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There is controversy regarding surgical treatment of gallbladder carcinomas. Generally, simple cholecystectomy alone (including laparoscopic cholecystectomy) is an adequate treatment for pathologic stage T1a gallbladder carcinoma. T1b tumors are associated with good long-term survival even after simple cholecystectomy, but are associated with a slightly elevated locoregional recurrence rate. Therefore, a definitive curative treatment with liver resection and lymph node dissection should be performed. According to anecdotal experiences at our institution, simple, minimally invasive, laparoscopic cholecystectomy in certain patients (T1a) is likely to provide an acceptable surgical outcome compared to radical surgery in treating gallbladder carcinoma. And as evidence for minimally invasive surgical treatment for gallbladder carcinoma with T1b and T2 gallbladder carcinomas has increased and technical improvements have occurred in laparoscopic lymph node dissection, we have extended the indication of minimally invasive laparoscopic surgery (including da Vinci Robotic surgery) to T2 gallbladder carcinoma. Even though we cannot draw firm conclusions because the sample size was small and study duration was short, preliminary results are intriguing. a) Among 15 patients with T1a gallbladder carcinomas who were treated with minimally invasive surgery, there has been no recurrence to date. b) Among 7 patients with T1b lesions, one patient had liver metastasis 2 years after surgery. c) Among 15 patients with T2 lesions, two patients had disease recurrence in the para-aortic lymph node area 1 and 5 months, respectively, after surgery (laparoscopic simple cholecystectomy). d) After doing regional lymph node dissection (sometimes aortocaval lymph nodes as well) in 2006, 2 of 10 patients (20%) had positive regional lymph nodes after surgery but no recurrence has occurred to date. For suspected T1 and T2 gallbladder carcinomas without regional and systemic metastasis, after a preoperative study (using EUS and PET) for the main lesion and metastasis, we found that we can treat them with minimally invasive laparoscopic (or da Vinci Robotic) cholecystectomy and lymph node dissection (if needed, including aortocaval para-aortic lymph nodes).
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