Laparoscopic segment 4b+5 liver resection for stage T3 gallbladder cancer

Background: There is still controversy over whether to perform laparoscopic surgery for T3 stage gallbladder cancer. In addition, the necessity of segment 4b+5 liver resection for stage T3 gallbladder has not been reported. This article aims to explore the safety, effectiveness, and short-term prognosis of laparoscopic segment 4b+5 liver resection for T3 stage gallbladder cancer. Methods: This is a retrospective multicenter propensity score-matched study. Disease-free survival, perioperative complications, and intraoperative safety were analyzed to evaluate safety and effectiveness. Results: There was no significant difference in the incidence of intraoperative bleeding, number of lymph nodes obtained, postoperative complications, or disease-free survival (DFS) between the open group (OG) and laparoscopic group (LG) (P> 0.05). The DFS time of the S4b+5 resection group (S4b5) was longer than that of the wedge group (P= 0.016). Cox regression showed that positive margins (HR, 5.32; 95% CI 1.03–27.63; P= 0.047), lymph node metastasis (HR, 2.70; 95% CI 1.31–5.53; P= 0.007), and liver S4b+5 resection (HR, 0.30; 95% CI 0.14–0.66; P= 0.003) were independent risk factors for DFS. The operative time of indocyanine green (ICG) fluorescence-guided liver S4b5 segment resection was shorter than that of traditional laparoscopic S4b+5 resection guided by hepatic veins (P≤ 0.001). Conclusion: Laparoscopic liver S4b+5 resection for T3 stage gallbladder cancer is safe and feasible and can prolong DFS. ICG fluorescence-guided negative staining may reduce the difficulty of the operation. Graphical abstract: <fig id="Figa" position="anchor"> <graphic position="anchor" specific-use="HTML" mime-subtype="PNG" href="MediaObjects/464_2022_9325_Figa_HTML.png" id="MO61"></graphic> </fig>