• Gallbladder Neoplasms
• Gallbladder diseases
• Laparoscopic cholecystectomy

• bibliometric analysis
• gallbladder cancer
• laparoscopic surgery
• postoperative management
• surgery

• Cholecystectomy
• Gallbladder cancer
• Laparoscopic
• Meta-analysis
• Minimally invasive
• Robotic

• Humans
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystectomy, Laparoscopic/methods
• Gallbladder Neoplasms/surgery
• Gallbladder Neoplasms/mortality
• Gallbladder Neoplasms/pathology
• Length of Stay/statistics & numerical data
• Network Meta-Analysis
• Operative Time
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/methods

• Gallbladder cancer
• Laparoscopy
• Meta-analysis
• Open

• Gallbladder carcinoma
• Laparoscopic radical resection
• Meta-analysis
• Open radical resection
• Outcome
• Systematic review

• Cholecystectomy
• Gallbladder neoplasms
• Laparoscopic surgery
• Meta-analysis

• Gallbladder cancer
• Gallbladder carcinoma
• Gallbladder neoplasm
• Laparoscopic
• Minimally invasive

• Gallbladder Neoplasms/surgery
• Humans
• Laparoscopy
• Research Design

• cholecystectomy
• hepatectomy
• prognosis
• radical re-resection
• unsuspected gallbladder carcinoma

• Cholecystectomy
• Extended
• Gallbladder cancer
• Laparoscopic cholecystectomy
• Simple

The aim of this review was to evaluate the effect of laparoscopic surgery on the treatment of patients with gallbladder cancer (GBC).

A comprehensive search of Medline and Cochrane Library was conducted to identify relevant articles. A meta-analysis was subsequently performed.

A total of 20 studies including 1217 patients met the inclusion criteria. The meta-analysis showed that the 5-year survival rate was significant higher in laparoscopic group than open group (48.4% vs. 38.5%; odds ratio [OR], 1.63; 95% confidence interval [CI], 1.22–2.19; P = 0.001). Although the scar recurrence rate was significant higher in laparoscopic group than open group (7.1% vs. 4.0%; OR, 2.10; 95% CI, 1.11–3.96; P = 0.02), the overall recurrence rates between two groups were not significant different (44.8% vs. 42.2%; OR, 0.86; 95% CI, 0.64–1.14; P = 0.29). In addition, compared with open extended cholecystectomy (EC), laparoscopic EC (LEC) was associated with less intraoperative blood loss, shorter post-operative hospital stays and insignificant less complication rate (10.0% vs. 18.3%; OR, 0.51; 95% CI, 0.15–1.73; P = 0.28).

Laparoscopic simple cholecystectomy does not lead to a worse prognosis when applied on patients with GBC. LEC can be performed in specialised expert centres on elective patients.

• Gallbladder cancer
• laparoscopic
• meta-analysis
• open

• Cholecystectomy
• Gallbladder neoplasm
• Laparoscopic cholecystectomy
• Surgical oncology

Radical resection is an effective therapeutic method to increase the survival rate of patients with gallbladder cancer (GBC). In addition to the surgical approach, the relationships between various clinicopathologic factors and the outcome of patients with GBC remain controversial.

Clinical and laboratory examination characteristics, pathological and surgical data, and post-operative survival time of 338 patients with advanced GBC who received treatment at the First Affiliated Hospital of Xi'an Jiaotong University, China from January 2008 to December 2012 were analyzed retrospectively. Factors influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analysis.

The overall survival rates for curative resection patients were significantly greater than those for non-curative resection patients (1-,3-,5-year survival rate and mean-survival time: 59.0%, 47.3%, 44.3% and 22.0 months vs. 12.7%, 8.3%, 7.7% and 3.0 months) (P < 0.001). For the curative resection patients, positive margin, lymph node metastasis, poorly pathological differentiation and the presence of ascites were all independent risk factors for poor prognosis. For patients with T3 stage, neither segmentectomy of IVb and V nor common bile duct resection improved the prognosis (P = 0.867 and P = 0.948). For patients with T4 stage, aggressive curative resection improved the prognosis (P = 0.007).

An advanced T stage does not preclude curative resection. Positive margin, lymph node metastasis, poorly pathological differentiation and the presence of ascites are all independent risk factors for poor prognosis in the curative intent resection patients. The range of liver resection and whether common bile duct resection is performed do not influence the prognosis as long as R0 resection is achieved.

