Role of laparoscopy in management of carcinoma of the gall bladder is still controversial. Unlike other gastro intestinal cancers, only few reports of radical cholecystectomy are available.
Retrospective analysis of 22 cases of radical cholecystectomy for carcinoma gall bladder from Jan 2003 to Dec 2007 was performed. All were stage I disease diagnosed by pre-operative imaging. Radical cholecystectomy comprised of resection of the gall bladder in North American approach along with segment IVA and V and the regional nodes. We used CUSA, In-Line Radio Frequency ablation, ultrasonic shears, bipolar vessel sealing devices, Argon plasma coagulation and surgical clips to divide the liver parenchyma. Drain was placed in all cases. Specimen was extracted using endo-bag
All 22 cases were completed by laparoscopy without any major intraoperative complication. Mean operative time was 140 min (129-190 min). Mean blood loss was 180 ml (100- 300ml). Overall postoperative morbidity was 22 %. Two patients had self limiting bile leak. There was no mortality. Mean ICU stay and mean hospital stay were 1.8 days (1-4 days) and 5.6 days (4-14 days). All margins were free. Average lymph node harvested was 16 (8-32). Mean number of positive nodes were 3(0-9). Median follow up is 18 months
Laparoscopic Radical cholecystectomy can be performed with acceptable morbidity. Oncological clearance with respect to margins and lymphadenectomy can be achieved. Long term follow up is needed to assess survival.
Program Number: P427