Radical surgery for incidental cancer gallbladder after laparoscopic cholecystectomy

To report our experience in the management of incidentally detected carcinoma gall bladder and establishment of a treatment protocol.

Retrospective review of 7 patients with incidentally detected carcinoma gall bladder during and after laparoscopic cholecystectomy for presumed benign disease. Clinical and histopathological data, treatment and long term outcome of all seven patients were reviewed. Exploratory laparotomy and radical surgery with curative intent consisting of liver resection, lymphadenectomy of the pedicle and excision of the port site were performed in all patients.

Liver resection including the segments IVB and V was done in 5 patients and in 2 patients resection of a wedge of hepatic parenchyma of more than 2 cm thickness including the gall bladder bed was carried out. Five patients underwent common bile duct excision with hepaticojejunostomy. Postoperatively, 2 patients developed fever and 1 patient had minimal altered blood in the nasogastric tube aspirate. These were successfully managed conservatively. All 7 patients had disease of pathological stage II and beyond. All patients received adjuvant chemotherapy. One patient died after 2 months of cholangitis and sepsis. One patient succumbed to metastatic disease after 12 months. The remaining patients are disease free on follow up.

Re-exploration and aggressive resection with adjuvant chemotherapy for incidental carcinoma of the gallbladder is safe and offers hope for long term survival.