Laparoscopic cholecystectomy and unsuspected gallbladder carcinoma

Gallbladder cancer is a relatively uncommon malignancy in the United States . Its presentation is similar to that of lithic disease of the gallbladder. Laparoscopic cholecystectomy has become the method of choice for removing the gallbladder in most benign conditions. Occasionally, unsuspected gallbl adder carcinoma is encountered in association with laparoscopic cholecystec tomy. Overall, gallbladder cancer portends a poor prognosis. However, in se lect cases, a favorable outcome can be expected and the less favorable pred icted expected outcome can be improved. Management of patients with gallbla dder cancer in different situations is discussed: gallbladder cancer noted postoperatively on final pathology, gallbladder cancer noted after removal of the gallbladder and opening of the specimen at the time of surgery, diff iculty encountered at the time of dissection and resultant suspicion of gal lbladder cancer, and diagnosis of extensive disease at initial placement of the laparoscope. The technique of extended cholecystectomy is outlined. (C ) 1999 Wiley-Liss, Inc.