Management of unsuspected gallbladder carcinoma discovered during or following laparoscopic cholecystectomy

Laparoscopic cholecystectomy (LC) is widely used in the treatment of symptomatic cholelithiasis. Gallbladder carcinoma (GBC) discovered during or after LC presents a management problem because of the difficulty of intraoperative staging. We conducted a retrospective, 8-year review of 10 patients with GBC discovered during or after LC. Of 3050 patients undergoing LC for cholelithiasis, 10 (0.3%) had GBC. The histological diagnoses of the 10 GBC patients included well-differentiated adenocarcinomas (n = 5), papillary adenocarcinomas (n = 2), moderately differentiated adenocarcinomas (n = 2), and poorly differentiated adenocarcinoma (n = 1). Of these patients, four had TNM classified T1 tumors, three had T2 tumors, one had T2N0M0 tumor, one had T2N1M0 tumor, and one had T3N0M0 tumor. In three of them (T2N0M0, T2N1M0, and T3N0M0), the procedure was converted to open cholecystectomy, wedge resection of liver bed tissue in segment 5, and lymph node dissection after frozen-section biopsy of the laparoscopically removed gallbladder revealed GBC. Patients were closely followed at regular intervals until death or May 2000. The median follow-up period was 24.5 months. One patient died of carcinomatosis 6 months after undergoing the open procedure. The remaining nine patients did not have any recurrence during the follow-up period. No patient had a port site recurrence of GBC. Based on our limited experience, early GBC (T1a or T1s) can successfully be managed by simple cholecystectomy, either by LC or the open method.