Clinical Study of Gallbladder Carcinoma Identified after Simple Cholecystectomy as an Initial Operation

ABSTRACT

PURPOSE: Gallbladder carcinoma (GBC) is a rare neoplasm with poor prognosis. With the introduction and the wide acceptance of laparoscopic surgery, the diagnostic rate of incidental GBC has increased. We report our experience with the reoperated GBC diagnosed after simple cholecystectomy. METHODS: From March 2001 to July 2005, 17 patients with a postoperative diagnosis of GBC after prior simple cholecystectomy were referred to our center for curative reoperation. The types of simple cholecystectomy were open cholecystectomy in 5 cases, and laparoscopic cholecystectomy in 12 cases. The types of reoperation were hepatic wedge resection with lymph node dissection (HWR /(c) LND, n=9), HWR with LND and bile duct resection (HWR /(c) LND and BDR, n=4), right hepatectomy (RH) with LND and BDR (n=1), extended RH with LND, BDR and caudate lobectomy (n=1) and extended left hepatectomy with LND and BDR (n=1). Residual tumor is defined as the tumor tissue detected on reoperation; bile duct, liver, lymph node, lymphatics, vessels and nerves. RESULTS: There is no operative mortality. The median hospital stay was 18.5days (range, 8 - 44 days). The median interval between 1st and 2nd operation was 23.5 days (range, 6 - 44 days). The median operative time was 379 minutes (range, 240-726). Five complications occurred in 4 patients. One patient received intraoperative transfusion. The depth of tumor invasion in 17 patients was T2 in 15, T3 in 1, and T4 in 1. There was no residual tumor in 8 out of 17 patients. In the other 9 patients, the residual tumor was identified after reoperation; liver in 2, lymph node in 7, bile duct in 3, lymphatics in 6, vessels in 3, and nerves in 3. Three patients of 17 patients recurred and 2 patients of them died. In curative reoperation after simple cholecystectomy, the median follow-up length was 14.7 months (1-53 months). One- and two-year survival rates were 90.9%, 79.6%, respectively. Vascular, lymphatic, and neural invasions were the significant risk factors for recurrence by the log-rank test. CONCLUSION: Reoperation of GBC diagnosed after simple cholecystectomy is safe and may be effective. Lymphatic, vascular, and neural invasion may have a dismal effect on the disease-free survival.