Does Laparoscopic Cholecystectomy Worsen the Prognosis of Unsuspected Gallbladder Cancer?

Abstract

Background: Several reports claim that there is a risk that laparoscopic cholecystectomy (LC) might worsen the prognosis of unsuspected gallbladder cancer. Hypothesis: Several factors rather than LC could influence prognosis. Methods: A retrospective clinicopathologic study was performed on 20 patients, 9 patients (3 men and 6 women, aged from 36 to 75 years [mean age, 62.3 years]) undergoing LC and 11 patients (2 men and 9 women, aged from 53 to 91 years [mean age, 65.3 years]) undergoing open cholecystectomy (OC), with postoperatively diagnosed gallbladder cancer. The correlation was evaluated between cumulative survival rates and the following 7 prognostic factors: age, sex, histopathological grade, pathologic stage, occurrence of bile spillage, type of cholecystectomy (LC or OC), and additional surgical treatments. Results: Seven patients (87%) after LC and 9 patients (82%) after OC had cancer recurrence: the difference is of no statistical significance (P=.9). There were no recurrences of cancer in the abdominal wall after either LC or OC. Survival rate was statistically correlated to tumor stage (P=.007) and to the occurrence of bile spillage (P=.002). Survival rate did not change according to whether the operation was carried out using LC or OC (P=.60). Conclusion: These results would seem to lend support to the opinion that LC does not worsen the prognosis for unsuspected gallbladder cancer.

Preliminary Experience of Laparoscopic Cholecystectomy with Gallbladder Bed Dissection for Suspected Gallbladder Cancer

“…On the other hand, Ouchi et al 16 analyzed the results of a large number of gallbladder cancer cases treated by LC in Japan, and found no association between LC and a worse prognosis for gallbladder cancer. Some other recent reports also reached the same conclusions [17][18][19] . Furthermore, papers in which laparoscopic surgery was intentionally used in cases of gallbladder cancer have gradually increased 20,21 .…”

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

“…On the other hand, recently some reports show that the prognosis of patients with incidental gallbladder carcinoma is similar between those resected by laparoscopic approach and open approach [171][172][173][174]. However, in LC, the dissection plane on the liver side is within the subserosal layer.…”

Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy

“…On the other hand, it has been reported that there was no statistically significant difference in the incidence of abdominal wall recurrences among LC versus OC versus LC converted to OC, and that surgical approach has no influence on prognosis [27,32]. Moreover, other reports have shown that the prognosis of GBC discovered incidentally after LC was no worse than that diagnosed after OC [10,12,33].…”

“…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].…”