Gallbladder cancer (GBCA) has dismal prognosis due to early invasion into adjacent organs and lymphatic metastasis which obviate curative surgery at laparotomy. Since the laparoscopic cholecystectomy has been performed in our institution from
Sep.
1993,
authors have experienced incidental GBCA. The purpose of this study is to review clinicopathological findings of GBCA found incidentally during laparoscopic cholecystectomy for gallstone disease.
Seven cases of GBCA were incidentally found among 250 cases of laparoscopic cholecystec-tomy for the gallstones (2.7%) from September, 1993 to June, 1996. During the same period, there was 23 GBCA patients admitted to department of department of
internal medicine, and three patients revealed GBCA at open cholecystectomy for gallstone disease. Medical records and pathological findings of those thirty three patients were reviewed retrospectively and analyzed.
Among thirty three cases of GBCA, seven cases were incidentally found during laparoscopic cholecystectomy (21%; 7/33). Overall operability was 49% (16/33), and six cases (26%; 6/23) were operated with preoperative diagnosis of GBCA. Sex ratio
showed
female prepondderance (2.3:1). The mean age was 60 years. The operations were cholecystectomy (10 cases), cholecystectomy with common bile duct resection (2 cases), cholecystectomy with pancreaticoduodenectomy (1 case), cholecystectomy with
T-tube
choledochostomy (1 case), and open biopsy only (2 cases). The resectability was 88% (14/16) in operable cases. In laparoscopic cases, two cases were converted to open laparotomy because of suspicion of GBCA, and cholecystectomy and open biopsy
were
done. Five cases were diagnosed by permanent pathologic examination after laparoscopic cholecystectomy. Pathological findings revealed that 81% were advanced beyond the proper muscle layer. Regional lymph node metastasis were found in three cases
of
open surgery (33%; 3/9). Distant metastasis to the liver or peritoneal seeding were found in five cases (two in laparoscopic cholecystectomy, and three in open surgery). Operative mortality was 6.3% (1/16). Possible curative resections were
performed
for two cases in laparoscopic cholecystectomy cases (29%, 2/7), and five cases in open surgery cases (56%; 5/9).
In conclusion, surgeons should be aware that GBCA may be hidden in gallstone diseases in laparoscopic cholecystectomy especially in old age, woman, and thick-walled gallbladder, and more effort for operative diagnosis including frozen biopsy
after
resection is needed to avoid incomplete surgery, Additionally asymptomatic gallstone should be carefully followed in view of relatively high incidence of GBCA in gallstone disease.
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