Unsuspected Gallbladder Cancer: Radical Second Operation vs Cholecystectomy Alone

ABSTRACT

PURPOSE: This study was designed to evaluate effectiveness of additional operation for gallbladder cancers (GBC) diagnosed after simple cholecystectomy. METHODS: Retrospective pathological review of 250 GBC (Mar. 1986~Nov. 2000) revealed that in 38 cases the malignancy had been proven by later pathologic study after the patients had initially undergone simple cholecystectomy. Twelve patients had a subsequent reoperation and the other 26 were observed. Types of reoperation were liver wedge resection (n=4), wedge resection with CBD resection (n=2), extended right lobectomy (n=2), wedge resection with Whipple's operation (n=1), hepatopancreaticoduodenectomy (n=1), bile duct resection (n=1) and open biopsy (n=1). We analyzed the clinical outcomes of these patients. RESULTS: (1) Patients with pT1 (n=19) survived without additional operation. (2) Five patients with pT2 lesion without reoperation and 5 patients with reoperation (LN(-) 4, LN(+) 1) were still alive without evidence of recurrence at an average of 35 months follow up (duration 3~84 months). The remaining 3 patients with reoperation (LN(+)) died at postoperative 7, 11 and 20 months. (3) One patient with pT3 cancer without LN metastasis was alive at 80 months after reoperation. (4) Among 4 patients with pT3 lesion, 3 died while the other without reoperation (unknown LN status) was alive without recurrence at 80 months after reoperation. CONCLUSION: It was suggested that pT1 cancer can betreated with cholecystectomy alone. Additional operation should be applied to pT2 or more advanced cancers, and to cases of positive resection margin. Thorough gross examination of gallbladder specimens during cholecystectomy is essential to avoid missing hidden GBC.