[Gallbladder cancer in the age of laparoscopic surgery]

Abstract

In routine post operative microscopic test of unsuspected of cancer gallbladder--before or during laparoscopic cholecystectomy--cancer is recognized in 0.5% to 1%. Bad prognosis is mainly connected with how far advanced the cancer is. It seems that laparoscopic technic it is a disadvantage itself as it conduces to dissemination of cancer in peritoneal cavity and also in cicatrix. Our experience so far proofs that repeatedly during the second traditional operation--even up to several days after laparoscopy--dissemination of cancer is found in peritoneum. Today's views regarding treatment of not advanced cancer considerable are based on experience when the traditional operations were used to remove gallbladder. Further more--it permitted to accept that just cholecystectomy is sufficient in cases when cancer infiltration has not gone beyond mucous membrane. In cases of more advanced cancer extensive operations may prolong life. Due to that observation in cases of gallbladder with cancer infiltration beyond mucous membrane and removed in laparoscopic way an extensive operation is carried out later and it is taking in adherent liver parenchyma and lymphatic tissue in hepato-duodenal ligament or if necessary main biliary tract. Extensive operations are being carried out till microscopic routine test has been performed and few days after laparoscopic cholecystectomy. Some other solution rely during laparoscopic operation--on treating respective with thicken wall gallbladder as a suspected of cancer and microscopic test is carried out intraoperatively. It conditions accomplishment of extensive operation. It must be emphasise that laparoscopic technique encourages dissemination of cancer. From different point of view switching from laparoscopic to traditional cholecystectomy with 1% risk of cancer in thicken wall gallbladder against remaining will be deprived of benefits of laparoscopic operation. Still this quite complicated problem remains open to discussions, research and it needs some time yet before solution will be found.