title: Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Many cases have been reported of disastrous port-site recurrence after laparoscopic cholecystectomy (LC) revealed unsuspected gallbladder carcinoma (GBC). Some investigators have reported that the prognosis of patients after LC showed unsuspected GBC is not worsened by laparoscopic procedures. We retrospectively reviewed our cases and the literature to reconfirm the intrinsic risks of LC for unsuspected GBC.
  
  
  METHODS
  Of 1663 patients who underwent LC from January 1991 to December 2003 in a single institution, 9 (0.54%) with unsuspected GBC were reviewed.
  
  
  RESULTS
  These 9 patients consisted of 5 men and 4 women, whose ages ranged from 58 to 87 years, with a median age of 73 years. Two patients with a pT1a tumor (limited to mucosa) and 2 patients with a pT1b tumor (muscle layer) underwent no further operation. The remaining 5 patients with a pT2 tumor (subserosa) underwent further operations with lymph node dissection. Five patients (2 patients with pT1b and 3 patients with pT2) developed recurrence and all of them died within a median period of 19 months (range 14-37 months) after LC. The causes of death were bone metastases in 1 patient (pT2), local recurrence in 2 patients (pT1b and pT2), and peritoneal metastasis in 2 patients (one elderly patient with pT1b who underwent laparoscopic common bile duct exploration, and one patient with pT2 in whom the cystic duct was damaged during surgery). Four patients (2 with pT1 and 2 with pT2) have been doing well with a median follow-up of 39.5 months (range 12-99 months) after LC.
  
  
  CONCLUSIONS
  Surgeons should always prevent bile spillage during LC and when removing the resected gallbladder. When laparoscopic common bile duct exploration is planned, especially for elderly women, surgeons should also bear in mind the increasing possibility of unsuspected GBC.
authors.affiliation: Department of Surgery, Tohkai Hospital, 1-1-1 Chiyodabashi, Chikusa-ku, Nagoya 464-0011, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Naokazu
authors.initials: N
authors.lastname: Hayakawa
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kitagawa
authors.forename: Yuki
authors.initials: Y
authors.lastname: Katohno
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sasaya
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takara
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D015897:Comorbidity; D005260:Female; D005705:Gallbladder Diseases / Q000453:epidemiology* / Q000601:surgery; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D042882:Gallstones / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed