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Gallbladder cancer discovered during laparoscopic surgery. Potential for iatrogenic tumor dissemination
Y Fong1, M F Brennan, A Turnbull
1Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
Objective:
To examine the results of treatment of laparoscopically discovered gallbladder cancer.
Design:
Retrospective review of clinical data for the 10 patients with laparoscopically discovered gallbladder cancer who were referred to our institution for definitive surgical therapy.
Setting:
An oncologic referral center.
Patients:
All patients in the 24-month period from November 1990 to November 1992 with this entity who were referred for surgical therapy.
Intervention:
Exploratory laparotomy was performed on all patients. Resection with curative intent was performed when possible.
Main Outcome Measures:
Resectability and outcome of cancer treatment.
Results:
In three patients, a subsequent radical resection was performed and as a result, two patients are currently free of disease. Intraperitoneal spread, not present at the original laparoscopy and associated with violation of tumor at laparoscopy, precluded potentially curative resection for four patients. In two of these patients, there was obvious tumor growth within the laparoscopy tracts.
Conclusions:
Tumor dissemination is a real hazard of laparoscopic violation of gallbladder integrity in the presence of gallbladder cancer. Modification of management based on awareness of such a hazard is needed to improve resectability and outcome of future cases of laparoscopically discovered gallbladder cancer.