Evaluation Of The Perioperative Safety And Prognostic For Gallbladder Cancer Under Laparoscopic Radical Resection

Objective: With the development of the concept on minimally invasive surgery,the minimally invasive surgical treatment to gallbladder cancer has also entered the exploratory stage,but at present,the minimally invasive treatment of gallbladder cancer is mostly limited to early stage gallbladder cancer(p Tis-p T2),and the number of patients included in the study is small,lack of high-quality research reports.In this study,the preoperative general situation,perioperative complication rate,postoperative tumor recurrence and survival time of patients with different stages of gallbladder cancer were compared between laparoscopic surgery and open surgery.To evaluate the perioperative situation,incidence of complications and postoperative tumor recurrence of advanced gallbladder cancer treated by laparoscopy,and to compare the effects of different surgical methods on the survival of patients.Methods: The clinical data of 114 patients with gallbladder cancer treated in the Department of Hepatobiliary and Pancreatic surgery in our hospital from January2012 to August 2020 were collected and analyzed retrospectively.The incidence of perioperative complications,postoperative rehabilitation and the length of survival after surgery were compared and analyzed,the safety of laparoscopic surgery for patients with different stages of gallbladder cancer was also evaluated.The time of tumor recurrence was thought as the main end point and death as the secondary end point,so as to compare the prognostic differences of different surgical methods on patients with different stages of gallbladder cancer.Results: According to the inclusion and exclusion criteria,a total of 107 patients with confirmed gallbladder cancer were enrolled.There was no significant difference in preoperative general data between laparoscopic treatment group and open treatment group.Through the comparison of different surgical methods,the laparoscopic treatment group was superior to the open operation group in postoperative drainage tube removal time and postoperative hospital stay,and the incidence of perioperative complications in the endoscopic treatment group was better than that in the open operation group.There was no significant difference in the incidence of grade 3 and 4 complications between the laparoscopic surgery group and the open treatment group.Although combined with S4B+5 segment hepatectomy takes longer than wedge resection,it does not increase the postoperative hospital stay and the incidence of postoperative grade 3 and 4 complications.Meanwhile it shows that combined with S4B+5 segment hepatectomy can reduce the incidence of positive margin.At the same time,it was found that laparoscopic treatment did not shorten the recurrence-free survival(RFS)time and the overall survival(OS)time.Meanwhile it was found that the postoperative survival time was mainly affected by the stage of the tumor.It has nothing to do with the mode of operation.At the same time,it was found that the prognosis of patients with positive margin was significantly worse than that of patients with negative margin.Conclusion: Laparoscopic treatment of patients with advanced gallbladder cancer can reduce intraoperative blood loss,shorten postoerative fasting time,drainage tube removal time,postoperative hospital stay,and the incidence of postoperative grade3 and 4 complications is lower than that of open surgery group.It can be seen that laparoscopic treatment of gallbladder cancer is safe,and the postoperative survival time of patients is not affected by laparoscopic surgery.In addition,compared with wedge hepatectomy,S4B+5 segment resection will not increase the amount of intraoperative blood loss and postoperative complications,and will not affect the postoperative survival time of patients with advanced gallbladder cancer.Radical cholecystectomy combined with S4B+5 segment hepatectomy is recommended for patients with advanced gallbladder cancer.