Laparoscopic cholecystectomy and gallbladder cancer

✍ Scribed by G. S. Ferzli; R. Daou

• Publisher: Springer
• Year: 1994
• Tongue: English
• Weight: 78 KB
• Volume: 8
• Category: Article
• ISSN: 0930-2794
• DOI: 10.1007/bf00188303

✦ Synopsis

Laparoscopic cholecystectomy and gallbladder cancer

Since its introduction in 1987 by Mouret [3], laparoscopic cholecystectomy has become the treatment of choice for patients having operations for cholelithiasis. Carcinoma of the gallbladder is seen in frequent association with cholelithiasis, but the diagnosis is made preoperatively in only 10--40% [7, 8] of those cases. This means that many cases with cancer of the gallbladder will be approached laparoscopically.

Review of the literature reveals four reports of gallbladder cancer managed laparoscopically, two in letters to surgical journals [1,4] and two others as case reports [2,6]. In all four cases, iatrogenic parietal and intraperitoneal dissemination of the tumor occurred. This spread was especially apparent along the trocar site used to extract the gallbladder.

A recent report by Fong et al.

[5] described an additional four patients in whom inadvertent dissemination of a tumor at laparoscopy precluded potentially curative resection. Tumor growth within the cannula tract was obvious in two patients despite the short interval to reoperation and in two others the spread was intraperitoneal.

Tumor dissemination is known to occur after needle biopsies of cancer of the lung, thyroid, ovary, and prostate. This dissemination apparently exists after laparoscopic cholecystectomy for gallbladder cancer. In order to avoid dissemination and worsening the prognosis of an already-terrible disease, the following recommendations are offered: