Gallbladder Cancer: The Role of Laparoscopy and Radical Resection

Objectives:We assess how laparoscopy has altered the presentation of patients with gallbladder cancer and determine whether radical resection in patients with gallbladder cancer is beneficial. Summary Background Data:The widespread adoption of laparoscopic cholecystectomy has led to an increased frequency of incidentally discovered gallbladder carcinoma. Little data exist to guide surgeons in the optimum management of patients with gallbladder cancer, particularly with respect to the potential advantages of radical resection. Methods:Records of 107 patients with gallbladder cancer admitted to a tertiary academic medical center between 1995 and 2004 were reviewed. Gallbladder cancer was found incidentally in 53 patients (50%). Fifty-two of these patients underwent a routine laparoscopic cholecystectomy and were found to have gallbladder cancer intraoperatively or following the operation by subsequent pathologic evaluation of the specimen. Gallbladder cancer had been diagnosed preoperatively by radiology in the other 54 patients (50%). These patients did not undergo laparoscopic cholecystectomy and were explored electively. Results:The median age at presentation was 67 years and 66% were female. Patients who were found to have gallbladder carcinoma incidentally at laparoscopic cholecystectomy had a significant increase in survival when compared with those who were admitted electively with a known diagnosis (P < 0.001). All patients who presented with a known diagnosis had stage II or greater disease, and 36% of these were stage IV carcinomas. However, 82% of those patients who were found incidentally were stage I or II. The overall 5-year survival for all patients was 15%; those discovered incidentally at laparoscopic cholecystectomy had a 5-year survival of 33%. This difference was significant among patients with stage II carcinomas. In the laparoscopic group, there was no difference in survival between the patients who were immediately converted to an open resection when identified to have gallbladder cancer intraoperatively (n = 6) and those who had a completed laparoscopic cholecystectomy and were re-explored at a later point when found to have gallbladder cancer by subsequent pathology (n = 33). There was a significant improvement in survival in 50 patients (47%) who underwent some form of radical resection (P < 0.001). Stage for stage comparison showed that this was significant in stage II disease. Patients who underwent hepatic resection along with lymphadenectomy and extra hepatic biliary resection had similar survival compared with those who had hepatic resection and lymphadenectomy alone. Conclusions:Laparoscopic cholecystectomy appears to have resulted in the earlier discovery of gallbladder cancer in some patients, resulting in increased probability of survival. Patients discovered with gallbladder carcinoma during a laparoscopic cholecystectomy do not have to be converted immediately to an open resection and should be referred to a tertiary care center for further exploration. Adjunctive radical surgical resection, either at the time of cholecystectomy or subsequently, increases survival significantly in early stage disease.

[1]  A. Agarwal,et al.  Gallbladder cancer: the role of laparoscopy and radical resection. , 2009, Annals of surgery.

[2]  J. Buckels,et al.  Methylprednisolone therapy in deceased donors reduces inflammation in the donor liver and improves outcome after liver transplantation. , 2009, Annals of surgery.

[3]  V. Kiviniemi,et al.  Lichtenstein Hernioplasty Versus Totally Extraperitoneal Laparoscopic Hernioplasty in Treatment of Recurrent Inguinal Hernia—A Prospective Randomized Trial , 2009, Annals of surgery.

[4]  R. Obermaier,et al.  Impact of Different Crystalloid Volume Regimes on Intestinal Anastomotic Stability , 2009, Annals of surgery.

[5]  W. Lau,et al.  The Current Role of Radiofrequency Ablation in the Management of Hepatocellular Carcinoma: A Systematic Review , 2009, Annals of surgery.

[6]  M. Cuesta,et al.  Laparoscopic Sigmoid Resection for Diverticulitis Decreases Major Morbidity Rates: A Randomized Control Trial: Short-term Results of the Sigma Trial , 2009, Annals of surgery.

[7]  Jose Salinas,et al.  Survival With Emergency Tourniquet Use to Stop Bleeding in Major Limb Trauma , 2009, Annals of surgery.

[8]  P. Wille-Jørgensen,et al.  Mechanical bowel preparation for elective colorectal surgery. , 2009, The Cochrane database of systematic reviews.

[9]  P. Garg,et al.  Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias , 2009, Surgical Endoscopy.

