Laparoscopic Resection of Biliary Malignancies

Osamu Itano, MD PhD, Go Oshima, MD, Minoru Tanabe, MD PhD, Shigeyuki Kawachi, MD PhD, Masahiro Shinoda, MD PhD, Minoru Kitagou, MD PhD, Ryo Nishiyama, MD, Hiroto Fujisaki, MD, Kysho Mihara, MD, Tomonori Fujimura, MD, Yoshie Kadota, MD, Shigenori Ei, MD, Yusuke Katsuki, MD, Masanori Odaira, MD, Masayuki Tanaka, MD, Satoshi Aikou, MD PhD, Yuko Kitagawa, MD PhD. Department of Surgery, Keio University, School of Medicine, Tokyo, Japan; and Department of Surgery, Eiju General Hospital, Tokyo, Japan


PURPOSE: The purpose of this study was to evaluate short term results of the laparoscopic resection of biliary malignancies
METHODS AND PROCEDURES: From May 2007 to September 2011, there were 20 laparoscopic surgeries for biliary malignaincies carried out at our hospital. Laparoscopic-assisted pylorus preserving pancreaticoduodenectomy was performed for one ampulla vater carcinoma and four common bile duct carcinomas. Two laparoscopic-assisted extended left hemihepatectomy and 3 laparoscopic-assisted extended right hemihepatectomies were performed for 5 hilar cholangiocarcinomas. Seven laparoscopic extended cholecystectomy (one with Roux-en-Y choledochojejunostomy) , 2 laparoscopic-assisted liver S4aS5 subsegmentectomies, and 1 laparoscopic-assisted left hemihepatectomy were performed for 10 gallbladder cancers. Laparoscopic-assisted procedures consisted of laparoscopic mobilization of the target organs, followed by open resection and reconstruction through an 8-12 cm extraction site.
RESULTS: For laparoscopic-assisted pylorus preserving pancreaticoduodenectomy, the mean operative time was 693±77 minutes. The mean blood loss was 1157±477ml. There were no intraoperative complications. Postoperative complications developed in 2 patient (pancreatic fistula), which resolved with conservative management. The mean postoperative hospital stay was 19.8±9.4 days. For hilar cholangiocarcinoma, the mean operative time was 701±105 minutes. The mean blood loss was 1132±617ml. There were no intraoperative complications. One patient died of postoperative liver dysfunction. For gallbladder cancers, the mean operative time was 367±173 minutes and the mean blood loss was 270±338ml. There were no intraoperative or postoperative complications. The mean postoperative hospital stay was 6.7±1.6 days.
Pathological examination showed R0 resections in all cases. Recurrence was detected in 2 cases (liver metastasis in one hilar cholangiocarcinoma case and lymph node metastasis in one gallbladder carcinoma case), but no port site metastasis or peritoneal dissemination was observed.
CONCLUSION: Laparoscopic surgery for biliary tract cancer is feasible and safe, but more data may be needed for evaluation of long-term outcome.

Session Number: Poster – Poster Presentations
Program Number: P360
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