Port site metastases from gallbladder cancer after laparoscopic cholecystectomy. Results of a Swedish survey and review of published reports

Objective: To investigate the incidence of port site metastases from unsusp ected gallbladder cancer after laparoscopic cholecystectomy. Design: Retrospective national multicentre study, 1991-94. Setting: All 8 university and 24 central hospitals, Sweden. Subjects and interventions: All 32 hospitals were interviewed by means of a written questionnaire. The registers of all Swedish Oncological Centres an d the registers of the National Board of Health and Welfare were checked fo r reported cases of gallbladder cancer and surgical classification codes fo r cholecystectomy. To detect laparoscopic interventions incorrectly registe red as open operations, all cholecystectomies registered as open were match ed against the Swedish Registry of Laparoscopic Cholecystectomy for the yea rs 1991-93 and all patients records for 1994 were scrutinised. Results: Replies were obtained from 30/32 clinics (94%) and 11976 laparosco pic cholecystectomies were done. Of 447 patients with verified gallbladder carcinoma 270 had their gallbladders removed, 55 (20%) laparoscopically. 9 of these (16%) developed port site metastases and 6 died from their disease at a median of 18 months (range 5-22). Two patients are alive, 54 and 45 m onths after cholecystectomy. One patient has been lost to follow-up. Conclusions: Port site metastases from gallbladder cancer may be more commo n than previously thought. A laparoscopic procedure should not be done if c ancer of the gallbladder is suspected.