Peritoneal seeding of gallbladder cancer after laparoscopic cholecystectomy

Abstract

We report a case of peritoneal seeding of an unsuspected adenocarcinoma of the gallbladder following laparoscopic cholecystectomy despite the use of a retrieval bag. The metastasis developed at the umbilical trocar site, which was also used to extract the resected gallbladder. There was no evidence foe a leak of the retrieval bag. Most likely malignant cells became desquamated during the operation, implanting themselves in the tissue during the removal of the bag. Taking into consideration previous reports and the dismal prognosis of the disease, we discuss the management in the case of an incidental carcinoma.

Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer?

“…The incidence of bile spillage due to gallbladder perforation during LC is reported to be >50% [27], However, there may be more risk factors than bile spillage. For example, case reports have shown port site recurrences in patients without bile spillage or tumor violation and where a bag was used for removal of the gallbladder [20,21]. We also had a patient who developed a late recurrence (port site, peritoneal seeding, and liver metastasis) after a pathological T1NOM0 GBC without any complication at LC.…”

“…Because GBC is potentially curable at these early stages, it is important that the initial cholecystectomy procedure does not worsen the prognosis. Many case reports of early recurrences, peritoneal seeding, and port site metastases following laproscopy in patients with GBC [5,12,19,20,21,24] have led to suspicion that LC could worsen the prognosis of GBC, Bile spillage, tumor perforation, and excessive manipulation of the tumor were thought to worsen the results, although clinical studies confirming are lacking [30]. On the other hand, animal experiments suggest that pneumoperitoneum with (CO2) stimulates tumor growth [13] and that peritoneal injury enhances the peritoneal implantation of human GBC cells in mice [1].…”

“…Many case reports have documented the risk of port site metastases and early peritoneal dissemination following LC in unexpected GBC [5,12,19,20,21,24], even in patients with carcinoma in situ and pathological T-I carcinomas [29,31]. Although animal experiments have shown a stimulation of tumor growth by carbon dioxide (CO2) and an enhanced tumor implantation related to peritoneal injury [I, 13], a negative influence of LC on the survival rates of GBC has never really been proven in larger clinical series.…”

Metastatic melanoma of gastrocolic ligament treated with minimally invasive approach

“…It also could help in identifying patients who would not benefit from resection because of multiple and or widespread metastasis in the abdomen. A possible disadvantage for laparoscopic removal of metastatic melanoma is the fear that laparoscopy may predispose for disseminated metastasis and/or trocar site recurrence, as has been observed with patients with intraabdominal malignancy [5,6]. The exact mechanism and the magnitude of this complication are as yet unknown.…”

Adenocarcinoma of the Gallbladder: Biology of Disease, Prognosticators, and Staging

“…Laparoscopic cholecystectomy with the finding of unsuspected CG may be followed by cutaneous seeding (Kim and Roy 1994), and laparoscopic removal of CG may cause peritoneal cancer dissemination (Pezet et al 1992;Sailer et al 1995;Marmorale et al 1998;Ohtani et al 1998;Shirai et al 1998). Cancer spread to the peritoneum in the setting of laparoscopic cholecystectomy was mainly found in the presence of T3 tumors (Wysocki and Krzywon 2000).…”