Gallbladder carcinoma in the era of laparoscopic cholecystectomy
K. Yamaguchi, K. Chijiiwa, H. Ichimiya, M. Sada, K. Kawakami, F. Nishikata, K. Konomi and M. Tanaka
Department of Surgery I, Kyushu University Faculty of Medicine, Fukuoka, Japan.
OBJECTIVE: To assess the usefulness of laparoscopic cholecystectomy for
unsuspected and suspected gallbladder carcinoma. DESIGN: Retrospective
review with a mean follow-up of 27 months, ranging from 1 to 47 months.
SETTING: University hospital and 8 affiliated hospitals. PATIENTS: Of 2616
laparoscopic cholecystectomies performed over 4 years, 24 gallbladder
carcinomas were treated by laparoscopic cholecystectomy and retrospectively
reviewed. RESULTS: The clinical course depended on the histopathologic
depth of invasion of gallbladder carcinoma. All 6 cases of pathologic tumor
(pT) stage in situ (pTis) gallbladder carcinoma and 2 cases of pT1
gallbladder carcinoma showed no invasion to the lymphatic, venous, or
perineural spaces, and these 8 patients were all doing well from 2 to 19
months (mean, 11 months) after laparoscopic cholecystectomy. Sixteen cases
of pT2 or pT3 gallbladder carcinoma invaded the subserosal layer or the
liver, and 5 of the 16 patients were dead of liver dysfunction, abdominal
wound recurrence, or liver metastasis 5 days and 7, 12, 15, and 18 months
after operation, although additional resection of the liver bed with lymph
node dissection was performed after laparoscopic cholecystectomy in 4 of
these 5 patients. Abdominal wall recurrence in the absence of distant
metastasis was present in 3 (19%) of the 16 patients with pT2 or pT3
gallbladder carcinoma due to inoculation of cancer cells in the abdominal
stab wounds where the gallbladder or laparoscope was removed. CONCLUSIONS:
Gallbladder carcinoma at the pTis or pT1 stage removed laparoscopically
needs no other treatment. We recommend that the gallbladder be removed by
vinyl bag and port sites be excised or washed with normal saline to prevent
port site recurrence in patients with laparoscopic cholecystectomy for pT2
or pT3 carcinoma.
