Laparoscopic Radical Cholecystectomy Versus Open Radical Cholecystectomy in the Management of Early Gallbladder Cancer: A Controlled Clinical Trial

Abstract Introduction: Carcinoma of the gallbladder, an aggressive tumor, has two primary surgical approaches for treating in the early stages: laparoscopic radical cholecystectomy (LRC) and open radical cholecystectomy (ORC). In recent trends, LRC has emerged as a viable alternative to ORC, offering potential benefits in recovery and complication rates. This study aimed to compare the operative time and incidence of early recurrence, and efficacy of laparoscopic versus conventional open method of radical cholecystectomy in patients with early (incidental and primary) gallbladder cancer (GBC). Materials and Methods: A controlled clinical trial comparing two groups (laparoscopic and open) was conducted at a single center with a total of 42 patients, 21 in each group. All patients comprised cases of early GBC (stages I and II). The patients were systematically allocated to each group on an odd and even basis, and outcomes were observed and documented intraoperatively and postoperatively. Results: During the study period, 46 patients with GBC underwent a radical cholecystectomy. Of these, 21 patients undergoing LRC formed the study group. Of the remaining 25 patients, 21 underwent ORC, which formed the control group, and 4 patients were initially planned for a laparoscopic approach but had to be converted to open due to adhesions and bleeding. The median operative time was significantly higher in the LRC group (230 min vs. 170 min, P < 0.001), whereas blood loss (200 mL vs. 350 mL, P < 0.001) and hospital stay (6 vs. 9 days, P < 0.001) were significantly lower in the LRC group than in the ORC group. Lymph node yield (12 vs. 13, P = 0.475) and the rate of interaortocaval node dissection (33.3% vs. 19.0%, P = 0.595) were comparable between the two groups, with no statistically significant difference. No patient developed a recurrence at a port site. One case in the LRC group had a bile leak and required a longer hospital stay. Seventeen out of 21 (81.0%) cases in the LRC group required blood transfusion compared with 21 cases in the ORC group (100%; P = 0.035). The conversion rate is 4 out of 25 LRC cases (16%) converted to ORC due to excessive adhesions and bleeding. Conclusion: LRC lowers hospital stay and blood loss compared to ORC with comparable oncological outcomes.