LAPAROSCOPIC CHOLECYSTECTOMY CAN DISSEMINATE IN-SITU CARCINOMA OF THEGALLBLADDER

BACKGROUND: Early case reports suggest more frequent and rapid recurre nces of carcinoma of the gallbladder after laparoscopic cholecystectom y (LC) than after open cholecystectomy. This cancer has a poor prognos is and occurs in 1 percent of patients who undergo cholecystectomies. STUDY DESIGN: A recent community hospital series of gallbladder carcin oma (GBC) was reviewed and the total reported experience of GBC after LC was compiled. Diagnostic findings were compared for patients with G BC and a consecutive series of 24 patients who had LC for benign disea se. RESULTS: Nine patients with GBC were found among 928 patients who had undergone cholecystectomy (0.97 percent incidence). Compared to pa tients without GBC, patients with carcinoma were older, had thicker ga llbladder walls, and had more abnormalities detected intraoperatively (all p less than or equal to 0.05). Recurrence of GBC occurred more ra pidly after LC, and in diffuse peritoneal and port sites when compared with recurrence patterns after open cholecystectomy. CONCLUSIONS: In patients with GBC, LC may be sufficient when the disease is confined t o the gallbladder mucosa and the gallbladder is excised intact without bile spillage. However, patients whose gallbladders are torn during d issection or patients who have invasive tumors should undergo laparoto my and local reexcision. In situ GBC can be implanted if the organ is torn during dissection. When gallbladders with suspicious wall thicken ing or adhesions are noted at LC, especially in older patients, the pr ocedure should be converted to open cholecystectomy.