Gallbladder cancer: laparoscopic and classic cholecystectomy

Gallbladder carcinoma is an abdominal malignancy with an extraordinarily poor prognosis that depends on the stage at the time of the diagnosis.

In the past 8 years, 3,158 laparoscopic cholecystectomies (LC), and 8 years before that, 3,083 classic cholecystectomies (CC) were performed in the authors' department.

In 15 LC cases and 7 CC cases, gallbladder carcinoma was found. There was preoperative or intraoperative suspicion of malignancy in 3 LC and 5 CC cases. According to the tumor-node-metastasis (TNM) classification system, these cases were categorized as stage 3 (S3) or S4, and resumption of the operation was necessary. Two LC cases and five CC cases were inoperable malignancies requiring palliative treatment. The others were managed with surgery for the completion of an extended cholecystectomy. The survival rate for all the patients was less than 1 month. In 12 LC cases and 2 CC cases, malignancy was diagnosed postoperatively. The stages for the LC group were S1(T in situ) in four cases and S1(T1) in eight cases. The stage for the CC group was S1(T1) in both cases. After simple LC or CC, the survival time was more than 2 years for eight patients and more than 3 years for four patients. Two patients were still alive, respectively, 1 and 2 years postoperatively. The difference in the numbers of diagnosed and resected gallbladder carcinoma in the earlier stages between the LC and CC groups is statistically significant ( p < 0.01).

With the increased use of LC for presumed gallstone disease, the diagnosis and removal of gallbladder carcinoma in the earlier stages could be more frequent.