Elena-Mihaela Vrabie, Iulian Mosteanu, Mihai-Adrian Eftimie, Irina Balescu, Alexandra Trotea, Gheorghe Potlog, Catalin-Andrei Savin, Luiza-Maria Tirca, Ali Alloub, Cezar Stroescu, Traian Dumitrascu, Irinel Popescu, Vladislav Brasoveanu, Nicolae Bacalbasa
{"title":"腹腔镜与开放入路在胆囊癌治疗中的对比——Fundeni临床研究所9年的经验。","authors":"Elena-Mihaela Vrabie, Iulian Mosteanu, Mihai-Adrian Eftimie, Irina Balescu, Alexandra Trotea, Gheorghe Potlog, Catalin-Andrei Savin, Luiza-Maria Tirca, Ali Alloub, Cezar Stroescu, Traian Dumitrascu, Irinel Popescu, Vladislav Brasoveanu, Nicolae Bacalbasa","doi":"10.21614/chirurgia.3111","DOIUrl":null,"url":null,"abstract":"<p><p><b>Introduction:</b> Gallbladder cancer is the most common biliary malignancy frequently diagnosed incidentally on cholecystectomy specimens for presumed benign disease. Once the diagnosis is confirmed on histopathologically, the treatment must be completed by resecting the gallbladder liver bed and regional lymph nodes. The laparoscopic approach seems to be efficient and oncologically safe. The aim of our study was to present the 9-year experience in treating gallbladder cancer in our surgery clinic by both open and laparoscopic approach completed by a literature review with the latest updates regarding the state of the laparoscopic approach in treating this type of cancer. <b>Materials and Methods:</b> Fifty-seven patients underwent radical surgery and 26 resections had a palliative purpose. Among radical resections, 52 were performed by using the open approach and 5 by using the laparoscopic approach. 14 cases out of 57 were completion procedures performed after a malignant histopathological finding was confirmed on a simple cholecystectomy specimen. In the majority of cases, the primary simple cholecystectomy was performed by laparoscopic approach. The laparoscopic approach was used in 3 cases of re-resection and 2 per-primam resections. <b>Results:</b> The median age of the patients was 64.21 years in the open group and 67.2 years in the laparoscopic group. Most patients were females. All patients had one or more comorbidities with an ASA score of 3 or 4 in 52 patients out of 57. ASA score had lower values in the laparoscopic group. The average surgery time for the laparoscopic group was 308 minutes, similar to the one for the open group that was 294 minutes. The complication rate was higher in the open group. The number of harvested lymph nodes was similar between the groups. The laparoscopic group benefited of lower postoperative pain, faster recovery and shorter hospital stay (6.2 days versus 13 days). Gallbladder cancer evolves asymptomatic in early stages and the diagnosis in advanced stages limits the therapeutic options. Still, in cases incidentally diagnosed on cholecystectomy specimens for presumed benign disease (stages T1-T3), the re-resection might be performed by laparoscopic approach. Also, in per-primam diagnosed selected cases, the laparoscopic resection might be performed by experimented teams. <b>Conclusions:</b> The laparoscopic approach is an ideal alternative to the open approach in treating early-stage gallbladder cancer. This surgical approach provides oncological safety, similar R0 resection rates and number of harvested lymph-nodes. The maximum benefit of this surgical approach is achieved in high-volume centers with experimented teams.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 2","pages":"178-192"},"PeriodicalIF":0.8000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Laparoscopic versus Open Approach in Gallbladder Cancer Treatment - 9-Year Experience in Fundeni Clinical Institute.\",\"authors\":\"Elena-Mihaela Vrabie, Iulian Mosteanu, Mihai-Adrian Eftimie, Irina Balescu, Alexandra Trotea, Gheorghe Potlog, Catalin-Andrei Savin, Luiza-Maria Tirca, Ali Alloub, Cezar Stroescu, Traian Dumitrascu, Irinel Popescu, Vladislav Brasoveanu, Nicolae Bacalbasa\",\"doi\":\"10.21614/chirurgia.3111\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Introduction:</b> Gallbladder cancer is the most common biliary malignancy frequently diagnosed incidentally on cholecystectomy specimens for presumed benign disease. Once the diagnosis is confirmed on histopathologically, the treatment must be completed by resecting the gallbladder liver bed and regional lymph nodes. The laparoscopic approach seems to be efficient and oncologically safe. The aim of our study was to present the 9-year experience in treating gallbladder cancer in our surgery clinic by both open and laparoscopic approach completed by a literature review with the latest updates regarding the state of the laparoscopic approach in treating this type of cancer. <b>Materials and Methods:</b> Fifty-seven patients underwent radical surgery and 26 resections had a palliative purpose. Among radical resections, 52 were performed by using the open approach and 5 by using the laparoscopic approach. 