Incidental gallbladder carcinoma diagnosed after laparoscopic cholecystectomy

Abstract

Purpose:To evaluate the clinicopathological features of incidental gallbladder carcinoma (IGC) after laparoscopic cholecystectomy (LC). Method: A total of 1,034 patients were treated consecutively with LC for gallbladder disease. In this series, 11 patients (1.1%) except for patients with suspected carcinoma were given a diagnosis of IGC after LC. Results: All patients had gallbladder stones and 7 coexisted with clinical cholecystitis. Macroscopic findings of these tumors showed superficial type in 4 (36.4%), nodular type in 1 (9.1%) and flat type in 6 (54.5%). The depth of tumor invasions was confined to the mucosa in 2 (18.2%), the proper muscle layer in 2 (18.2%), the subserosa in 5 (45.4%) and the serosa in 2 (18.2%). All patients with pT1 are alive without recurrence. All 7 patients with stage pT2 cancer or lower underwent additional surgery. Among these patients, 6 had malignant lesions, while 1 had no malignant lesion at the time of second surgery. Of the 6 patients who had malignant lesions at the time of second surgery, two patients are alive without recurrence, 1 is alive with recurrence, and 4 died of recurrence. Conclusions: The prognosis of patients with early stage cancer is generally good, while that of patients with advanced cancer is poor even if additional surgery is performed after LC. IGC may occur in clinical cholecystitis and/or flat type cancer lesions with gallbladder stones. These factors may be difficult to diagnose as gallbladder cancer, preoperatively. Additional examinations are needed in case of acute cholecystitis because of insufficient gallbladder evaluation before LC.