Unexpected gallbladder cancer after laparoscopic cholecystectomy for acute cholecystitis: a worrisome picture.
OBJECTIVE
The objective of this study is to assess the prognosis of unexpected gallbladder cancer diagnosed after laparoscopic cholecystectomy for acute cholecystitis.


METHODS
Data of all patients treated for unexpected gallbladder cancer after laparoscopic cholecystectomy at a tertiary care surgical center between January 1998 and December 2009 were reviewed. Demographics and clinical and pathological data of patients submitted to adjunctive revisional surgery were analyzed. Survival was calculated by the Kaplan-Meier method, and log-rank test was used to compare the survival curves. The Cox proportional hazard model was used to determine the effect on survival of urgent surgery for acute cholecystitis and of the other common factors such as age, gender, tumor grading, pT stage, nodal involvement, residual disease at re-exploration, and American Joint Committee on Cancer stage.


RESULTS
In the considered period, 34 patients with pT1b, pT2, or pT3 unexpected gallbladder cancer underwent a second standard revisional procedure including resection of liver segments 4b and 5, lymphadenectomy, and port-sites excision. Thirteen patients had previously undergone urgent surgery for acute cholecystitis; 21 had undergone a routine operation. The 5-year overall survival was 63.3 %. At multivariate analysis, G3 tumor grading (hazard ratio, 12.261; p = 0.002), residual disease at re-exploration [hazard ratios (HR) = 7.760, p = 0.004], and urgent surgery for acute cholecystitis (HR = 5.436, p = 0.012) were independent predictors of poor prognosis.


CONCLUSIONS
The prognosis of unexpected gallbladder cancer is worsened when laparoscopic cholecystectomy is performed for acute cholecystitits. The unfavorable impact of emergency surgery on prognosis might be related to intraoperative gallbladder emptying with bile spillage and cancer dissemination.
Department of Surgical Sciences, Policlinico Gemelli, "A. Gemelli" Medical School, Catholic University of the Sacred Heart, Largo Gemelli 8, 00168 Rome, Italy. gclemente@rm.unicatt.it
Gennaro
G
Clemente
Gennaro
G
Nuzzo
Agostino Maria
AM
De Rose
Ivo
I
Giovannini
Giuseppe
G
La Torre
Francesco
F
Ardito
Felice
F
Giuliante
D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000150:complications / Q000601:surgery*; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016019:Survival Analysis