[10]  Steve Thomas,et al.  Early Enteral Nutrition Within 24 h of Intestinal Surgery Versus Later Commencement of Feeding: A Systematic review and Meta-analysis , 2009, Journal of Gastrointestinal Surgery.

[11]  M. McCarthy,et al.  A retrospective, descriptive, exploratory study evaluating incidence of postoperative urinary retention after spinal anesthesia and its effect on PACU discharge. , 2008, Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses.

[12]  S. Baldus,et al.  Response Evaluation by Endoscopy, Rebiopsy, and Endoscopic Ultrasound Does Not Accurately Predict Histopathologic Regression After Neoadjuvant Chemoradiation for Esophageal Cancer , 2008, Annals of surgery.

[13]  L. Britt,et al.  Major Deficit in the Number of Underrepresented Minority Academic Surgeons Persists , 2008, Annals of surgery.

[14]  G. Gravante,et al.  Mechanical bowel preparation for colorectal surgery: a meta-analysis on abdominal and systemic complications on almost 5,000 patients , 2008, International Journal of Colorectal Disease.

[15]  T. Hernandez-Boussard,et al.  Mechanical Bowel Preparation in Intestinal Surgery: A Meta-Analysis and Review of the Literature , 2008, Journal of Gastrointestinal Surgery.

[16]  W. Lau,et al.  Hepatocellular carcinoma: current management and recent advances. , 2008, Hepatobiliary & pancreatic diseases international : HBPD INT.

[17]  J. Hagen,et al.  En bloc esophagectomy reduces local recurrence and improves survival compared with transhiatal resection after neoadjuvant therapy for esophageal adenocarcinoma. , 2008, The Journal of thoracic and cardiovascular surgery.

[18]  M. Stuschke,et al.  Long-term results of a phase III study investigating chemoradiation with and without surgery in locally advanced squamous cell carcinoma (LA-SCC) of the esophagus , 2008 .

[19]  Raymond Fang,et al.  Complications after fasciotomy revision and delayed compartment release in combat patients. , 2008, The Journal of trauma.

[20]  John F Kragh,et al.  Practical use of emergency tourniquets to stop bleeding in major limb trauma. , 2008, The Journal of trauma.

[21]  C. Delaney.  Outcome of Discharge Within 24 to 72 Hours After Laparoscopic Colorectal Surgery , 2008, Diseases of the colon and rectum.

[22]  T. Goetze,et al.  Benefits of Reoperation of T2 and More Advanced Incidental Gallbladder Carcinoma: Analysis of the German Registry , 2008, Annals of surgery.

[23]  L. Stassen,et al.  Mechanical bowel preparation for elective colorectal surgery: a multicentre randomised trial , 2007, The Lancet.

[24]  M. Ghusn,et al.  Laparoscopic inguinal hernia repair without mesh fixation, early results of a large randomised clinical trial , 2008, Surgical Endoscopy.

[25]  B. Koneru,et al.  The Ischemic Preconditioning Paradox in Deceased Donor Liver Transplantation—Evidence from a Prospective Randomized Single Blind Clinical Trial , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[26]  L. Grande,et al.  Ischemic Pre‐conditioning in Deceased Donor Liver Transplantation: A Prospective Randomized Clinical Trial , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[27]  H. Volk,et al.  Brain Death Activates Donor Organs and Is Associated with a Worse I/R Injury After Liver Transplantation , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[28]  S. Alexopoulos,et al.  Primary Nonfunction (PNF) in the MELD Era: An SRTR Database Analysis , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[29]  P. Morel,et al.  Should preoperative mechanical bowel preparation be abandoned? , 2007, Annals of surgery.

[30]  G. Klintmalm,et al.  Liver retransplantation for primary nonfunction: Analysis of a 20‐year single‐center experience , 2007, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[31]  D. Rattner,et al.  Operative time is a poor surrogate for the learning curve in laparoscopic colorectal surgery , 2007, Surgical Endoscopy.

[32]  G. Kazemier,et al.  Radiofrequency ablation in patients with primary and secondary hepatic malignancies , 2006, Journal of Gastrointestinal Surgery.

[33]  Pál Ondrejka,et al.  ["Fast track" colorectal surgery]. , 2007, Orvosi hetilap.

