Postoperative diagnosis of gallbladder carcinoma. Observation or reoperation?

Background: The prognosis of gallbladder carcinoma is generally poor. The 5 -year survival rate amounts to less than 5 % in most series due to the high proportion of advanced stages at the time of diagnosis. Early stages are c ommonly found only with histological work-up after cholecystectomy (CCE). I n these cases the question arises whether or not reoperation for completion resection would be indicated. Patients/Methods: A retrospective analysis examined all patients of the Cli nic of Surgery (Charite) in Berlin with gallbladder carcinoma operated on b etween January 1981 and August 1993. A literature search was carried out us ing the MEDLINE retrieval system for the key words "gallbladder carcinoma", "surgical therapy", and "reoperation" limited to the period after 1970. Results: The retrospective results of the own clinic and the analysis of th e literature review demonstrate significantly higher survival rates after r eoperation compared to CCE alone and observation for all cases of gallbladd er carcinoma with stages T1b or higher stages. The extended radical CCE can be performed with low morbidity. With preceding laparoscopic CCE the troca r sites have to be completely excised. Discussion: To avoid the situation of postoperative diagnosis of gallbladde r carcinoma, the surgeon should intraoperatively during CCE perform a caref ul macroscopic control of the gallbladder. Suspect findings should be follo wed intraoperatively by histological examination. Nevertheless, local sprea d of GBCa and distribution of lymphatic metastases can certainly not be ass essed completely after simple CCE. Based on the published results and becau se of low morbidity reoperation is indicated for most cases of GBCa when di agnosed postoperatively.