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[Gallbladder carcinoma and laparoscopic cholecystectomy. An emergent problem]
F Romano1, C Franciosi, R Caprotti
1Clinica Chirurgica I, Ospedale San Gerardo, II Università di Milano, Bicocca, Via Donizetti, 106, 20052 Monza.
Minerva Chirurgica
|April 20, 2001
Summary
Occult gallbladder cancer (GC) is increasing with laparoscopic surgery (LC). Risk factors include polyps, age over 70, gallstones, and thickened gallbladder walls, necessitating further examination.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Oncology
Background:
- Gallbladder cancer (GC) is incidentally found in 1.5-3% of cholecystectomies.
- The rise in laparoscopic surgery (LC) may lead to an increased incidence of occult GC.
Purpose of the Study:
- To determine if laparoscopic cholecystectomy (LC) has increased the detection rate of gallbladder cancer (GC).
- To evaluate risk factors and treatment options for unsuspected GC diagnosed post-LC.
Main Methods:
- A retrospective study of 1200 laparoscopic cholecystectomies (LC) performed between January 1991 and December 1998.
- Analysis of seven cases of GC diagnosed after LC.
- Evaluation of clinical outcomes based on histopathologic stage.
Main Results:
- Seven cases (0.6%) of undiagnosed GC were found during LC, a higher rate than with open surgery (0.3%).
- Post-LC follow-up showed survival in early-stage (pT1, pT2) patients.
- Advanced stages (pT2, pT3) had poor outcomes, with some deaths due to peritoneal dissemination.
- Two cases involved polypoid lesions that were confirmed as carcinoma.
Conclusions:
- Undiagnosed gallbladder cancer (GC) is increasing with the adoption of laparoscopic cholecystectomy (LC).
- Risk factors for unsuspected GC include polypoid lesions, age > 70, chronic gallstones, and thickened gallbladder wall.
- Preoperative examination and frozen section analysis are recommended for patients with these risk factors.