Gallbladder Carcinomas found after a Laparoscopic Cholecystectomy

ABSTRACT

PURPOSE: An laparoscopic cholecystectomy (LC) is being increasingly performed for benign gallbladder disease. Accordingly, gallbladder carcinomas have been increasingly reported in patients after undergoing an LC. This study aims to reveal the clinicopathological features and prognosis of gallbladder carcinomas found after an LC. METHODS: Between April 1994 and March 2007, 2714 patients underwent an LC and 1.5% of the patients were diagnosed histologically as having a gallbladder carcinoma. We retrospectively evaluated the clinicopathological features and long-term survival of the patients. RESULTS: There were 19 male patients and 21 female patients, with a mean age of 60.7 degrees+/-12.3 years. The indications for LC included acute calculous cholecystitis, chronic calculous cholecystitis and polypoid lesions of the gallbladder (PLGs). An LC only was performed in 26 patients (13 pT1a, 7 pT1b and 6 pT2 cases) while additional surgery including gallbladder bed resection and lymph node dissection was performed in 14 patients (2 pT1a, 2 pT1b, 8 pT2 and 2 pT3 cases). The patients with a carcinoma associated with PLGs were younger, had more incidence of pT1a and had well differentiated carcinomas and a better 5-year survival rate as compared to patients with a non-polypoid carcinoma. Whereas no recurrences or deaths occurred for the 24 pT1 patients, two of the 14 pT2 patients had a recurrence. Both pT3 patients had a recurrence despite additional surgery. In patients with pT2 or more, additional surgery did not improve survival (p = 0.82). CONCLUSION: The polypoid morphology of gallbladder carcinoma, but not additional surgery, favorably affects survival of gallbladder carcinoma patients following an LC. However, a further multi-institutional study may be needed to determine the benefit of additional surgery.