Prognosis of Patients with the Gallbladder Carcinoma Undergone Laparoscopic Cholecystectomy as an Initial Operation

ABSTRACT

PURPOSE: Laparoscopic cholecystectomy (LC) has become a standard procedure for treatment of benign gallbladder diseases. There has been a small proportion of gallbladder cancers (GBC) which were incidentally found in the LC specimen, and LC has been tried in some patients with suspected GBC. This study intended to analyze the prognosis of patients with GBC undergone LC and the outcome of extended re-operation. METHODS: From Jan. 1995 to Aug. 2001, the outcome of 59 GBC patients undergone LC initially were analyzed. 100 GBC patients undergone laparotomic resection were chosen as control group. CO2 inflation method was used for LC. RESULTS: The depths of cancer invasion in 59 patients were as following pTis in 2 (3.4%), pT1a in 4 (6.8%), pT1b in 14 (23.7%), pT2 in 28 (47.5%), and pT3 in 11 (18.6%). Re-operation was carried out at average 14 days after LC in 25 (42%) patients. There was no recurrence in patients with pTis and pT1a GBC, but there were two recurrent cases in pT1b GBC (each case with and without re-operation). The survival rate of patients of pT2 GBC who underwent re-operation after LC was better than that of patients who underwent one-stage laparotomic resection, but this difference was not demonstrated in patients with pT3 GBC. CONCLUSION: We think that LC does not deteriorate the prognosis of patients with incidentally detected GBC if appropriate re-operation is carried out according to the cancer staging. However, there is some possibility of tumor cell spillage during LC, so laparotomy should be preferred to LC for patients with suspected GBC in preoperative assessment.