title: Radical surgery for incidental cancer gallbladder after laparoscopic cholecystectomy.
abstract: OBJECTIVE
  To report our experience in the management of incidentally detected carcinoma gall bladder and establishment of a treatment protocol.
  
  
  METHODS
  Retrospective review of 7 patients with incidentally detected carcinoma gall bladder during and after laparoscopic cholecystectomy for presumed benign disease. Clinical and histopathological data, treatment and long term outcome of all seven patients were reviewed. Exploratory laparotomy and radical surgery with curative intent consisting of liver resection, lymphadenectomy of the pedicle and excision of the port site were performed in all patients.
  
  
  RESULTS
  Liver resection including the segments IVB and V was done in 5 patients and in 2 patients resection of a wedge of hepatic parenchyma of more than 2 cm thickness including the gall bladder bed was carried out. Five patients underwent common bile duct excision with hepaticojejunostomy. Postoperatively, 2 patients developed fever and 1 patient had minimal altered blood in the nasogastric tube aspirate. These were successfully managed conservatively. All 7 patients had disease of pathological stage II and beyond. All patients received adjuvant chemotherapy. One patient died after 2 months of cholangitis and sepsis. One patient succumbed to metastatic disease after 12 months. The remaining patients are disease free on follow up.
  
  
  CONCLUSIONS
  Re-exploration and aggressive resection with adjuvant chemotherapy for incidental carcinoma of the gallbladder is safe and offers hope for long term survival.
authors.affiliation: Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh-160012, India. kamanlil@yahoo.com
authors.forename: Lileswar
authors.initials: L
authors.lastname: Kaman
authors.forename: Arunanshu
authors.initials: A
authors.lastname: Behera
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Singh
authors.forename: M
authors.initials: M
authors.lastname: Nedounsejiane
mesh_terms: D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005706:Gallbladder Neoplasms / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome