Laparoscopy may benefit some patients with early gallbladder cancer

Last Updated: 2015-08-06

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Laparoscopy can be safe and have good long-term results in selected patients with gallbladder cancer (GBC), new research from Korea suggests.

Laparoscopy, including laparoscopic lymphadenectomy (LLA) in selected patients with early GBC without evidence of liver invasion is safe, the authors wrote in an article online July 20 in the Journal of the American College of Surgeons.

"Laparoscopic surgery for gallbladder cancer has been contraindicated for a long time, but we found that the outcomes after laparoscopic surgery were excellent. All patients with T1 survived and the survival of those with T2 was excellent," Dr. Ho-Seong Han, of Seoul National University Bundang Hospital in Seongnam, Korea, told Reuters Health by email.

"Laparoscopy has the advantages of less pain, fast recovery and less stress to the patients and has been performed in almost every field of surgery," Dr. Han added.

Dr. Han and colleagues evaluated the long-term survival after intended laparoscopic surgery for early-stage GBC.

Over about 10 years, the researchers enrolled 83 patients suspected of early-stage GBC with no evidence of liver invasion. The authors analyzed the data of 45 of these patients with pathologically proven GBC to determine the safety and oncological outcomes of a laparoscopic approach to GBC.

Extended cholecystectomy, including LLA, was performed on 32 patients and simple cholecystectomy on 13 patients. Based on final pathological results, the T stages were Tis (n=2), T1a (n=10), T1b (n=8), and T2 (n=25).

The researchers studied 26 patients with postoperative follow-up longer than five years to determine the five-year actual survival outcomes.

After a median followup of 60 months after surgery, recurrence occurred in four patients as distant metastases, with no local recurrence around the gallbladder bed or lymphadenectomy. The disease-specific five-year survival rate of the 45 patients was 94.2%. The disease-specific actual survival of the 26 patients whose postoperative follow-up period exceeded five years was 92.3% at five years.

Dr. Daniel A. Anaya, of the Moffitt Cancer Center in Tampa, Florida, told Reuters Health by email, "The authors were able to demonstrate how a well-thought-out approach, in a select group of patients, using minimally invasive techniques and performed in the right setting, can yield excellent long-term outcomes (overall survival and disease-free survival).

"The results from this study further support the use of minimally invasive techniques (laparoscopy), for very well selected patients (not all patients with gallbladder cancer are candidates for this approach), as long as the procedure is performed in high-volume specialized centers with the appropriate expertise," said Dr. Anaya, who was not involved in the study.

"Although the results reported are impressive, the study included a small number of patients. Future studies need to validate this approach and examine the generalizability of the algorithm in other settings outside the institution where the study was performed," he added.

The authors agreed that larger trials are needed to confirm their results.

"This study is focused on early GBC, but future studies involving advanced GBC may be necessary. Randomized trials comparing open and laparoscopic surgery may be necessary as well," Dr. Han told Reuters Health.

The authors reported no disclosures.

SOURCE: http://bit.ly/1IZlKoU

J Am Coll Surg 2015.