Journal of Hepato-Biliary-Pancreatic Surgery

, Volume 12, Issue 5, pp 391–398 | Cite as

Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy

  • Hideo Yamamoto
  • Naokazu Hayakawa
  • Yuji Kitagawa
  • Yuki Katohno
  • Takahiro Sasaya
  • Daisuke Takara
  • Masato Nagino
  • Yuji Nimura
Original articles



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 words

Unsuspected gallbladder carcinoma Port-site metastasis Laparoscopic common bile duct exploration (LCBDE) 


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  1. 1.
    Dubois, F, Icard, P, Berthelot, G, Levard, H 1990Coelioscopic cholecystectomy. Preliminary report of 36 casesAnn Surg211602PubMedGoogle Scholar
  2. 2.
    Wibbenmeyer, LA, Wade, TP, Chen, RC, Meyer, RC, Turgeon, RP, Andrus, CH 1995Laparoscopic cholecystectomy can disseminate in situ carcinoma of the gallbladderJ Am Coll Surg18150410PubMedGoogle Scholar
  3. 3.
    Paolucci, V, Schaeff, B, Schneider, M, Gutt, C 1999Tumor seeding following laparoscopy: international surveyWorld J Surg2398997CrossRefPubMedGoogle Scholar
  4. 4.
    Clair, DG, Lautz, DB, Brooks, DC 1992Rapid development of umbilical metastases after laparoscopic cholecystectomy for unsuspected gallbladder carcinomaSurgery1133558Google Scholar
  5. 5.
    Figueiras, RG, Tie, MD, Villarroya, JAL, Fernandez, MJA, Rodriguez, AAG, Pintos, MA 1999Port-site metastases after laparoscopic cholecystectomy for an unexpected gallbladder carcinomaAbdom Imaging244046CrossRefPubMedGoogle Scholar
  6. 6.
    Drouard, F, Delamarre, J, Capron, JP 1991Cutaneous seeding of gallbladder cancer after laparoscopic cholecystectomyN Engl J Med3251316Google Scholar
  7. 7.
    Lundberg, O, Kristoffersson,  1999Port-site metastases from gallbladder cancer after laparoscopic cholecystectomy. Results of a Swedish survey and review of published reportsEur J Surg16521522CrossRefPubMedGoogle Scholar
  8. 8.
    Yenumula, PR, Sheridan, WG 2000Port-site metastasis following laparoscopic cholecystectomy: a review of the literature and a case reportEur J Surg Oncol2695102CrossRefPubMedGoogle Scholar
  9. 9.
    Jeon, HM, Kim, JS, Lee, CD, Kim, EK, Kim, SN, Kim, JS 1999Late development of umbilical metastasis after laparoscopic cholecystectomy for a gallbladder carcinomaOncol Rep62837PubMedGoogle Scholar
  10. 10.
    Fusco, MA, Paluzzi, MW 1993Abdominal wall recurrence after laparoscopic-assisted colectomy for adenocarcinoma of the colonDis Colon Rectum3685861CrossRefPubMedGoogle Scholar
  11. 11.
    Hughes, ES, McDermott, FT, Polglase, AI, Johnson, WR 1983Tumor recurrence in the abdominal wall scar after large bowel cancer surgeryDis Colon Rectum265712PubMedGoogle Scholar
  12. 12.
    Wexner, SD, Cohen, SM 1995Port-site metastases after laparoscopic colorectal surgery for cure of malignancyBr J Surg822958PubMedGoogle Scholar
  13. 13.
    Suzuki, K, Kimura, T, Ogawa, H 2000Long-term prognosis of gallbladder cancer diagnosed after laparoscopic cholecystectomySurg Endosc147126CrossRefPubMedGoogle Scholar
  14. 14.
    Suzuki, K, Kimura, T, Ogawa, H 1998Is laparoscopic cholecystectomy hazardous for gallbladder cancer?Surgery1233114CrossRefPubMedGoogle Scholar
  15. 15.
    Yoshida, T, Matsumoto, T, Sasaki, Morii Y, Ishio, T, Bandoh, T,  et al. 2000Laparoscopic cholecystectomy in the treatment of patients with gallbladder cancerJ Am Coll Surg19115863CrossRefPubMedGoogle Scholar
  16. 16.
    American Joint Committee on Cancer1997AJCC cancer staging manual5th edn.JB LippincottPhiladelphia1038Google Scholar
  17. 17.
