Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy

Abstract

Background/Purpose 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. Methods Of 1663 patients who underwent LC from January 1991 to December 2003 in a single institution, 9 (0.54%) with unsuspected GBC were reviewed. Results 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. Conclusions 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.

Incidental gallbladder cancer diagnosed during or after laparoscopic cholecystectomy in members of the Turkish population with gallstone disease

“…LC performed for gallstone disease rarely results in a diagnosis of unexpected gallbladder cancer. In the English-language research literature, the incidence of gallbladder cancer diagnosed during or after LC is 0.2%-2.85% (3)(4)(5)(6)(7)(8)(9)(10)(11). In this single-center study, we report our experience with gallbladder cancer incidentally diagnosed during or after LC performed for gallstone disease.…”

Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition

“…(Grade 1, evidence level C) Statement: It is reported that the frequency of the incidental gallbladder carcinoma that is found serendipitously by postoperative pathological examination is reported to be 0.3-1.0% in gallbladder resected for cholacystolithiasis [176][177][178][179]. In patients in whom the histological analysis using whole gallbladder serial sections reveals the depth of cancer invasion limited to the mucosa or muscularis propria, an additional resection is not necessary if the cystic duct stump is negative.…”

Laparoscopic liver resection with lymph node dissection for gallbladder tumors suspected to be T1b/T2 carcinoma

“…OT: operation time; BL: intraoperative blood loss; LOS: postoperative length of hospital stay; GBT: laparoscopic liver resection with lymph node dissection for gallbladder tumor; PR: laparoscopic partial liver resection; LLS: laparoscopic left lateral sectionectomy of the liver; AR: laparoscopic anatomical resection of the liver (resection of one or more sections, excluding LLS); SAR: laparoscopic small anatomical resection of the liver (resection of less than a full segment); NC: not countable; NS: not significantly different from GBT data; P < 0.001/P < 0.05: significantly different from GBT data or GB bed with limited LN dissection and no bile duct resection for treatment of GBC is thought to have similar advantages, although such a procedure also has potential disadvantages (risk of tumor cell dissemination and port site recurrence). [11] Liver resection for treatment of T1b/T2 GBC involves PR of the anterolateral segments, where laparoscopic approaches are easily applied, [4,5] and the techniques for LN dissection have also been applied in other established procedures. [15,18] Although dissection of the posterosuperior pancreatic and peri-splenic vein LNs is difficult, this dissection can reportedly be easier with the Kocher maneuver.…”

“…[5] Few reports have described intended laparoscopic treatments for gallbladder carcinoma (GBC); [7][8][9] however, many studies of occult GBC revealed high incidences of port site recurrence and peritoneal dissemination after laparoscopic cholecystectomy. [10,11] The treatment of T1b/T2 GBC, [12] which is not in the early stage of intramucosal layer but without serosal invasion, involves a combination of liver resection, lymph node (LN) dissection, and bile duct resection and reconstruction in cases of invasion. [13,14] Laparoscopic procedures have been less commonly adapted to GBC treatment mainly because of concerns regarding the aggressive features of the malignancy and the technically demanding surgical procedure.…”

“…Furthermore, tumor dissemination and port site recurrence are thought to occur mainly due to bile leakage from intraoperative GB perforation. [9,11] Theoretically, combined resection of the GB bed liver could prevent these events. [10,11,16,17] Therefore, we have employed a laparoscopic procedure for treatment of GB tumors (GBTs) suspected to be T1b/ T2 GBC located in the GB body/fundus without cystic duct invasion.…”