The management of gallbladder cancer: before, during, and after laparoscopic cholecystectomy

Carcinoma of the gallbladder is a rare disease, but when encountered in the patient undergoing laparoscopic cholecystectomy, it can pose a number of dilemmas. Familiarity with the risk factors for malignant gallbladder disease can help identify patients in whom more extensive preoperative evaluation is warranted. When carcinoma is identified preoperatively, cholecystectomy should be performed as an open procedure. If malignancy is encountered unexpectedly during laparoscopic cholecystectomy, the procedure should be converted to an open resection to allow for appropriate evaluation of the stage of disease and appropriate surgical management. Most commonly, malignancy is identified postoperatively, only after pathological examination of the resected gallbladder. Except in rare circumstances, open reoperation is necessary to achieve an adequate curative resection. The current concerns about port site recurrence and carcinomatosis after laparoscopic resection of a gallbladder carcinoma are unwarranted based on current published data. The role of prophylactic excision or irradiation of port sites is uncertain based on current understanding of the biological behavior of the disease.