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

Abstract

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.

Keywords

• Bisegmentectomy
• cholecystectomy
• extended
• gallbladder cancer
• laparoscopy
• radical