GALLBLADDER CANCER DISCOVERED DURING LAPAROSCOPIC SURGERY - POTENTIALFOR IATROGENIC TUMOR DISSEMINATION

Objectives To examine the results of treatment of laparoscopically dis covered gallbladder cancer. Design: Retrospective review of clinical d ata for the 10 patients with laparoscopically discovered gallbladder c ancer who were referred to our institution for definitive surgical the rapy. Setting: An oncologic referral center. Patients: All patients in the 24-month period from November 1990 to November 1992 with this ent ity who were referred for surgical therapy. Intervention: Exploratory laparotomy was performed on all patients. Resection with curative inte nt was performed when possible. Main Outcome Measures: Resectability a nd outcome of cancer treatment. Results: In three patients, a subseque nt radical resection was performed and as a result, two patients are c urrently free of disease. Intraperitoneal spread, not present at the o riginal laparoscopy and associated with violation of tumor at laparosc opy, precluded potentially curative resection for four patients. In tw o of these patients, there was obvious tumor growth within the laparos copy tracts. Conclusions: Tumor dissemination is a real hazard of lapa roscopic violation of gallbladder integrity in the presence of gallbla dder cancer. Modification of management based on awareness of such a h azard is needed to improve resectability and outcome of future cases o f laparoscopically discovered gallbladder cancer.