Objective: To assess the usefulness of laparoscopic cholecystectomy fo
r unsuspected and suspected gallbladder carcinoma. Design: Retrospecti
ve review with a mean follow-up of 27 months, ranging from 1 to 47 mon
ths. Setting: University hospital and 8 affiliated hospitals. Patients
: Of 2616 laparoscopic cholecystectomies performed over 4 years, 24 ga
llbladder 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 cas
es of pathologic tumor (pT) stage in situ (pTis) gallbladder carcinoma
and 2 cases of pT1 gallbladder carcinoma showed no invasion to the ly
mphatic, venous, or perineural spaces, and these 8 patients were all d
oing well from 2 to 19 months (mean, 11 months) after laparoscopic cho
lecystectomy. Sixteen cases of pTZ or pT3 gallbladder carcinoma invade
d the subserosal layer or the liver, and 5 of the 16 patients were dea
d of liver dysfunction, abdominal wound recurrence, or liver metastasi
s 5 days and 7, 12, 15, and 18 months after operation, although additi
onal resection of the liver bed with lymph node dissection was perform
ed after laparoscopic cholecystectomy in 4 of these 5 patients. Abdomi
nal wall recurrence in the absence of distant metastasis was present i
n 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 carc
inoma 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.