Gallbladder carcinoma - when to use laparoscopic approach?

AIM: To assess how laparoscopy has altered the presentation of patients with gallbladder cancer and determine whether radical resection in patients with gallbladder cancer is beneficial.

METHOD: 47 patients underwent surgery because of suspected gallbladder cancer. Cancer was found incidentally in 29 patients (61.7 %) during routine laparoscopic cholecystectomy using frozen biopsy. Gallbladder cancer had been diagnosed preoperatively in the other 18 patients (38.3 %).

RESULTS

Patients in whom carcinoma was found incidentally at laparoscopic cholecystectomy had a significant increase in survival when compared with those who were admitted electively with a known diagnosis. All patients who presented with a known diagnosis had stage II or higher, and 38.3 % of these were in stage IV. However, 58.6 % of those patients who were found incidentally were in stage I or II. The overall 2-year survival for all patients was 45 %; those discovered incidentally at laparoscopic cholecystectomy (Tis-T2) had a 2-year survival of 87 %.

CONCLUSION

Laparoscopic cholecystectomy resulted in an earlier discovery of gallbladder cancer in some patients, resulting in increased probability of survival. Adjunctive radical surgical resection, either at the time of cholecystectomy or subsequently, increases survival significantly in early stage disease (Tab.2, Fig. 2, Ref. 24). Text in PDF www.elis.sk Keywords: gallbladder carcinoma, laparoscopic approach.