To evaluate the feasibility and safety of laparoscopic cholecystectomy (LC) combined with liver wedge resection in patients with preoperative highly-suspected gallbladder cancer.

Clinical data of 20 patients with preoperative highly-suspected gallbladder cancer who underwent LC combined with liver wedge resection in Department of Hepatobiliary Surgery, Huashan Hospital Fudan University from January 2022 to December 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 11 patients were male and 9 female, aged from 29 to 88 years, with a median age of 64 (58, 72) years. After active preoperative evaluation and preparation, all patients underwent LC combined with liver wedge resection (en bloc) 2 cm from the gallbladder bed. Surgical condition and perioperative recovery were observed. Postoperative pathological data and short-term recurrence were analyzed.

All operations were successfully performed without conversion to open surgery. No intraoperative gallbladder rupture or bile leakage occurred. 12 patients underwent LC combined with liver wedge resection. The mean operation time was (92±13) min and intraoperative blood loss was 70 (50, 105) ml. 8 patients underwent LC combined with liver wedge resection plus regional lymph node dissection. The mean operation time was (155±18) min and intraoperative blood loss was 170 (135, 200) ml. The length of hospital stay was (4.7±1.4) d. Pathological examination revealed 8 cases of frozen section (-)/paraffin section (+), 8 cases of frozen section (+)/paraffin section (+), and 4 cases of frozen (-)/paraffin (+), respectively. Among 20 patients with preoperative highly-suspected gallbladder cancer, pathological paraffin section confirmed gallbladder cancer in 12 patients, including Tis (n=1), T1a (n=2), T1b (n=2), T2a (n=5), and T2b (n=2). Vascular invasion was observed in 1 case and perineural invasion in 3 cases. Cystic duct margins were negative in all cases. Pathological types included 7 cases of gallbladder adenocarcinoma, 3 cases of focal carcinoma, and 2 cases of neuroendocrine carcinoma. Based on frozen and paraffin section results, different additional surgical procedures were performed: 3 pTis/T1a patients with frozen section (-)/paraffin section (+) received no additional surgery; 1 pT2a patient with frozen section (-)/paraffin section(+) underwent salvage open hepatic segmentectomy (S4b+S5) plus regional lymph node dissection at postoperative 1 month. 8 patients with frozen section (+)/paraffin section (+) received intraoperative laparoscopic regional lymph node dissection and no salvage surgery. No perioperative death occurred. 1 elderly patient developed postoperative pulmonary infection, and no significant postoperative complications were observed in the remaining cases. The median follow-up time was 18.0 (9.5, 26.5) months. No tumor recurrence, metastasis or death was observed during the follow-up.

For patients with highly-suspected gallbladder cancer, LC combined with liver wedge resection (en bloc) is a safe and effective procedure. It effectively avoids iatrogenic dissemination and tumor residue during surgery, reduces the risk of recurrence and implantation, and improves clinical prognosis without increasing complications.