Minimally Invasive Surgery For Gallbladder Cancer Needing Adjacent Viscera Resection

ABSTRACT

Background: The minimally invasive surgery (MIS) in GBC is being increasingly performed with superior short term results and non-inferior oncological outcomes. Most of the studies on minimally invasive radical cholecystectomy (MIRC) included patients with GBC limited to the gall bladder. Bile duct or adjacent viscera has been resected only in a very few studies. One of the reasons perhaps for not imbibing MIS in advanced GBC is the innate complexity of resection of the involved adjacent organs and need performing a bilioenteric anastomosis. Aim of this study is to assess safety, feasibility and short-term outcomes of locally advanced GBC patients who underwent MIRC with adjacent bile duct or viscera resection. Methods: Retrospective analysis of prospectively maintained data of 11 patients who underwent MIRC with adjacent viscera resection for suspected case of GBC in a single surgical unit between January 2017 to December 2019 at Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, a tertiary referral teaching institute. Results: During the study period 11 patients underwent adjacent viscera resection along with MIRC.Ten patients had Common bile duct (CBD) excision (4 choledochal cyst and 6 direct tumor infiltration), four patients had gastroduodenal resection (3 sleeve duodenectomy and 1 distal gastrectomy with proximal duodenectomy) and three patients had colonic resection (2 sleeve resection and 1 segmental resection). Seven patients had single organ resection (3 CBD and 4 CDC), 2 of them had double organ (CBD & duodenum, duodenum & colon) and 2 patients had triple organ resection (CBD, duodenum and colon). Conclusion: The minimally invasive approach inGBC patients who need extrahepatic adjacent viscera resection was found to be feasible and safe with favourable perioperative and oncological outcomes.Further studies are needed from high-volume centres engaged in minimally invasive hepatobiliary surgery.