Long Huang1,2, Chenjun Zhang1,2, Yifeng Tian1,2, Chengyu Liao1,2, Maolin Yan1,2, Funan Qiu1,2, Songqiang Zhou1,2, Zhide Lai1,2, Yaodong Wang1,2, Ye Lin3, Shi Chen4,5. 1. Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, No. 134 East Street, Fuzhou, 350001, China. 2. Department of Hepatobiliary and pancreatic Surgery, Fujian Provincial Hospital, Fujian Medical University, No. 134 East Street, Fuzhou, 350001, China. 3. Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Guangzhou, 510080, China. 25410818@qq.com. 4. Shengli Clinical Medical College of Fujian Medical University, Fujian Medical University, No. 134 East Street, Fuzhou, 350001, China. wawljwalj@163.com. 5. Department of Hepatobiliary and pancreatic Surgery, Fujian Provincial Hospital, Fujian Medical University, No. 134 East Street, Fuzhou, 350001, China. wawljwalj@163.com.
Abstract
BACKGROUND: There is still controversy over whether to perform laparoscopic surgery for T3 stage gallbladder cancer. In addition, the necessity of segment 4b+5 liver resection for stage T3 gallbladder has not been reported. This article aims to explore the safety, effectiveness, and short-term prognosis of laparoscopic segment 4b+5 liver resection for T3 stage gallbladder cancer. METHODS: This is a retrospective multicenter propensity score-matched study. Disease-free survival, perioperative complications, and intraoperative safety were analyzed to evaluate safety and effectiveness. RESULTS: There was no significant difference in the incidence of intraoperative bleeding, number of lymph nodes obtained, postoperative complications, or disease-free survival (DFS) between the open group (OG) and laparoscopic group (LG) (P > 0.05). The DFS time of the S4b+5 resection group (S4b5) was longer than that of the wedge group (P = 0.016). Cox regression showed that positive margins (HR, 5.32; 95% CI 1.03-27.63; P = 0.047), lymph node metastasis (HR, 2.70; 95% CI 1.31-5.53; P = 0.007), and liver S4b+5 resection (HR, 0.30; 95% CI 0.14-0.66; P = 0.003) were independent risk factors for DFS. The operative time of indocyanine green (ICG) fluorescence-guided liver S4b5 segment resection was shorter than that of traditional laparoscopic S4b+5 resection guided by hepatic veins (P ≤ 0.001). CONCLUSION: Laparoscopic liver S4b+5 resection for T3 stage gallbladder cancer is safe and feasible and can prolong DFS. ICG fluorescence-guided negative staining may reduce the difficulty of the operation.
BACKGROUND: There is still controversy over whether to perform laparoscopic surgery for T3 stage gallbladder cancer. In addition, the necessity of segment 4b+5 liver resection for stage T3 gallbladder has not been reported. This article aims to explore the safety, effectiveness, and short-term prognosis of laparoscopic segment 4b+5 liver resection for T3 stage gallbladder cancer. METHODS: This is a retrospective multicenter propensity score-matched study. Disease-free survival, perioperative complications, and intraoperative safety were analyzed to evaluate safety and effectiveness. RESULTS: There was no significant difference in the incidence of intraoperative bleeding, number of lymph nodes obtained, postoperative complications, or disease-free survival (DFS) between the open group (OG) and laparoscopic group (LG) (P > 0.05). The DFS time of the S4b+5 resection group (S4b5) was longer than that of the wedge group (P = 0.016). Cox regression showed that positive margins (HR, 5.32; 95% CI 1.03-27.63; P = 0.047), lymph node metastasis (HR, 2.70; 95% CI 1.31-5.53; P = 0.007), and liver S4b+5 resection (HR, 0.30; 95% CI 0.14-0.66; P = 0.003) were independent risk factors for DFS. The operative time of indocyanine green (ICG) fluorescence-guided liver S4b5 segment resection was shorter than that of traditional laparoscopic S4b+5 resection guided by hepatic veins (P ≤ 0.001). CONCLUSION: Laparoscopic liver S4b+5 resection for T3 stage gallbladder cancer is safe and feasible and can prolong DFS. ICG fluorescence-guided negative staining may reduce the difficulty of the operation.
Authors: K Uesaka; K Yasui; T Morimoto; A Torii; Y Yamamura; Y Kodera; T Hirai; T Kato; T Kito Journal: J Am Coll Surg Date: 1996-10 Impact factor: 6.113
Authors: R Zhang; Y H Wu; D Zhang; Y J Zhang; Y H Qiu; N Yang; T Q Song; J Y Lou; J T Li; X H Mao; S P Li; S B Si; Z Q Cai; C Chen; Z M Geng; Z H Tang Journal: Zhonghua Wai Ke Za Zhi Date: 2020-04-01
Authors: G Piccolo; M Di Vita; A Cavallaro; R Fisichella; A Zanghì; D Spartà; F Cardì; A Cappellani Journal: Eur Rev Med Pharmacol Sci Date: 2014-12 Impact factor: 3.507