Laparoscopic cholecystectomy and gallbladder cancer

Background: This study was designed to assess the treatment of patients in whom gallbladder cancer was diagnosed in the course of histological examination of their gallbladders, which were removed during laparoscopic cholecystectomy. Methods: Six (0.29%) cancers were found among 2,017 patients who underwent laparoscopic cholecystectomy. Four of these cancers (0.22%) were in 1,831 gallbladders with normal walls, two (1.0%) were in 186 with thicker walls, and two (1.8%) were in 109 patients in whom conversion was necessary because of extensive inflammation and thickening of gallbladder wall. Results: In two cases, the cancer did not cross the muscular layer. In one of them, no further treatment was undertaken. In the second case, liver resection and lymphadenectomy was performed. In the other four cases, dissemination was diagnosed during laparotomy, precluding radical treatment. Conclusions: Thickened and infiltrated gallbladder walls in patients without preoperative symptoms of cholecystitis should raise a suspicion of cancer. The surgeon should be prepared to perform a conversion, an intraoperative histological examination, and an appropriate radical operation, if necessary.