The Management of Gallbladder Cancer: Before, During, and After Laparoscopic Cholecystectomy

Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy

“…Unsuspected precancerous lesions or carcinomas of the gallbladder have been diagnosed during or after cholecystectomy [2,3,13,14,17], AM, adenomyomatosis; F, female; GBP, gallbladder polyp (polypoid lesion); GS, gallstone; LC, laparoscopic cholecystectomy; M, male; pap, papillary adenocarcinoma; pT1a, the tumor invades the lamina propria; pT1b, the tumor invades the muscle layer; well, well-differentiated adenocarcinoma. F, female; GBP, gallbladder polyp (polypoid lesion); GS, gallstone; Hx, resection of the gallbladder bed with lymph node dissection following LC; LC, laparoscopic cholecystectomy; M, male; pap, papillary adenocarcinoma; pN0, no regional lymph node metastasis; pN2, metastases in peripancreatic (head only), periduodenal, periportal, coeliac and/or superior mesenteric lymph nodes; pNx, regional lymph nodes cannot be assessed; por, poorly differentiated adenocarcinoma; pT2, the tumor invades perimuscular connective tissue without extension beyond the serosa or into the liver; pT3, the tumor perforates the serosa or directly invades one adjacent organ (or both); well, well-differentiated adenocarcinoma.…”

“…Simple cholecystectomy is adequate for pT1a lesion, and tumors greater than stage pT2 should be treated by an additional radical operation. However, for pT1b tumors, the value of a second radical operation remains controversial [3,[13][14][15]28]. In the current study, patients with pT1a and 1b tumors underwent LC only, without any recurrences.…”

“…Moreover, Sarli et al [33] reported that tumor stage and the occurrence of bile spillage were strongly correlated with prognosis, and that survival rate was not affected by whether the operation was carried out using LC or OC. The role of prophylactic excision of port sites is uncertain based on the current understanding of the biological behavior of the disease and clinical usefulness of such prophylactic excision has not been demonstrated [6,13]. Although, the retrieval of the resected gallbladder using a plastic bag does not always prevent port site metastases [28], we used this method, and no port site metastases or peritoneal dissemination were observed in any of our CHR, chronic cholecystitis; F, female; GBP, gallbladder polyp (polypoid lesion); GS, gallstone; Hx, resection of the gallbladder bed with lymph node dissection following LC; LC, laparoscopic cholecystectomy; M, male; mod, moderately differentiated adenocarcinoma; pap, papillary adenocarcinoma; pN0, no regional lymph node metastasis; pN1, metastases in cystic, pericholedochal and/or hilar lymph nodes (in the hepatoduodenal ligament); pNx, regional lymph nodes cannot be assessed; pT1a, the tumor invades the lamina propria; pT2, the tumor invades perimuscular connective tissue without extension beyond the serosa or into the liver; Re-ope, additional surgery; well, well-differentiated adenocarcinoma.…”

“…In order to avoid the need for reoperation following LC, the resected gallbladder should be carefully examined during the operation, and in cases where malignancy is suspected, frozen section examination should be recommended [13][14][15]. However, this method is not definitive because the entire lesion cannot be examined.…”

Laparoscopic cholecystectomy and gallbladder cancer

“…However, the role of prophylactic excision of port-sites is uncertain based on current understanding of the biological behavior of the disease [49], and clinical usefulness of such prophylactic excision has not been evidenced. In fact, opposite results have been obtained in the animal model [50] that suggest that prophylactic port-site excision might even be deleterious in GBC.…”