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Current Role of Minimally Invasive Radical Cholecystectomy for Gallbladder Cancer

机译:微创根治性胆囊切除术在胆囊癌中的作用

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摘要

Background. For Tis and T1a gallbladder cancer (GbC), laparoscopic cholecystectomy can provide similar survival outcomes compared to open cholecystectomy. However, for patients affected by resectable T1b or more advanced GbC, open approach radical cholecystectomy (RC), consisting in gallbladder liver bed resection or segment 4b-5 bisegmentectomy, with locoregional lymphadenectomy, is considered the gold standard while minimally invasive RC (MiRC) is skeptically considered. Aim. To analyze current literature on perioperative and oncologic outcomes of MiRC for patients affected by GbC. Methods. A Medline review of published articles until June 2016 concerning MiRC for GbC was performed. Results. Data relevant for this review were presented in 13 articles, including 152 patients undergoing an attempt of MiRC for GbC. No randomized clinical trial was found. The approach was laparoscopic in 147 patients and robotic in five. Conversion was required in 15 (10%) patients. Postoperative complications rate was 10% with no mortality. Long-term survival outcomes were reported by 11 studies, two of them showing similar oncologic results when comparing MiRC with matched open RC. Conclusions. Although randomized clinical trials are still lacking and only descriptive studies reporting on limited number of patients are available, current literature seems suggesting that when performed at highly specialized centers, MiRC for GbC is safe and feasible and has oncologic outcomes comparable to open RC.
机译:背景。对于Tis和T1a胆囊癌(GbC),与开腹胆囊切除术相比,腹腔镜胆囊切除术可以提供相似的生存结果。但是,对于受可切除的T1b或更高级的GbC影响的患者,开放式根治性胆囊切除术(RC)包括胆囊肝床切除术或4b-5段双段切除术以及局部淋巴结清扫术,被认为是金标准,而微创RC(MiRC)怀疑地考虑。目标。分析有关GbC患者的MiRC围手术期和肿瘤学结局的最新文献。方法。对截至2016年6月的有关GbC的MiRC的已发表文章进行了Medline审查。结果。与该评价相关的数据在13篇文章中提供,包括152例针对GbC的MiRC尝试的患者。未发现随机临床试验。该方法为147例患者进行腹腔镜检查,其中5例为机器人检查。 15(10%)位患者需要进行转换。术后并发症发生率为10%,无死亡。 11项研究报告了长期生存结果,其中两项在比较MiRC与匹配的开放式RC时显示出相似的肿瘤学结果。结论。尽管仍缺乏随机临床试验,并且仅提供了有关有限数量患者的描述性研究,但现有文献似乎表明,在高度专业化的中心进行的MiRC用于GbC的治疗是安全可行的,其肿瘤学结果可与开放RC媲美。

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