[34]  J. Donohue,et al.  Surgical treatment of gallbladder cancer , 2007, Journal of Gastrointestinal Surgery.

[35]  C. Leijonmarck,et al.  Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair , 2007, Surgical Endoscopy.

[36]  J. Izbicki,et al.  Reduced Incidence of Nodal Micrometastasis after Major Response to Neoadjuvant Chemoradiation in Locally Advanced Esophageal Cancer , 2007, Annals of Surgical Oncology.

[37]  D. Gouma,et al.  Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial) , 2006, BMC surgery.

[38]  H. Kehlet,et al.  Laparoscopic colonic surgery – mission accomplished or work in progress? , 2006, Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland.

[39]  M. Choti,et al.  Evidence-Based Gallbladder Cancer Staging: Changing Cancer Staging by Analysis of Data From the National Cancer Database , 2006, Annals of surgery.

[40]  R. Bleichrodt,et al.  Ischemia and prolonged reperfusion before anastomotic construction do not reduce wound strength in the rat intestine. , 2006, Surgery.

[41]  M Birth,et al.  Influence of operator experience in radiofrequency ablation of malignant liver tumours on treatment outcome. , 2006, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[42]  G. Ercolani,et al.  Effect of ischemic preconditioning in whole liver transplantation from deceased donors. A pilot study , 2006, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[43]  A. Senagore,et al.  A critical analysis of laparoscopic colectomy at a single institution: lessons learned after 1000 cases. , 2006, American journal of surgery.

[44]  P. Ewings,et al.  Randomized clinical trial comparing laparoscopic and open surgery for colorectal cancer within an enhanced recovery programme , 2006, The British journal of surgery.

[45]  B. Jobe,et al.  Clinical review: Healing in gastrointestinal anastomoses, Part I , 2006, Microsurgery.

[46]  S. Baldus,et al.  Histomorphologic Tumor Regression and Lymph Node Metastases Determine Prognosis Following Neoadjuvant Radiochemotherapy for Esophageal Cancer: Implications for Response Classification , 2005, Annals of surgery.

[47]  Guy Marchal,et al.  Local Recurrence After Hepatic Radiofrequency Coagulation: Multivariate Meta-Analysis and Review of Contributing Factors , 2005, Annals of surgery.

[48]  R. Veldkamp,et al.  Laparoscopic surgery versus open surgery for colon cancer : short-term outcomes of a randomised trial , 2022 .

[49]  W. Lau,et al.  The continuing challenge of hepatic cancer in Asia. , 2005, The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland.

[50]  Nils Lehmann,et al.  Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[51]  J. Connor,et al.  Randomized controlled trial comparing the controlled rehabilitation with early ambulation and diet pathway versus the controlled rehabilitation with early ambulation and diet with preemptive epidural anesthesia/analgesia after laparotomy and intestinal resection. , 2005, American journal of surgery.

[52]  H. Kehlet,et al.  Functional Recovery After Open Versus Laparoscopic Colonic Resection: A Randomized, Blinded Study , 2005, Annals of surgery.

[53]  C. Doig,et al.  An Aggressive Surgical Approach Leads to Improved Survival in Patients With Gallbladder Cancer: A 12-Year Study at a North American Center , 2005, Annals of surgery.

[54]  J. Skurnick,et al.  Ischemic preconditioning in deceased donor liver transplantation: A prospective randomized clinical trial of safety and efficacy , 2005, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[55]  S. Isaji,et al.  Radical operations for carcinoma of the gallbladder: Present status in Japan , 1991, World Journal of Surgery.

[56]  J. Fleshman,et al.  A comparison of laparoscopically assisted and open colectomy for colon cancer. , 2004, The New England journal of medicine.

[57]  John Wong,et al.  Learning Curve for Radiofrequency Ablation of Liver Tumors: Prospective Analysis of Initial 100 Patients in a Tertiary Institution , 2004, Annals of surgery.

[58]  S. Mulier,et al.  Size and geometry of hepatic radiofrequency lesions. , 2003, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[59]  M. D'Angelica,et al.  Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma , 2003, Cancer.

[60]  J. Steurer,et al.  Multidimensional Analysis of Learning Curves in Laparoscopic Sigmoid Resection , 2003, Diseases of the colon and rectum.

