title: Clinical implication of bile spillage in patients undergoing laparoscopic cholecystectomy for gallbladder cancer.
abstract: We determined the influence of bile spillage on recurrence and survival during laparoscopic cholecystectomy (LC) for gallbladder (GB) cancer. Among the 136 patients with GB cancer treated at Ajou University Hospital between 1994 and 2007, 28 underwent LC alone. We compared patients without bile spillage (bile spillage [-] group, n = 16) with patients who had bile spillage (bile spillage [+] group, n = 12). There was no statistical difference in stage between the groups. In the bile spillage (-) group, all patients underwent curative resection and there were two patients with locoregional recurrences and three patients with systemic recurrences. In the bile spillage (+) group, five patients underwent R1 resection and one patient underwent R2 resection and all eight recurrent patients had systemic recurrences. The disease-free survival and overall survival were shorter in the bile spillage (+) group (disease-free survival, 71.4 vs 20.9 months; P = 0.028; overall survival, 72.6 vs 25.8 months; P = 0.014). Bile spillage is likely to be an association with an incomplete resection and systemic recurrences. When GB cancer is suspected during LC, conversion to open surgery for preventing bile spillage and achieving curative resection should be considered.
authors.affiliation: Division of Critical Care Medicine for Surgical Patients, Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, Korea.
authors.forename: Jae-Myeong
authors.initials: JM
authors.lastname: Lee
authors.forename: Bong-Wan
authors.initials: BW
authors.lastname: Kim
authors.forename: Wook Hwan
authors.initials: WH
authors.lastname: Kim
authors.forename: Hee-Jung
authors.initials: HJ
authors.lastname: Wang
authors.forename: Myung Wook
authors.initials: MW
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016019:Survival Analysis