Gallbladder carcinoma during laparoscopic cholecystectomy: is it associated with bad prognosis?

Laparoscopic cholecystectomy is the treatment of choice for gallstone disea se. The ultrasonogram has failed for the early detection of gallbladder can cer, especially if inflammation (chronic or acute) is present. Incidental g allbladder could be an important cancer finding during laparoscopic cholecy stectomy, due to the potential cancer cell dissemination during the procedu re. In our Department, 6500 laparoscopic cholecystectomies have been perfor med in the last 5 years and in 15 cases (0.23%) gallbladder cancer was foun d during surgery or after histological examination of the resected gallblad der. In none of these 15 patients was pre-operative diagnosis of gallbladde r carcinoma postulated. When re-evaluation of the pre-operative ultrasonogr ams was done, it was possible to observe signs suggesting the presence of n eoplastic infiltration in 4 of them (28.6%). During videoscopic exploration , also in 4 patients, the suspicion of gallbladder cancer was noted. Laparo scopic cholecystectomy was completed in 9 patients. In 2 of them, in situ o r mucosal invasion was demonstrated with a long survival. One patient prese nted recurrence at the biliary hilum 2,5 years after surgery. Six patients were re-operated and in 4 of them peritoneal or port site metastasis was fo und; all died early (4.5 month median survival). The other 2 patients were submitted to liver bed resection and lymph node dissection. These patients are free of cancer recurrence after 15 months of follow-up. Six patients we re converted to open surgery, performing palliative procedures and died bef ore the 12 month follow-up. The suspicion of pre-operative gallbladder canc er is generally unlikely to be confirmed based on ultrasonographic signs; b ut, in some cases with high suspicion, further investigation (TAC, tumor ma rkers, etc.) must be indicated in order to avoid poor results. Laparoscopic cholecystectomy could be associated with bad prognosis, and then, when gal lbladder cancer is suspected during the laparoscopic procedure, conversion to open surgery could be the best choice.