14 cases out of 57 were completion procedures performed after a malignant histopathological finding was confirmed on a simple cholecystectomy specimen. In the majority of cases, the primary simple cholecystectomy was performed by laparoscopic approach. The laparoscopic approach was used in 3 cases of re-resection and 2 per-primam resections. <b>Results:</b> The median age of the patients was 64.21 years in the open group and 67.2 years in the laparoscopic group. Most patients were females. All patients had one or more comorbidities with an ASA score of 3 or 4 in 52 patients out of 57. ASA score had lower values in the laparoscopic group. The average surgery time for the laparoscopic group was 308 minutes, similar to the one for the open group that was 294 minutes. The complication rate was higher in the open group. The number of harvested lymph nodes was similar between the groups. The laparoscopic group benefited of lower postoperative pain, faster recovery and shorter hospital stay (6.2 days versus 13 days). Gallbladder cancer evolves asymptomatic in early stages and the diagnosis in advanced stages limits the therapeutic options. Still, in cases incidentally diagnosed on cholecystectomy specimens for presumed benign disease (stages T1-T3), the re-resection might be performed by laparoscopic approach. Also, in per-primam diagnosed selected cases, the laparoscopic resection might be performed by experimented teams. <b>Conclusions:</b> The laparoscopic approach is an ideal alternative to the open approach in treating early-stage gallbladder cancer. This surgical approach provides oncological safety, similar R0 resection rates and number of harvested lymph-nodes. The maximum benefit of this surgical approach is achieved in high-volume centers with experimented teams.</p>\",\"PeriodicalId\":10171,\"journal\":{\"name\":\"Chirurgia\",\"volume\":\"120 2\",\"pages\":\"178-192\"},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2025-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Chirurgia\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.21614/chirurgia.3111\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chirurgia","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.21614/chirurgia.3111","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"SURGERY","Score":null,"Total":0}
Laparoscopic versus Open Approach in Gallbladder Cancer Treatment - 9-Year Experience in Fundeni Clinical Institute.
Introduction: Gallbladder cancer is the most common biliary malignancy frequently diagnosed incidentally on cholecystectomy specimens for presumed benign disease. Once the diagnosis is confirmed on histopathologically, the treatment must be completed by resecting the gallbladder liver bed and regional lymph nodes. The laparoscopic approach seems to be efficient and oncologically safe. The aim of our study was to present the 9-year experience in treating gallbladder cancer in our surgery clinic by both open and laparoscopic approach completed by a literature review with the latest updates regarding the state of the laparoscopic approach in treating this type of cancer. Materials and Methods: Fifty-seven patients underwent radical surgery and 26 resections had a palliative purpose. Among radical resections, 52 were performed by using the open approach and 5 by using the laparoscopic approach. 14 cases out of 57 were completion procedures performed after a malignant histopathological finding was confirmed on a simple cholecystectomy specimen. In the majority of cases, the primary simple cholecystectomy was performed by laparoscopic approach. The laparoscopic approach was used in 3 cases of re-resection and 2 per-primam resections. Results: The median age of the patients was 64.21 years in the open group and 67.2 years in the laparoscopic group. Most patients were females. All patients had one or more comorbidities with an ASA score of 3 or 4 in 52 patients out of 57. ASA score had lower values in the laparoscopic group. The average surgery time for the laparoscopic group was 308 minutes, similar to the one for the open group that was 294 minutes. The complication rate was higher in the open group. The number of harvested lymph nodes was similar between the groups. The laparoscopic group benefited of lower postoperative pain, faster recovery and shorter hospital stay (6.2 days versus 13 days). Gallbladder cancer evolves asymptomatic in early stages and the diagnosis in advanced stages limits the therapeutic options. Still, in cases incidentally diagnosed on cholecystectomy specimens for presumed benign disease (stages T1-T3), the re-resection might be performed by laparoscopic approach. Also, in per-primam diagnosed selected cases, the laparoscopic resection might be performed by experimented teams. Conclusions: The laparoscopic approach is an ideal alternative to the open approach in treating early-stage gallbladder cancer. This surgical approach provides oncological safety, similar R0 resection rates and number of harvested lymph-nodes. The maximum benefit of this surgical approach is achieved in high-volume centers with experimented teams.
期刊介绍:
Chirurgia is a bimonthly journal. In Chirurgia, original papers in the area of general surgery which neither
appeared, nor were sent for publication in other periodicals, can be published. You can send original articles,
new surgical techniques, or comprehensive general reports on surgical topics, clinical case presentations and,
depending on publication space, - reviews of some articles of general interest to surgeons from other publications.
Chirurgia is also a place for sharing information about the activity of various branches of the Romanian Society of
Surgery, information on Congresses and Symposiums organized by the Romanian Society of Surgery and
participation notes in other scientific meetings.
Letters to the editor: Letters commenting on papers published in Chirurgia are welcomed. They should contain
substantive ideas and commentaries supported by appropriate data, and should not exceed 2 pages. Please
submit these letters to the editor through our online system.