Gallbladder Carcinoma Diagnosed after Laparoscopic Cholecystectomy

Lee, Hyo Sang; Kim, Kyung Sik; Choi, Jin Sub; Lee, Sang Hoon; Lee, Woo Jung; Kim, Byong Ro

Abstract

BACKGROUND/AIMS: Laparoscopic cholecystectomy has become popular. Occasionally, unsuspected gallbladder carcinoma is diagnosed after the operation by pathologic examination, incidentally. And even when the gallbladder carcinoma is suspected preoperatively, it is determined whether or not the additional radical operation will proceed, according to the pathologic diagnosis after laparoscopic cholecystectomy. Multiple staging systems have been described, including the modified Nevin classification (Donohue et al 1990, Nevin et al 1976), the AJCC TNM staging system, and there are controversies in the surgical management of gallbladder carcinoma for each stage. The purpose of this study was to evaluate the role and the meaning of the laparoscopic cholecystectomy in the surgical management of the gallbladder carcinoma.
METHODS
A retrospective analysis was made of 24 patients with gallbladder carcinoma that was confirmed by pathologic diagnosis after laparoscopic cholecystectomy in Severance Hospital between January 1993 and Feburary 2002.
RESULTS
Gallbladder carcinoma was found in 1.1% of the 2141 cholecystectomy specimens. Gallbladder carcinoma was suspected preoperatively in 11 patients (45.8%). The location of the lesions was the serosal side in 16 patients (66.7%), the liver bed side in 1 patient, and undetermined in 7 patients. The histologic type was adenocarcinoma in all patient, and well differentiated in 16 patients (66.7%), moderate and poorly differentiated in 8 patients (33.3%). According to the AJCC TNM staging system, there were 13 stage I (54%), 5 stage II (20.8%), 2 stage III (8.3%), 4 stage IV (16.7%). The lymph node metastasis was observed in 4 patients (16.7%). In 18 patients (75%), only laparoscopic cholecystectomies were performed, and additional radical cholecystectomies were performed in 4 patients (16.7%). The patients with stage I and II tumor were alive without recurrence except 1 follow-up loss, and there was not any port site recurrence.
CONCLUSION
Laparoscopic cholecystectomy is sufficient with stage I gallbladder carcinoma. It may be considered that the patient with stage II gallbladder carcinoma is closely followed without additional radical cholecystectomy after laparoscopic cholecystectomy, if properly selected. The use of vinyl bag for retrieval of specimen is recommended to avoid the port site recurrence. For advanced gallbladder carcinoma (stage III and IV), the additional radical cholecystectomy is recommended. When gallbladder cancer is suspected, an open operation should be performed with sufficient preoperative staging work-up.