• Cholecystectomy, Laparoscopic/methods
• Female
• Follow-Up Studies
• Gallbladder Neoplasms/diagnosis
• Gallbladder Neoplasms/mortality
• Gallbladder Neoplasms/surgery
• Humans
• Length of Stay/trends
• Male
• Middle Aged
• Neoplasm Staging
• Republic of Korea/epidemiology
• Retrospective Studies
• Survival Rate/trends
• Time Factors
• Treatment Outcome

Gallbladder cancer is the most common malignant tumor of the biliary tract. It is difficult to diagnose early due to the lack of special symptoms and physical signs. Most cases are diagnosed in advanced stages and the response to traditional chemotherapy and radiotherapy is extremely limited, with modest impact on overall survival. Despite improvements in outcome associated with extended resections, selection of patients for such extensive surgery remains controversial. In this article, we analyze and discuss the key issues about the surgical management of gallbladder cancer, with the hope of a more comprehensive recognition of this malignancy.

• Gallbladder cancer
• Surgical treatment
• R0 resection
• Lymphadenectomy

• EUS
• Gallbladder bed resection
• Gallbladder carcinoma
• Laparoscopic resection
• Lymphadenectomy

AIM: To perform a systematic review of incidental or unsuspected gallbladder (GB) cancer diagnosed during or after cholecystectomy.

METHODS: Data in PubMed, EMBASE, and Cochrane Library were reviewed and 26 publications were included in the meta-analysis. The inclusion criterion for incidental GB cancer was GB cancer diagnosed during or after cholecystectomy that was not suspected at a preoperative stage. Pooled proportions of the incidence, distribution of T stage, and revisional surgery of incidental GB cancer were analyzed.

RESULTS: The final pooled population comprised 2145 patients with incidental GB cancers. Incidental GB cancers were found in 0.7% of cholecystectomies performed for benign gallbladder diseases on preoperative diagnosis (95%CI: 0.004-0.012). Nearly 50% of the incidental GB cancers were stage T2 with a pooled proportion of 47.0% (95%CI: 0.421-0.519). T1 and T3 GB cancers were found at a similar frequency, with pooled proportions of 23.0% (95%CI: 0.178-0.291) and 25.1% (95%CI: 0.195-0.317), respectively. The pooled proportion that completed revisional surgery for curative intent was 40.9% (95%CI: 0.329-0.494). The proportion of patients with unresectable disease upon revisional surgery was 23.0% (95%CI: 0.177-0.294).

CONCLUSION: A large proportion of incidental GB cancers were T2 and T3 lesions. Revisional surgery for radical cholecystectomy is warranted in T2 and more advanced cancers.

• Gallbladder cancer
• Laparoscopic surgery
• Cholecystectomy
• Revisional surgery
• Incidental diagnosis

• Cholecystectomy
• Gallbladder Neoplasms/diagnosis
• Gallbladder Neoplasms/epidemiology
• Gallbladder Neoplasms/pathology
• Gallbladder Neoplasms/surgery
• Humans
• Incidence
• Incidental Findings
• Neoplasm Staging
• Reoperation
• Risk Factors
• Treatment Outcome

• Adult
• Aged
• Carcinoma/mortality
• Carcinoma/pathology
• Carcinoma/surgery
• Cholecystectomy, Laparoscopic
• Female
• Gallbladder Neoplasms/mortality
• Gallbladder Neoplasms/pathology
• Gallbladder Neoplasms/surgery
• Humans
• Incidental Findings
• Length of Stay
• Lymph Node Excision
• Male
• Middle Aged
• Operative Time
• Retrospective Studies

AIM: To access the short-term outcomes of simultaneous laparoscopic surgery combined with resection for synchronous lesions in patients with colorectal cancer.

METHODS: Between March 1996 and April 2010 prospectively collected data were reviewed from 93 consecutive patients who had colorectal cancer and underwent simultaneous multiple organ resection (combined group) and 1090 patients who underwent conventional laparoscopic right hemicolectomy or laparoscopic low/anterior resection for colorectal cancer (non-combined group). In the combined group, there were nine gastric resections, three nephrectomies, nine adrenalectomies, 56 cholecystectomies, and 21 gynecologic resections. In addition, five patients underwent simultaneous laparoscopic resection for three organs. The patient demographics, intra-operative outcomes, surgical morbidity, and short-term outcomes were compared between the two groups (the combined and non-combined groups).

