are important for surgeons practising laparoscopic cholecystectomy (LC). Long-term effects of initial LC versus open cholecystectomy (OC) on the prognosis of patients with GBC remain undefined. Patients who are suspected to have GBC should not undergo LC, since it is advantageous to perform the en-bloc radical surgery at the initial operation. Since preoperative diagnosis of early GBC is difficult, preventive measures, such as preventing bile spillage and bagging the gallbladder should be applied for every LC. Many port-site recurrences (PSR) have been reported after LC, but the incidence of wound recurrence is not higher than after OC. No radical procedure is required after postoperative diagnosis of incidental pT1a GBC. It is unclear if patients with pT1b GBC require extended cholecystectomy. In pT2 GBC, patients should have radical surgery (atypical or segmental liver resection and lymphadenectomy). In advanced GBC (pT3 and pT4), radical surgery can cure only a small subset of patients, if any. Additional port-site excision is recommended, but the effectiveness of such measure is debated.
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Affiliation(s)
- Ralf Steinert
- Department Surgery, University of Magdeburg, Germany
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Yamamoto H, Hayakawa N, Kitagawa Y, Katohno Y, Sasaya T, Takara D, Nagino M, Nimura Y. Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy. ACTA ACUST UNITED AC 2006; 12:391-8. [PMID: 16258808 DOI: 10.1007/s00534-005-0996-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2004] [Accepted: 04/04/2005] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE Many cases have been reported of disastrous port-site recurrence after laparoscopic cholecystectomy (LC) revealed unsuspected gallbladder carcinoma (GBC). Some investigators have reported that the prognosis of patients after LC showed unsuspected GBC is not worsened by laparoscopic procedures. We retrospectively reviewed our cases and the literature to reconfirm the intrinsic risks of LC for unsuspected GBC. METHODS Of 1663 patients who underwent LC from January 1991 to December 2003 in a single institution, 9 (0.54%) with unsuspected GBC were reviewed. RESULTS These 9 patients consisted of 5 men and 4 women, whose ages ranged from 58 to 87 years, with a median age of 73 years. Two patients with a pT1a tumor (limited to mucosa) and 2 patients with a pT1b tumor (muscle layer) underwent no further operation. The remaining 5 patients with a pT2 tumor (subserosa) underwent further operations with lymph node dissection. Five patients (2 patients with pT1b and 3 patients with pT2) developed recurrence and all of them died within a median period of 19 months (range 14-37 months) after LC. The causes of death were bone metastases in 1 patient (pT2), local recurrence in 2 patients (pT1b and pT2), and peritoneal metastasis in 2 patients (one elderly patient with pT1b who underwent laparoscopic common bile duct exploration, and one patient with pT2 in whom the cystic duct was damaged during surgery). Four patients (2 with pT1 and 2 with pT2) have been doing well with a median follow-up of 39.5 months (range 12-99 months) after LC. CONCLUSIONS Surgeons should always prevent bile spillage during LC and when removing the resected gallbladder. When laparoscopic common bile duct exploration is planned, especially for elderly women, surgeons should also bear in mind the increasing possibility of unsuspected GBC.
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Affiliation(s)
- Hideo Yamamoto
- Department of Surgery, Tohkai Hospital, 1-1-1 Chiyodabashi, Chikusa-ku, Nagoya 464-0011, Japan
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Lundberg O, Kristoffersson A. Pneumoperitoneum impairs blood flow and augments tumor growth in the abdominal wall. Surg Endosc 2003; 18:293-6. [PMID: 14691694 DOI: 10.1007/s00464-003-9035-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2003] [Accepted: 07/23/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite several clinical and experimental studies, the mechanisms behind the development of port site metastases in laparoscopic surgery have remained largely unknown. The current study was designed to investigate the effect of pneumoperitoneum on blood flow in the abdominal wall and its possible effects on tumor growth at this site. METHODS A total of 40 Wistar Fu rats had a laser Doppler probe placed on their left rectus muscle and a suspension of 50,000 adenocarcinoma cells was injected into their right rectus muscle. The experimental group (n = 20) was insufflated with air at 10 mmHg for 45 min while abdominal blood flow was registered before and during insufflation and after exsufflation. The control group (n = 20) was not insufflated but the blood flow was recorded in the same manner. After 9 days, all animals were killed and the occurrence of tumor was observed. The tumors were analyzed with respect to weight and volume. RESULTS The insufflation caused an 82% reduction in blood flow in the experimental group (p < 0.001). No reduction in blood flow was registered in the control group. Tumor nodules developed significantly more often in the insufflated group (20/20) compared to the controls (14/20) (p = 0.016). Tumor weight (p = 0.003) and volume (p < 0.001) were significantly increased in the insufflated group. CONCLUSIONS Pneumoperitoneum seems to enhance tumor growth. It also causes a significant reduction in blood flow in the abdominal wall, which may contribute to the increased susceptibility of tumor take.
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Affiliation(s)
- O Lundberg
- Department of Surgery, University Hospital of Northern Sweden, S-901 85, Umeå, Sweden.
