Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy
Many cases have been reported of disastrous port-site recurrence after laparoscopic cholecystectomy (LC) revealed unsuspected gallbladder carcinoma (GBC). Some investigators have reported that the prognosis of patients after LC showed unsuspected GBC is not worsened by laparoscopic procedures. We retrospectively reviewed our cases and the literature to reconfirm the intrinsic risks of LC for unsuspected GBC.
Of 1663 patients who underwent LC from January 1991 to December 2003 in a single institution, 9 (0.54%) with unsuspected GBC were reviewed.
These 9 patients consisted of 5 men and 4 women, whose ages ranged from 58 to 87 years, with a median age of 73 years. Two patients with a pT1a tumor (limited to mucosa) and 2 patients with a pT1b tumor (muscle layer) underwent no further operation. The remaining 5 patients with a pT2 tumor (subserosa) underwent further operations with lymph node dissection. Five patients (2 patients with pT1b and 3 patients with pT2) developed recurrence and all of them died within a median period of 19 months (range 14–37 months) after LC. The causes of death were bone metastases in 1 patient (pT2), local recurrence in 2 patients (pT1b and pT2), and peritoneal metastasis in 2 patients (one elderly patient with pT1b who underwent laparoscopic common bile duct exploration, and one patient with pT2 in whom the cystic duct was damaged during surgery). Four patients (2 with pT1 and 2 with pT2) have been doing well with a median follow-up of 39.5 months (range 12–99 months) after LC.
Surgeons should always prevent bile spillage during LC and when removing the resected gallbladder. When laparoscopic common bile duct exploration is planned, especially for elderly women, surgeons should also bear in mind the increasing possibility of unsuspected GBC.
Key wordsUnsuspected gallbladder carcinoma Port-site metastasis Laparoscopic common bile duct exploration (LCBDE)
Unable to display preview. Download preview PDF.
- 4.Clair, DG, Lautz, DB, Brooks, DC 1992Rapid development of umbilical metastases after laparoscopic cholecystectomy for unsuspected gallbladder carcinomaSurgery1133558Google Scholar
- 6.Drouard, F, Delamarre, J, Capron, JP 1991Cutaneous seeding of gallbladder cancer after laparoscopic cholecystectomyN Engl J Med3251316Google Scholar
- 16.American Joint Committee on Cancer1997AJCC cancer staging manual5th edn.JB LippincottPhiladelphia1038Google Scholar
- 26.Shirai, Y, Yoshida, K, Tsukada, K, Muto, T 1992Inapparent carcinoma of the gallbladder — an appraisal of a radical second operation after simple cholecystectomyCancer62142232Google Scholar