Laparoscopic Surgery for Gallbladder Cancer: An Expert Consensus Statement

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Authors: Ho-Seong Han ; Yoo-Seok Yoon ; Anil K. Agarwal ; Giulio Belli ; Osamu Itano ; Andrew A. Gumbs ; Dong Sup Yoon ; Chang Moo Kang ; Seung Eun Lee ; Toshifumi Wakai ; Roberto I. Troisi

MeSH: Cholecystectomy, Laparoscopic*/adverse effects ; Consensus ; Contraindications, Procedure ; Gallbladder Neoplasms/diagnosis* ; Gallbladder Neoplasms/surgery* ; Hepatectomy/methods ; Humans ; Incidental Findings ; Lymph Node Excision/methods ; Patient Selection ; Practice Guidelines as Topic ; Reoperation ; Survival Rate

Abstract: BACKGROUND: Despite the increasing number of reports on the favorable outcomes of laparoscopic surgery for gallbladder cancer (GBC), there is no consensus regarding this surgical procedure.

OBJECTIVE: The study aimed to develop a consensus statement on the application of laparoscopic surgery for GBC based on expert opinions.

METHODS: A consensus meeting among experts was held on September 10, 2016, in Seoul, Korea.

RESULTS: Early concerns regarding port site/peritoneal metastasis after laparoscopic surgery have been abated by improved preoperative recognition of GBC and careful manipulation to avoid bile spillage. There is no evidence that laparoscopic surgery is associated with decreased survival compared with open surgery in patients with early-stage GBC if definitive resection during/after laparoscopic cholecystectomy is performed. Although experience with laparoscopic extended cholecystectomy for GBC has been limited to a few experts, the postoperative and survival outcomes were similar between laparoscopic and open surgeries. Laparoscopic reoperation for postoperatively diagnosed GBC is technically challenging, but its feasibility has been demonstrated by a few experts.

CONCLUSIONS: Laparoscopic surgery for GBC is still in the early phase of the adoption curve, and more evidence is required to assess this procedure.