Laparoscopic cholecystectomy and gallbladder cancer

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.

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“…This procedure is also advised by other authors [7,15,23]. Wyscocki et al [30] recommend conversion to an open resection prior to removal.…”

Section: Discussionmentioning

confidence: 91%

How to proceed in patients with carcinoma detected after laparoscopic cholecystectomy

Frauenschuh

Greim

Kraas

2000

Langenbeck's Archives of Surgery

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“…In a 1978 report, gallbladder cancer was an incidental finding in <1% of patients undergoing cholecystectomy [8]. In a more recent study of laparoscopic cholecystectomy, only six cases of cancer (0.29%) were found among 2,017 patients [13]. However, the incidence of carcinoma of the gallbladder among patients presenting with acute cholecystitis has not been well studied.…”

Section: Discussionmentioning

confidence: 97%

Gallbladder cancer presenting with acute cholecystitis: a population-based study

et al. 2005

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“…It has been reported that GBC is detected in approximately 1% of patients undergoing cholecystectomy5 and that GBC is unexpectedly found in 0.2%–0.8% of patients undergoing LC . As increasing numbers of LCs are being performed, its role in the management of potentially malignant disease must be carefully examined.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patients

Ouchi

Mikuni

Kakugawa

2002

Journal of Hepato-Biliary-Pancreatic Surgery

173

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Laparoscopic cholecystectomy and gallbladder cancer

Abstract: Thickened and infiltrated gallbladder walls in patients without preoperative symptoms of cholecystitis should raise a suspicion of cancer. The surgeon should be prepared to perform a conversion, an intraoperative histological examination, and an appropriate radical operation, if necessary.

Cited by 22 publications

References 12 publications

How to proceed in patients with carcinoma detected after laparoscopic cholecystectomy

How to proceed in patients with carcinoma detected after laparoscopic cholecystectomy

Gallbladder cancer presenting with acute cholecystitis: a population-based study

Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patients

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