Y Fong1, N Heffernan, L H Blumgart. 1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Abstract
BACKGROUND: This study attempted to determine whether aggressive surgical therapy is warranted after gallbladder carcinoma is discovered during or after laparoscopic cholecystectomy. METHODS: The clinical course and outcome of 42 consecutive patients with laparoscopically discovered gallbladder carcinoma seen over a 5-year period at a tertiary referral center were examined. Nine of the patients had TNM classified T2 tumors and 32 had full thickness penetration of the gallbladder including 16 T3 and 16 T4 tumors. RESULTS: At reexploration, 22 of the patients were found to have lymph node, peritoneal, or bilateral liver disease precluding reresection. Nineteen patients underwent liver resection (13 trisegmentectomies and 6 bisegmentectomies), portal lymphadenectomy, and hepaticojejunostomy as the definitive surgical procedure for the carcinoma. There was 1 perioperative death, and the median hospital stay was 11 days (range, 6-28 days). At last follow-up 17 of the 22 nonresected patients had died, with a median survival of 5 months. With a follow-up of 16 months, only 3 of the resected patients had died. CONCLUSIONS: The authors conclude that aggressive resection of gallbladder carcinoma discovered laparoscopically is safe and effective.
BACKGROUND: This study attempted to determine whether aggressive surgical therapy is warranted after gallbladder carcinoma is discovered during or after laparoscopic cholecystectomy. METHODS: The clinical course and outcome of 42 consecutive patients with laparoscopically discovered gallbladder carcinoma seen over a 5-year period at a tertiary referral center were examined. Nine of the patients had TNM classified T2 tumors and 32 had full thickness penetration of the gallbladder including 16 T3 and 16 T4 tumors. RESULTS: At reexploration, 22 of the patients were found to have lymph node, peritoneal, or bilateral liver disease precluding reresection. Nineteen patients underwent liver resection (13 trisegmentectomies and 6 bisegmentectomies), portal lymphadenectomy, and hepaticojejunostomy as the definitive surgical procedure for the carcinoma. There was 1 perioperative death, and the median hospital stay was 11 days (range, 6-28 days). At last follow-up 17 of the 22 nonresected patients had died, with a median survival of 5 months. With a follow-up of 16 months, only 3 of the resected patients had died. CONCLUSIONS: The authors conclude that aggressive resection of gallbladder carcinoma discovered laparoscopically is safe and effective.
Authors: Elijah Dixon; Charles M Vollmer; Ajay Sahajpal; Mark Cattral; David Grant; Christopher Doig; Al Hemming; Bryce Taylor; Bernard Langer; Paul Greig; Steven Gallinger Journal: Ann Surg Date: 2005-03 Impact factor: 12.969