Does the laparoscopic cholecystectomy accelerate the intraperitoneal dissemination of previously unrecognized gallbladder cancer

Abstract

Background: Many observations suggest that early intraperitoneal dissemination and port site metastasis occur after laparoscopic cholecystectomy in previously unrecognized gallbladder cancer.

Material and methods: In the years 1992-1999 nine patients after laparoscopic cholecystectomy, were operated on because of previously unsuspected gallbladder cancer following standard postoperative microscopic examination. All gallbladders with markedly thickened wall were removed from abdominal cavity in protective bag. In three cases tumor infiltrated muscular layer (T1b), and in six serosa (T3). All patients 12 to 65 days after cholecystectomy were operated in order to extended operational margins.

Results: In four cases (three T1, one T3) during the second operation 3 cm width of the liver parenchyma surrounding the gallbladder bed was resected, along the dissection of the lymphatic of the hepatoduodenal ligament. In these four patients no neoplastic infiltration was found on microscopic examination. All four patients are alive with no signs of recurrence within 3, 5, 17 and 40 months after cholecystectomy. In five persons (all T3), at the second operation, we found intraperitoneal carcinomatosis, and operation was limited to only explorative laparotomy. Four of these five patients died 3, 4, 10 and 11 months after cholecystectomy. One patient is alive 22 months after operation; in this case microscopic examination did not confirm the macroscopic intraoperative diagnosis.

Conclusion: Laparoscopic cholecystectomy probably accelerates intraperitoneal dissemination in previously unrecognized gallbladder cancer, especially in stage T3 patients and contemporary standard precautions are inadequate.