title: Laparoscopic cholecystectomy and incidental carcinoma of the extrahepatic bilary tree.
abstract: OBJECTIVE
  Gallbladder carcinoma is found in 0.2% to 5% of patients undergoing cholecystectomy, and gallstones are found in 70% to 98% of patients with gallbladder carcinoma. Early diagnosis of carcinoma is difficult because of the absence of specific symptoms and the frequent association with chronic cholecystitis and gallstones. At present, laparoscopic cholecystectomy is the gold standard for the surgical treatment of symptomatic cholelithiasis and other benign gallbladder diseases. The aims of this study were to evaluate retrospectively the incidence of occasional and occult gallbladder carcinomas to ascertain the effect of laparoscopy on diagnosis and treatment of unexpected extrahepatic biliary tree carcinomas and to assess possible guidelines that can be taken into consideration when the problem is encountered.
  
  
  METHODS
  Clinical records of 3900 patients undergoing laparoscopic cholecystectomy were reviewed. Patients with occasional (intraoperative = Group A) or occult (postoperative = Group B) diagnosis of gallbladder or common bile duct carcinoma entered the study group. Follow-up data were obtained in June 2000.
  
  
  RESULTS
  A total of 14 patients (0.35%), 3 men and 11 women, mean age 60.8 years (range 37 to 73) with extrahepatic biliary tree carcinoma were found. Occasional carcinomas occurred in 8 patients, occult carcinomas in 6. No deaths occurred in either group. The overall survival at mean follow-up of 30.5 months is 50%. Five patients are disease free, and 2 are alive with evidence of recurrence.
  
  
  CONCLUSIONS
  In 2 large series of unselected consecutive laparoscopic cholecystectomy, only 14 unsuspected malignant tumors of the extrahepatic biliary tree were found (0.35%). The limits of the preoperative workup and the difficult diagnosis of biliary tract carcinoma during laparoscopic cholecystectomy, has led to the present retrospective study and several significant recommendations.
authors.affiliation: Department of Surgery, P. Stefanini, Policlinico Umberto I, University of Rome La Sapienza Rome, Italy. gianfrancosilecchia@uniroma1.it
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
authors.forename: Luigi
authors.initials: L
authors.lastname: Raparelli
authors.forename: Jose' Maria
authors.initials: JM
authors.lastname: Jover Navalon
authors.forename: Ana Serantes
authors.initials: AS
authors.lastname: Gomez
authors.forename: Mariano Moreno
authors.initials: MM
authors.lastname: Azcoita
authors.forename: Alberto
authors.initials: A
authors.lastname: Materia
authors.forename: Nicola
authors.initials: N
authors.lastname: Basso
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000150:complications* / Q000601:surgery; D003138:Common Bile Duct Neoplasms / Q000150:complications* / Q000601:surgery; D005260:Female; D005629:Frozen Sections; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies