European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2025
Open versus laparoscopic radical cholecystectomy for incidental and non-incidental gallbladder cancer. A propensity score analysis in a retrospective cohort from Chilean center.
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Muñoz César, Sepúlveda Guillermo, Rojas Jesús, González Franz, Sotelo Sergio, Varela Carlos, Marino Carlo, Ortega Carlidia
Аннотация
BACKGROUNDS: Radical cholecystectomy (RC) has few comparative studies between open (ORC) and laparoscopic (LRC) techniques for the treatment of gallbladder cancer (GBC). Our aim is to evaluate the short- and long-term outcomes of ORC versus LRC for the treatment of GBC in a high incidence center.
METHODS: Retrospective cohort study. All patients with incidental and non-incidental CVB from June 2014 to December 2021 in Regional Hospital of Talca, Chile were included. A comparison between ORC and LRC was performed for perioperative surgical and oncologic variables. Survival analysis was performed using the Kaplan-Meier method and Cox Regression.
RESULTS: A total of 312 patients were evaluated, 250 (80.4 %) were excluded due to stage IV at diagnosis and/or non-curative treatment. 62 (19.9 %) were treated with RC, 34(55 %) of them by laparoscopy. 51(82.6 %) were women. Mean age 62.7 years. 43 (68.8 %) were incidental GBC. 46 (75.8 %) were T2-3 GBC. Surgical time, resected lymph nodes, weight of the operative specimen, tumor type and R0 resection were not different between ORC and LRC. Hemorrhage, morbidity and operative stay were lower with LRC(p < 0.05). 1 (1.7 %) patient died after ORC (p = NS). With a median follow-up of 30 months the median survival at 12, 36 and 60 months was 92 %, 74 % and 72 % respectively. A multivariate survival analysis showed that TNM stage was the only factor associated with survival.
CONCLUSION: The short- and long-term results of LRC were better than ORC. A PSM analysis showed no significant difference; therefore, LRC should be adopted as the technique of choice when technically feasible.
METHODS: Retrospective cohort study. All patients with incidental and non-incidental CVB from June 2014 to December 2021 in Regional Hospital of Talca, Chile were included. A comparison between ORC and LRC was performed for perioperative surgical and oncologic variables. Survival analysis was performed using the Kaplan-Meier method and Cox Regression.
RESULTS: A total of 312 patients were evaluated, 250 (80.4 %) were excluded due to stage IV at diagnosis and/or non-curative treatment. 62 (19.9 %) were treated with RC, 34(55 %) of them by laparoscopy. 51(82.6 %) were women. Mean age 62.7 years. 43 (68.8 %) were incidental GBC. 46 (75.8 %) were T2-3 GBC. Surgical time, resected lymph nodes, weight of the operative specimen, tumor type and R0 resection were not different between ORC and LRC. Hemorrhage, morbidity and operative stay were lower with LRC(p < 0.05). 1 (1.7 %) patient died after ORC (p = NS). With a median follow-up of 30 months the median survival at 12, 36 and 60 months was 92 %, 74 % and 72 % respectively. A multivariate survival analysis showed that TNM stage was the only factor associated with survival.
CONCLUSION: The short- and long-term results of LRC were better than ORC. A PSM analysis showed no significant difference; therefore, LRC should be adopted as the technique of choice when technically feasible.