    Yamaguchi, K, Chijiiwa, K, Ichimiya, H, Sada, M, Kawakami, K, Nishikata, F,  et al. 1996Gallbladder carcinoma in the era of laparoscopic cholecystectomyArch Surg1319814PubMedGoogle Scholar
  18. 18.
    Sarli, L, Contini, S, Sansebastiano, G, Gobbi, S, Costi, R, Roncoroni, L 2000Dose laparoscopic cholecystectomy worsen the prognosis of unsuspected gallbladder cancer?Arch Surg13513404CrossRefPubMedGoogle Scholar
  19. 19.
    Z'graggen, K, Birrer, S, Maurer, CA, Wehrli, H, Klaiber, C, Baer, HU 1998Incidence of port-site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinomaSurgery1248318CrossRefPubMedGoogle Scholar
  20. 20.
    Ricardo, AE, Feig, BW, Ellis, LM, Hunt, KK, Culrey, SA, MacFadyen, BV,  et al. 1997Gallbladder cancer and trocar site recurrencesAm J Surg17461923CrossRefPubMedGoogle Scholar
  21. 21.
    Lundberg, O, Kristofferson, A 2000Wound recurrence from gallbladder cancer after open cholocystectomySurgery127296300CrossRefPubMedGoogle Scholar
  22. 22.
    Bouvy, ND, Marquet, RL, Jeekel, H, Bonjer, HJ 1996Impact of gas(less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastasesAnn Surg224694701CrossRefPubMedGoogle Scholar
  23. 23.
    Jacobi, CA, Sabat, R, Böhm, B, Zieren, HU, Volk, HD, Müller, JM 1997Pneumoperitoneum with carbon dioxide stimulates growth of malignant colonic cellsSurgery121728CrossRefPubMedGoogle Scholar
  24. 24.
    Wullstein, C, Woeste, G, Barkhausen, S, Gross, E, Hopt, UT 2002Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer?Surg Endosc1682832CrossRefPubMedGoogle Scholar
  25. 25.
    Birkett, DH 1995Spilled cells, spilled clips, spilled stones. New problems or old challengesSurg Endosc926971CrossRefPubMedGoogle Scholar
  26. 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
  27. 27.
    Jones, RS 1990Carcinoma of the gallbladderSurg Clin N Am70141928PubMedGoogle Scholar
  28. 28.
    Tokumura, H, Umezawa, A, Cao, H, Sakamoto, N, Imaoka, Y, Ouchi, A,  et al. 2002Laparoscopic management of common bile duct stones: transcystic approach and choledochotomyJ Hepatobiliary Pancreat Surg920612CrossRefPubMedGoogle Scholar
  29. 29.
    Lauter, DM, Froines, EJ 2000Laparoscopic common duct exploration in the management of choledocholithiasisAm J Surg1793724CrossRefPubMedGoogle Scholar
  30. 30.
    Ouchi, K, Mikuni, J, Kakugawa, Y 2002Organizing committee, 30th Annual Congress of the Japanese Society of Biliary Surgery. Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patientsJ Hepatobiliary Pancreat Surg925660CrossRefPubMedGoogle Scholar
  31. 31.
    Fong, Y, Heffernan, N, Blumgart, LH 1998Gallbladder carcinoma discovered during laparoscopic cholecystectomyCancer834237CrossRefPubMedGoogle Scholar
  32. 32.
    Fligelstone, LJ, Johnson, RC, Stiff, GJ, Wheeler, MH 1993Laparoscopy and gastrointestinal cancer [letterAm J Surg166571PubMedGoogle Scholar
  33. 33.
    Nduka, CC, Monson, JRT, Menzies-Gown, , Darzi, A 1994Abdominal wall metastases following laparoscopyBr J Surg8164852PubMedGoogle Scholar
  34. 34.
    Principe, A, Lugaresi, ML, Lords, RC, Golfieri, R, Gallo, MC, Bicchierri, I,  et al. 1997Unsuspected carcinoma of the gallbladder: case report of trocar-site metastasis following laparoscopic cholecystectomyHepato-gastroenterology449903PubMedGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2005

Authors and Affiliations

  • Hideo Yamamoto
    • 1
  • Naokazu Hayakawa
    • 1
  • Yuji Kitagawa
    • 1
  • Yuki Katohno
    • 1
  • Takahiro Sasaya
    • 1
  • Daisuke Takara
    • 1
  • Masato Nagino
    • 2
  • Yuji Nimura
    • 2
  1. 1.Department of SurgeryTohkai HospitalNagoyaJapan
  2. 2.Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan

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