Gallbladder cancer discovered during laparoscopic surgery. Potential for iatrogenic tumor dissemination
Y. Fong, M. F. Brennan, A. Turnbull, D. G. Colt and L. H. Blumgart
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
OBJECTIVE: To examine the results of treatment of laparoscopically
discovered gallbladder cancer. DESIGN: Retrospective review of clinical
data for the 10 patients with laparoscopically discovered gallbladder
cancer who were referred to our institution for definitive surgical
therapy. SETTING: An oncologic referral center. PATIENTS: All patients in
the 24-month period from November 1990 to November 1992 with this entity
who were referred for surgical therapy. INTERVENTION: Exploratory
laparotomy was performed on all patients. Resection with curative intent
was performed when possible. MAIN OUTCOME MEASURES: Resectability and
outcome of cancer treatment. RESULTS: In three patients, a subsequent
radical resection was performed and as a result, two patients are currently
free of disease. Intraperitoneal spread, not present at the original
laparoscopy and associated with violation of tumor at laparoscopy,
precluded potentially curative resection for four patients. In two of these
patients, there was obvious tumor growth within the laparoscopy tracts.
CONCLUSIONS: Tumor dissemination is a real hazard of laparoscopic violation
of gallbladder integrity in the presence of gallbladder cancer.
Modification of management based on awareness of such a hazard is needed to
improve resectability and outcome of future cases of laparoscopically
discovered gallbladder cancer.
