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Totally Laparoscopic Hepatic Bisegmentectomy (s4b+s5) and Hilar Lymphadenectomy for Incidental Gallbladder Cancer

Abstract

Background

Gallbladder cancer is suspected preoperatively in only 30 % of all patients, while the remaining 70 % of cases are discovered incidentally by the pathologist. The increasing rate of cholecystectomies via laparoscopy has led to the detection of more gallbladder cancers in an early stage, and extended resection with regional lymph node dissection has been suggested. We present a video of a totally laparoscopic liver resection (segments 5 and 4b) with regional lymphadenectomy in a patient with an incidental gallbladder cancer.

Methods

A 50-year-old woman underwent laparoscopic cholecystectomy, and pathology revealed a T1b gallbladder carcinoma. The patient was referred for further treatment. Contact with the primary surgeon revealed that no intraoperative cholangiogram was performed, and the gallbladder was removed intact, with no perforation, and inside a plastic retrieval bag. Pathology revision confirmed T1b, and positron emission tomography/computed tomography was negative. The multidisciplinary tumor board recommended radical re-resection, and a decision was made to perform a laparoscopic extended hilar lymphadenectomy, along the resection of segments 5 and 4b.

Results

Operative time was 5 h, with an estimated blood loss of 240 mL. Recovery was uneventful and the patient was discharged on the fourth postoperative day. Final pathology showed no residual disease and no lymph node metastasis.

Conclusions

Laparoscopic resection of liver segments 5 and 4b combined with a locoregional lymphadenectomy of the hepatoduodenal ligament is an oncologically appropriate technique, provided it is performed in a specialized center with experience in hepatobiliary surgery and advanced laparoscopic surgery. This video may help oncological surgeons to perform this complex procedure.

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References

  1. 1.

    Panebianco A, Volpi A, Lozito C, et al. Incidental gallbladder carcinoma: our experience. G Chir. 2013;34:167–9.

  2. 2.

    Ferrarese AG, Solej M, Enrico S, et al. Diagnosis of incidental gallbladder cancer after laparoscopic cholecystectomy: our experience. BMC Surg. 2013;13 Suppl 2:S20.

  3. 3.

    Toyonaga T, Chijiiwa K, Nakano K, et al. Completion radical surgery after cholecystectomy for accidentally undiagnosed gallbladder carcinoma. World J Surg. 2003;27:266–71.

  4. 4.

    Lendoire JC, Gil L, Duek F, et al. Relevance of residual disease after liver resection for incidental gallbladder cancer. HPB. 2012;14:548–53.

  5. 5.

    Mayo SC, Shore AD, Nathan H, et al. National trends in the management and survival of surgically managed gallbladder adenocarcinoma over 15 years: a population-based analysis. J Gastrointest Surg. 2010;14:1578–91.

  6. 6.

    Gil L, Lendoire J, Duek F, et al. Radical surgery for incidental gallbladder cancer: the value of a deferred pathological finding of residual disease [in Spanish]. Cir Esp. 2014;92:168–74.

  7. 7.

    Cavallaro A, Piccolo G, Panebianco V, et al. Incidental gallbladder cancer during laparoscopic cholecystectomy: managing an unexpected finding. World J Gastroenterol. 2012;18:4019–27.

  8. 8.

    Goetze TO, Paolucci V. Incidental T1b-T3 gallbladder carcinoma. Extended cholecystectomy as an underestimated prognostic factor-results of the German registry [in German]. Chirurg. 2014;85:131–8.

  9. 9.

    Yi X, Long X, Zai H, et al. Unsuspected gallbladder carcinoma discovered during or after cholecystectomy: focus on appropriate radical re-resection according to the T-stage. Clin Transl Oncol. 2013;15:652–8.

  10. 10.

    Choi KS, Choi SB, Park P, et al. Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: a systematic review and meta-analysis. World J Gastroenterol. 2015;21:1315–23.

  11. 11.

    Tian YH, Ji X, Liu B, et al. Surgical treatment of incidental gallbladder cancer discovered during or following laparoscopic cholecystectomy. World J Surg. 2015;39:746–52.

  12. 12.

    Goetze TO, Paolucci V. Immediate radical re-resection of incidental T1b  gallbladder cancer and the problem of an adequate extent of resection (results of the German Registry “Incidental Gallbladder Cancer”) [in German]. Zentralbl Chir. 2014;139 Suppl 2:e43–8.

  13. 13.

    Goetze TO, Paolucci V. Prognosis of incidental gallbladder carcinoma is not influenced by the primary access technique: analysis of 837 incidental gallbladder carcinomas in the German Registry. Surg Endosc. 2013;27:2821–8.

  14. 14.

    Fuks D, Regimbeau JM, Pessaux P, et al. Is port-site resection necessary in the surgical management of gallbladder cancer? J Visc Surg. 2013;150:277–84.

  15. 15.

    Maker AV, Butte JM, Oxenberg J, et al. Is port site resection necessary in the surgical management of gallbladder cancer? Ann Surg Oncol. 2012;19:409–17.

  16. 16.

    Goetze TO, Paolucci V. The prognostic impact of positive lymph nodes in stages T1 to T3 incidental gallbladder carcinoma: results of the German Registry. Surg Endosc. 2012;26:1382–9.

  17. 17.

    Pawlik TM, Gleisner AL, Vigano L, et al. Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection. J Gastrointest Surg. 2007;11:1478–86.

  18. 18.

    Machado MA, Makdissi FF, Surjan RC. Totally laparoscopic right hepatectomy with Roux-en-Y hepaticojejunostomy for right-sided intraductal papillary mucinous neoplasm of the bile duct. Ann Surg Oncol. 2014;21:1841–3.

  19. 19.

    Gumbs AA, Hoffman JP. Laparoscopic radical cholecystectomy and Roux-en-Y choledochojejunostomy for gallbladder cancer. Surg Endosc. 2010;24:1766–8.

  20. 20.

    Machado MA, Makdissi FF, Galvão FH, Machado MC. Intrahepatic Glissonian approach for laparoscopic right segmental liver resections. Am J Surg 2008;196:e38–42.

  21. 21.

    Machado MA, Makdissi FF, Surjan RC, et al. Laparoscopic resection of left liver segments using the intrahepatic Glissonian approach. Surg Endosc. 2009;23:2615–9.

  22. 22.

    Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection–2,804 patients. Ann Surg. 2009;250:831–41.

  23. 23.

    Gumbs AA, Hoffman JP. Laparoscopic completion radical cholecystectomy for T2 gallbladder cancer. Surg Endosc. 2010;24:3221-3.

  24. 24.

    Shirobe T, Maruyama S. Laparoscopic radical cholecystectomy with lymph node dissection for gallbladder carcinoma. Surg Endosc. 2014 doi:10.1007/s00464-014-3932-9.

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Disclosure

Drs. Machado, Makdissi, and Surjan have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Marcel Autran Machado MD, FACS.

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Supplementary material 1 (WMV 55317 kb)

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Machado, M.A., Makdissi, F.F. & Surjan, R.C. Totally Laparoscopic Hepatic Bisegmentectomy (s4b+s5) and Hilar Lymphadenectomy for Incidental Gallbladder Cancer. Ann Surg Oncol 22, 336–339 (2015) doi:10.1245/s10434-015-4650-9

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Keywords

  • Laparoscopic Cholecystectomy
  • Gallbladder Cancer
  • Gallbladder Carcinoma
  • Laparoscopic Liver Resection
  • Hepatoduodenal Ligament