RESULTS: There were no significant differences in the clinicopathological variables between the two groups. The operating time was significantly longer in the combined group than in the non-combined group, regardless of tumor location (laparoscopic right hemicolectomy and laparoscopic low/anterior resection groups; P = 0.048 and P < 0.001, respectively). The other intra-operative outcomes, such as the complications and open conversion rate, were similar in both groups. The rate of post-operative morbidity in the combined group was similar to the non-combined group (combined vs non-combined, 15.1% vs 13.5%, P = 0.667). Oncological safety for the colon and synchronous lesions were obtained in the combined group.

CONCLUSION: Simultaneous laparoscopic multiple organ resection combined with colorectal cancer is a safe and feasible option in selected patients.

• Laparoscopic combined resection
• Colorectal cancer
• Laparoscopic surgery

AIM: To evaluate the efficacy of simple and extended cholecystectomy for mucosa (T1a) or muscularis (T1b) gallbladder (GB) cancer.

METHODS: Original studies on simple and extended cholecystectomy for T1a or T1b GB cancer were searched from MEDLINE (PubMed), Cochrane Library, EMBase, and CancerLit using the search terms of GB, cancer/carcinoma/tumor/neoplasm.

RESULTS: Twenty-nine out of the 2312 potentially relevant publications met the eligibility criteria. Of the 1266 patients with GB cancer included in the publications, 706 (55.8%) and 560 (44.2%) had T1a and T1b GB cancer, respectively. Simple cholecystectomy for T1a and T1b GB cancer was performed in 590 (83.6%) and 375 (67.0%) patients, respectively (P < 0.01). In most series, the treatment of choice was simple cholecystectomy for T1a GB cancer patients with a 5-year survival rate of 100%. Lymph node metastasis was detected in 10.9% of the T1b GB cancer patients and in 1.8% of the T1a GB cancer patients, respectively (P < 0.01). Eight patients (1.1%) with T1a GB cancer and 52 patients (9.3%) with T1b GB cancer died of recurrent GB cancer (P < 0.01).

CONCLUSION: Simple cholecystectomy represents the adequate treatment of T1a GB cancer. There is no definite evidence that extended cholecystectomy is advantageous over simple cholecystectomy for T1b GB cancer.

• Gallbladder
• Cancer
• Cholecystectomy
• Simple
• Extended

• Biliary Tract Diseases/surgery
• Biliary Tract Surgical Procedures/methods
• Biliary Tract Surgical Procedures/standards
• Cholangiopancreatography, Endoscopic Retrograde
• Cholecystectomy, Laparoscopic/methods
• Cholecystectomy, Laparoscopic/standards
• Choledocholithiasis/surgery
• Common Bile Duct/surgery
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Laparoscopy/standards
• Laparotomy
• Postoperative Care
• Preoperative Care

• gallbladder cancer
• t1b
• decision analysis
• surgery

AIM: To explore the effectiveness of surgeons in determining the unsuspected gallbladder carcinoma (UGC) at laparoscopic cholecystectomy (LC) and the management of UGC.

METHODS: A total of 6429 patients with gallbladder disease were included in this study who underwent LC during June, 1989 and November, 2008. Patients with UGC were reviewed retrospectively to assess preoperative diagnosis, intraoperative findings and outcomes.

RESULTS: Of the total patients, 27 in 6429 (0.4%) were histopathologically diagnosed as UGC during (17) or after (10) LC. The tumor stages of the 27 diagnosed were pT₁ (9), pT₂ (9), and pT₃ (91), each with 9 cases. The survival rates of all the UCG patients in one-year, three-year and five-year were 74.1%, 63% and 59.3%, respectively. The five-year survival rates of pT₁ stage, pT₂ stage and pT₃ stage were 100%, 66.7% and 0.0%, respectively, not significantly affected by whether the patients had been diagnosed with UGC during or after LC (P < 0.05).

CONCLUSION: The survival rate from UGC is associated with tumor stage and it is confirmed that a carefully performed LC is adequate treatment for pT₁ stage cancer. If a suspicious lesion is found, intraoperative frozen section is performed for pathological examination. However, radical operation is recommended for T₂ patients and effective measures should be taken to avoid tumor implant and metastasis.

• Laparoscopic cholecystectomy
• Gallbladder carcinoma
• Unsuspected gallbladder carcinoma