Role of Minimally Invasive Reoperation for Postoperatively Diagnosed T2 Gallbladder Cancer: Multicenter Retrospective Cohort Study

초록

BACKGROUND: Although T2 gallbladder cancer (GBC) incidentally diagnosed after cholecystectomy requires additional resection, the surgical approaches are technically difficult due to inflammatory adhesion or fibrosis around the hepatoduodenal ligament and gallbladder bed. In this study, we sought to compare the surgical and oncologic outcomes of open and minimally invasive reoperation for postoperatively diagnosed T2 GBC. METHODS: Patients who underwent open (n = 110) and laparoscopic (n = 38) reoperation for T2 GBC between November 2004 and October 2022 at five tertiary referral centers were included in this multicenter retrospective cohort study. The short- and long-term outcomes were compared between the two groups. RESULTS: There were no differences in clinicopathological characteristics between the open and laparoscopic groups. Liver resection was more frequent in the open group (101 [91.8%] vs. 21 [55.3%], P < 0.001). Compared with open surgery, laparoscopic reoperation was associated with shorter postoperative hospital stay (9.0 [8.0-10.0] vs. 6.0 [3.8-8.3] days, P < 0.001) and a lower postoperative complication rate (24 [21.8%] vs. 1 [2.6%], P = 0.013). Among patients who underwent liver resection, the postoperative hospital stay was shorter in the laparoscopic group (9.0 [8.0-10.0] vs. 6.0 [4.0-9.0] days, P = 0.004). The 5-year disease-free survival (66.7% vs. 76.1%, P = 0.749) and overall survival (75.2% vs. 73.7%, P = 0.789) rates were not significantly different between the two groups. CONCLUSIONS: The results indicate that laparoscopic reoperation for postoperatively diagnosed T2 GBC has favorable postoperative outcomes and similar oncologic safety compared with open surgery. Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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