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Ziprin P, Ridgway PF, Peck DH, Darzi AW. Laparoscopic enhancement of tumour cell binding to the peritoneum is inhibited by anti-intercellular adhesion molecule-1 monoclonal antibody. Surg Endosc 2003; 17:1812-7. [PMID: 12958678 DOI: 10.1007/s00464-002-8766-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2003] [Accepted: 03/31/2003] [Indexed: 11/29/2022]
Abstract
BACKGROUND There still remain some concerns over the phenomenon of port-site metastases (PSM) after laparoscopic surgery. The aim of this study was to investigate the effect of the pneumoperitoneum on tumor-mesothelial cell interactions. METHODS The adhesion of a colon carcinoma cell line to a mesothelial cell monolayer exposed to carbon dioxide, helium, or air was assessed using an in vitro adhesion assay. Changes in adherence were correlated with alterations in cell surface molecule expression by the mesothelial cells using flow cytometry after exposure to the different environments. RESULTS Exposure of the mesothelial cells to an in vitro pneumoperitoneum significantly enhanced tumor cell binding to the mesothelial cell monolayer. No differences in cell viability were observed between the groups. This was associated with increased expression of mesothelial intercellular adhesion molecule-1 (ICAM-1) mediated by nuclear factor kappa-B. The enhanced adhesion was abolished by ICAM-1 inhibition. CONCLUSIONS This study demonstrated that the laparoscopic environment increases the susceptibility of the mesothelium to tumor cell adherence, and this may be explained by changes in ICAM-1 expression.
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Affiliation(s)
- P Ziprin
- Department of Surgical Oncology and Technology, Faculty of Medicine, Imperial College of Science Technology and Medicine, 10th Floor QEQM Building, St Mary's Hospital, Praed Street, London. W2 1NY, England, UK.
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Abstract
In the past decade, for benign as well as malignant colon diseases, minimally invasive surgery has gained more and more importance in colon surgery. Specimen retrieval after colonic resections is difficult due to the large size of the specimen usually resected. To date there is no standardized retrieval technique for the different procedures. Four incision sites are common for transabdominal specimen retrieval: left or right lower quadrant transrectal portside incision; periumbilical midline incision, and transverse suprapubic incision. Perineal incisions are used for retrieval following low anterior resection or abdomino-perineal extirpation. Three major complications are described in the literature: wound infection (0-9%); hernias (0-2%), and incision site recurrence (0-1.3%). There are no significant differences between the different incision sites with regard to the occurrence of complications. In laparoscopic surgery for malignant diseases retrieval is usually performed using a plastic bag, whereas retrieval can be performed hand-assisted without a bag during surgery for benign diseases. Wound edge protectors are recommended by several authors, yet there is no standard system which is accepted broadly. In conclusion, specimen retrieval in laparoscopic colon surgery is not standardized. The morbidity rate for specific retrieval complications ranges between 0 and 9%, yet there are no randomized controlled studies or evidence-based data regarding different retrieval approaches and systems.
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Affiliation(s)
- T Hackert
- Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany
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Ziprin P, Ridgway PF, Peck DH, Darzi AW. The theories and realities of port-site metastases: a critical appraisal. J Am Coll Surg 2002; 195:395-408. [PMID: 12229949 DOI: 10.1016/s1072-7515(02)01249-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Paul Ziprin
- Department of Surgical Oncology and Technology, Faculty of Medicine, Imperial College of Science Technology and Medicine, St Mary's Hospital, London, United Kingdom
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Wullstein C, Woeste G, Barkhausen S, Gross E, Hopt UT. Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer? Surg Endosc 2002; 16:828-32. [PMID: 11997831 DOI: 10.1007/s00464-001-9085-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2001] [Accepted: 09/27/2001] [Indexed: 01/03/2023]
Abstract
BACKGROUND Laparoscopy is thought to worsen the prognosis of gallbladder cancer (GBC) discovered unexpectedly at laparoscopic cholecystectomy (LC). However, laproscopy has never been shown to have an influence on patient survival in clinical series. METHODS We Performed a two-center retrospective analysis of 28 patients with GBC (11 previously known, 17 unexpectedly discovered by LC) to determine whether laparoscopy and complications related to LC had any influence on the prognosis of GBC. Resectability for cure after LC, survival, and recurrence related to both the procedure itself and complications associated with LC were analyzed. RESULTS Of the 17 patients with unexpected GBC, 16 were considered resectable for cure at the time of LC. Advanced disease was detected in eight patients by re staging (n = 5) or exploration (n = 3). Seven patients (43.8%) underwent reoperation for cure. Mean survival of patients with unexpected GBC was 26.5 months. Mean survival was shorter when complications (bile spillage, injury of common bile duct, or tumor violation) occurred during LC (10.2 vs 33 months, p = 0.016). If bile spillage was the only complication at LC, there was also a trend to shorter survival (12 vs 33 months, p = 0.061). CONCLUSION Complications during LC significantly worsen the prognosis of GBC. Therefore, bile spillage and excessive manipulation of the gallbladder should be avoided.
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Affiliation(s)
- C Wullstein
- Department of General, Thoracic, Vascular, and Transplantation Surgery, University of Rostock, Schillingallee 35, D-18055 Rostock, Germany
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