Laparoscopic cholecystectomy with full-thickness dissection for potentially cancerous lesions: comparison with standard technique.
OBJECTIVE
With an increase in laparoscopic cholecystectomy (LC) cases, unsuspected gallbladder cancers have been reported and intraabdominal cancer dissemination has been identified as a crucial problem. Since September 1991, we employed LC with full-thickness dissection (LC-F) for polypoid lesions of the gallbladder. In the present study, the utility of the procedure was investigated.


METHODS
For 261 patients who underwent standard LC (S-LC) or LC-F between September 1991 and August 1996, the operation time, intra- and post-operative complications relevant to the operative technique, histological findings of the gallbladders, and prognosis of each patient with gallbladder cancer were evaluated.


RESULTS
S-LC and LC-F were performed in 231 and 30 patients, respectively. The mean operation times for S-LC and LC-F were 157 and 120 min, respectively, (p < 0.05). Gallbladder perforation occurred in 29 S-LCs, whereas there was none in 30 LC-Fs (p < 0.05). Bleeding from the gallbladder bed occurred in 1 patient in each of the 2 groups, but was stopped easily. There was neither post-operative bleeding nor bile leakage in either group. Mucosal cancer was diagnosed in 3 gallbladders resected by S-LC and 1 resected by LC-F. One patient of the LC-F group with advanced cancer underwent laparotomy. All the patients have no signs of recurrence.


CONCLUSIONS
LC-F allows the complete removal of the connective tissue of the gallbladder bed without perforation and, therefore, is considered as a safe and useful procedure for resecting gallbladders with potentially cancerous lesions.
Kubota
K
K
Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.
Toyoda
H
H
Noie
T
T
Abe
H
H
Watanabe
M
M
Makuuchi
M
M
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D018194:Adenomyoma / Q000473:pathology / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005705:Gallbladder Diseases / Q000473:pathology / Q000601:surgery; D005706:Gallbladder Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D011127:Polyps / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies