A prospective observational study of laparoscopic approaches for suspected gallbladder cancer in Yamaguchi (YPB-002 LAGBY)

Abstract

Abstract Background: We have previously reported a novel laparoscopic approach for total biopsy of suspected gallbladder cancer (GBC). To evaluate the safety of this approach, the Laparoscopic Approaches for suspected GBC in Yamaguchi (YPB-002 LAGBY) study (UMIN ID 000035352) was conducted as a prospective observational study. Methods:From August 2018 to September 2022, a laparoscopic approach was applied for 40 patients with suspected GBC based on preoperative imaging diagnosis. Laparoscopic whole-layer cholecystectomy (LWLC) was performed for early-stage or suspected malignant lesions without liver invasion and laparoscopic gallbladder bed resection (LGBR) was performed for lesions with an unclear border between the gallbladder and liver. The appropriate strategy could be selected postoperatively depending on the final pathological diagnosis according to examination of permanent sections of gallbladder. However, if preoperative imaging reveals enlarged lymph nodes (LNs) with possible metastases, LN sampling with intraoperative pathological diagnosis is performed prior to gallbladder removal to determine whether to introduce neoadjuvant chemotherapy. Results: We performed LWLC in 30 cases, LGBR in 8 cases, and LN sampling alone in 2 cases. Median operation time was 165 min and median blood loss was 5.5 ml. No bile leakage caused by intraoperative perforation of the gallbladder was observed. Histologically, GBC was diagnosed in 16 cases (pTis, n=2; pT1a, n=2; pT1b, n=2; pT2, n=6, pT3, n=4). Seven of the 10 pT2/3 cases underwent additional open lymphadenectomy. Conclusions: Our laparoscopic approach for suspected GBC appears to represent a safe, useful procedure that could play an important role in the optimal treatment strategy.