Unsuspected gallbladder cancer diagnosed after laparoscopic cholecystectomy: focus on acute cholecystitis

The aim of the present study was to investigate clinicopathological features of patients who were diagnosed with unsuspected gallbladder cancer (UGC) after laparoscopic cholecystectomy (LC) and to clarify the relationship between acute cholecystitis (AC) and unsuspected gallbladder cancer.

From June 1997 to March 2008, a total of 2,607 LCs were performed at Ajou University Medical Center. Twenty-six patients (1.0%) were diagnosed with gallbladder cancer after LC. We excluded patients with preoperatively or intraoperatively suspected gallbladder cancer.

Of 1,128 patients with AC, 19 (1.6%) were identified with gallbladder cancer after surgery. The preoperative diagnosis included a high rate of acute and severe acute cholecystitis (n = 19; 73.1%). The rate of conversion to open surgery was 15.4% (4/26), and bile spillage occurred in 14 of 26 patients (53.8%). Adenocarcinoma (92.3%) and pT2 (65.4%) were the most common pathological findings. In 19 UGC patients with AC, the most common pathological finding was also pT2 (n = 12; 63.1%). In addition, all 5 of the patients with positive resection margin belonged to the UGC with AC group. Two of 26 patients (7.7%) underwent additional surgery after LC, and 2 patients (7.7%) underwent excision of the port site/wound for recurrence. The overall median survival was 32 months (95% Confidence Interval [CI] = 21-43). There were no significant differences in age, the presence of acute cholecystitis, or bile spillage (P > 0.05) However, tumor differentiation was associated significantly with survival rate.

The preoperative diagnosis included a high rate of acute and severe acute cholecystitis. Survival was not associated with the presence of AC and bile spillage. Therefore, we suggest that AC may not influence the prognosis of unsuspected gallbladder cancer after LC. Moreover, good tumor differentiation can guarantee favorable survival, even in UGC with AC.