Laparoscopy Versus Open Reoperation for Incidental Gallbladder Carcinoma After Laparoscopic Cholecystectomy.

Background

Some reports assert that there is a risk that laparoscopy might worsen the prognosis of incidental gallbladder carcinoma (IGBC) after laparoscopic cholecystectomy (LC) compared with open reoperation. The purpose of this study was to evaluate whether the surgical approach influences outcomes in patients with IGBC after LC.

Methods

We retrospectively reviewed the medical records of 106 patients diagnosed with IGBC who had undergone LC for benign gallbladder disease such as cholecystolithiasis at our hospital between April 2010 and February 2018. We included patients with incidentally diagnosed GBC after routine pathology: 45 patients (16 men and 29 women; age: 45-76 years [mean: 62.6 years]) who underwent laparoscopic surgery and 61 patients (24 men and 37 women; age: 51-82 years [mean: 62.6 years]) who underwent open surgery. We evaluated outcomes in each group regarding tumor stage and operative time, time of reoperation after first operation, blood loss volume, number of lymph nodes in pathological specimens, hospital stay, and complication and survival rates.

Results

Reoperation time after first operation, number of lymph nodes in pathological specimens, and operative time showed no statistical significance between laparoscopy and open reoperation. During follow-up, 3-year survival between laparoscopy (48.89%) and open reoperation (42.62%) showed no statistical significance, but laparoscopy had better 1-year survival (95.56% versus 86.89%, laparoscopy versus open, respectively; not significant [NS] <0.01) and 5-year survival (44.44% versus 29.51%, laparoscopy versus open, respectively; NS <0.05). However, comparing laparoscopy versus open surgery, respectively, blood -loss volume (100 ± 25.4 mL versus 200 ± 45.6 mL; NS <0.01), hospital stay (3.5 ± 1.9 days versus 5.6 ± 2.7 days, NS <0.01), and complication rates (6.7% versus 13.1%; NS <0.01) were lower, indicating better recovery and better patient experience.

Conclusions

Laparoscopic radical reoperation for IGBC after LC is a feasible, effective, and safe procedure and is associated with less bleeding, low morbidity, and shorter hospital stay.