How to proceed in patients with carcinoma detected after laparoscopic cholecystectomy

Abstract

Carcinoma of the gallbladder is a rare disease. Gallbladder carcinoma is detected in less than 1% of all gallstone operations. With the introduction of laparoscopic surgery and the higher acceptance of this technique, gallbladders are now removed much earlier than they used to be. With the increase of cholecystectomies, the diagnosis of unexpected gallbladder carcinoma became more frequent. We report on how to proceed in patients with a diagnosis of gallbladder carcinoma and discuss the additional problems that have arisen since laparoscopic cholecystectomy became established. From June 1990 to December 1999, we performed 6230 cholecystectomies in the surgical department of Moabit Hospital in Berlin. Of these, 42 (0.6%) were identified as carcinoma. There were 37 women and five men, and the mean age was 69 years. In 16 patients (39%), there was a preoperative suspicion of malignancy. In 26 patients (61%), malignancy was suspected intraoperatively or diagnosed postoperatively after pathologic examination of the resected gallbladder. In these patients, an open repeat operation was necessary in seven cases to achieve an adequate curative resection and staging. This involved additional liver bed resection and lymph node dissection of the hepatoduodenal ligament. Abdominal wall (port site) recurrence in the absence of distant metastasis was present only in two patients. We recommend removal using a bag in all gallbladders with wall thickening, irregularities, or scleroatrophic calcified gallbladder area. In stage Tis or T1, laparoscopic cholecystectomy is sufficient. In stage T2 and T3, we perform a repeat operation with liver bed resection and lymphadenectomy.

Rational therapeutic strategy for T2 gallbladder carcinoma based on tumor spread

“…For pT2 or more advanced tumors, many authors advocate radical resection with lymph node dissection [10][11][12][13][14] . Previous reports have shown a second radical resection to be associated with significantly better survival than cholecystectomy alone in pT2 GBCa patients whose cancers were incidentally found after cholecystectomy [15][16][17][18] , whereas, Wakai et al [19] have reported that 40.5% of patients with unapparent pT2 tumors survived > 5 years after cholecystectomy alone. S4a5 hepatectomy combined with extra-hepatic bile duct resection (BDR) and D2 lymph node dissection is a highly recommended operation for the treatment of T2 and T3 GBCa [6] , although, in T2 GBCa, the surgical procedure remains controversial, and there is no standard operation.…”

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

“…It is well known for its poor prognosis, and 15-30% of patients show no preoperative or intraoperative evidence of gallbladder cancer (2). Gallstone disease, porcelain gallbladder, sclerosing cholangitis, and advanced age are the best known risk factors for gallbladder cancer.…”

Laparoscopic cholecystectomy for treatment of unexpected early‐stage gallbladder cancer

“…Most surgeons recommend no additional treatment for patients with early-stage disease. Five-year survival rates vary from 80% to 100% [4,15]. Shirai [16] has suggested that a second radical operation may not be beneficial to early incidental gallbladder cancer if the surgical margins are tumor-free.…”