GALLBLADDER CARCINOMA IN THE ERA OF LAPAROSCOPIC CHOLECYSTECTOMY

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.