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Leopoldo Sarli, MD; Sandro Contini, MD; Giuliano Sansebastiano; Sara Gobbi, MD; Renato Costi, MD; Luigi Roncoroni, MD

Arch Surg. 2000;135:1340-1344.

Background  Several reports claim that there is a risk that laparoscopic cholecystectomy (LC) might worsen the prognosis of unsuspected gallbladder cancer.

Hypothesis  Several factors rather than LC could influence prognosis.

Methods  A retrospective clinicopathologic study was performed on 20 patients, 9 patients (3 men and 6 women, aged from 36 to 75 years [mean age, 62.3 years]) undergoing LC and 11 patients (2 men and 9 women, aged from 53 to 91 years [mean age, 65.3 years]) undergoing open cholecystectomy (OC), with postoperatively diagnosed gallbladder cancer. The correlation was evaluated between cumulative survival rates and the following 7 prognostic factors: age, sex, histopathological grade, pathologic stage, occurrence of bile spillage, type of cholecystectomy (LC or OC), and additional surgical treatments.

Results  Seven patients (87%) after LC and 9 patients (82%) after OC had cancer recurrence: the difference is of no statistical significance (P = .9). There were no recurrences of cancer in the abdominal wall after either LC or OC. Survival rate was statistically correlated to tumor stage (P = .007) and to the occurrence of bile spillage (P = .002). Survival rate did not change according to whether the operation was carried out using LC or OC (P = .60).

Conclusion  These results would seem to lend support to the opinion that LC does not worsen the prognosis for unsuspected gallbladder cancer.

From the Department of Surgery, Institute of General Surgery and Surgical Therapy (Drs Sarli, Gobbi, Costi, and Roncoroni), Institute of General Surgery and Transplantation (Dr Contini), and Institute of Hygiene (Mr Sansebastiano), Parma University School of Medicine, Parma, Italy.

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