Current status and progress in laparoscopic surgery for gallbladder carcinoma

Abstract

Gallbladder carcinoma (GBC) is the most common biliary tract malignancy associated with a concealed onset, high invasiveness and poor prognosis. Radical surgery remains the only curative treatment for GBC, and the optimal extent of surgery depends on the tumor stage. Radical resection can be achieved by simple cholecystectomy for Tis and T1a GBC. However, whether simple cholecystectomy or extended cholecystectomy, including regional lymph node dissection and hepatectomy, is the standard surgical extent for T1b GBC remains controversial. Extended cholecystectomy should be performed for T2 and some T3 GBC without distant metastasis. Secondary radical surgery is essential for incidental gall-bladder cancer diagnosed after cholecystectomy. For locally advanced GBC, hepatopancreatoduodenectomy may achieve R0 resection and improve long-term survival outcomes, but the extremely high risk of the surgery limits its implementation. Laparoscopic surgery has been widely used in the treatment of gastrointestinal malignancies. GBC was once regarded as a contraindication of laparoscopic surgery. However, with improvements in surgical instruments and skills, studies have shown that laparoscopic surgery will not result in a poorer prognosis for selected patients with GBC compared with open surgery. Moreover, laparoscopic surgery is associated with enhanced recovery after surgery since it is minimally invasive.

Keywords: Gallbladder carcinoma; Laparoscopic surgery; Simple cholecystectomy; Extended cholecystectomy; Hepatopancreatoduodenectomy; Incidental gallbladder cancer

Core Tip: Gallbladder carcinoma (GBC) is the most common biliary tract malignancy with a poor prognosis. Radical surgery is the mainstay of treatment, and the surgical extent depends on the tumor stage. Meanwhile, laparoscopic surgery has the advantage of enhanced recovery after surgery because it is minimally invasive, and has been widely used to treat gastrointestinal malignancies. Although GBC was once regarded as a contraindication for laparoscopic surgery, with improved surgical instruments and skills, recent studies have shown that laparoscopic surgery will not lead to a poorer prognosis compared with open surgery among selected patients with GBC in specialized centers.