[61]  P. Pattynama,et al.  Interstitial laser coagulation with temporary hepatic artery occlusion for patients with cirrhosis and irresectable hepatoma , 2003, The British journal of surgery.

[62]  Masao Tanaka,et al.  Completion Radical Surgery after Cholecystectomy for Accidentally Undiagnosed Gallbladder Carcinoma , 2003, World Journal of Surgery.

[63]  W. Lau,et al.  Percutaneous Local Ablative Therapy for Hepatocellular Carcinoma: A Review and Look Into the Future , 2003, Annals of surgery.

[64]  L. Forni,et al.  Pathophysiology and clinical implications of perioperative fluid excess. , 2003, British journal of anaesthesia.

[65]  K. Campbell,et al.  Cholecystectomy, liver resection, and pyloruspreserving pancreaticoduodenectomy for gallbladder cancer: Report of five cases , 2002, Journal of Gastrointestinal Surgery.

[66]  K. Hatakeyama,et al.  Radical Second Resection Provides Survival Benefit for Patients with T2 Gallbladder Carcinoma First Discovered after Laparoscopic Cholecystectomy , 2002, World Journal of Surgery.

[67]  Bengt Jeppsson,et al.  Anastomotic healing in the rat colon: comparison between a radiological method, breaking strength and bursting pressure , 2002, International Journal of Colorectal Disease.

[68]  P. Myles,et al.  Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial , 2002, The Lancet.

[69]  Y. Kakugawa,et al.  Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patients. , 2002, Journal of hepato-biliary-pancreatic surgery.

[70]  M. Nagino,et al.  Extensive surgery for carcinoma of the gallbladder , 2002, The British journal of surgery.

[71]  M. Nagino,et al.  Five-year survivors after aggressive surgery for stage IV gallbladder cancer. , 2001, Journal of hepato-biliary-pancreatic surgery.

[72]  W. Chapman,et al.  Radical Resection Improves Survival for Patients with pT2 Gallbladder Carcinoma , 2001, The American surgeon.

[73]  F. Romano,et al.  Laparoscopic cholecystectomy and unsuspected gallbladder cancer. , 2001, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[74]  V. Kapoor.  Incidental gallbladder cancer , 2001, American Journal of Gastroenterology.

[75]  M. Cadeddu,et al.  Defining a learning curve for laparoscopic colorectal resections , 2001, Diseases of the colon and rectum.

[76]  L. Hultén,et al.  Midline or transverse abdominal incision for right‐sided colon cancer—a randomized trial , 2001, Colorectal Disease.

[77]  H. Paajanen.  Lichtenstein inguinal herniorraphy under local infiltration anaesthesia as rapid outpatient procedure. , 2001, Annales chirurgiae et gynaecologiae. Supplementum.

[78]  H. Chen,et al.  Parents' attitudes and expectations regarding science education: comparisons among American, Chinese-American, and Chinese families. , 2001, Adolescence.

[79]  Y. Fong,et al.  Gallbladder cancer: recent advances and current guidelines for surgical therapy. , 2001, Advances in surgery.

[80]  R. Greim,et al.  How to proceed in patients with carcinoma detected after laparoscopic cholecystectomy , 2000, Langenbeck's Archives of Surgery.

[81]  O. Lundberg.  Port site metastases after laparoscopic cholecystectomy. , 2000, The European journal of surgery. Supplement. : = Acta chirurgica. Supplement.

[82]  W. Jarnagin,et al.  Gallbladder Cancer: Comparison of Patients Presenting Initially for Definitive Operation With Those Presenting After Prior Noncurative Intervention , 2000, Annals of surgery.

[83]  M. Nagino,et al.  Regional and para‐aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma , 2000, The British journal of surgery.

[84]  J. Buckels,et al.  Factors predicting perioperative cytokine response in patients undergoing liver transplantation , 2000, Critical care medicine.

[85]  A. Budzyński,et al.  Laparoscopic cholecystectomy and gallbladder cancer , 1999, Surgical Endoscopy.

[86]  T. Kondo,et al.  Outcomes of aggressive treatment of stage IV gallbladder cancer and predictors of survival. , 1999, Hepato-gastroenterology.

[87]  Y. Takada,et al.  Treatment of gallbladder cancer by radical resection , 1999, The British journal of surgery.

[88]  J. Donohue,et al.  The National Cancer Data Base report on carcinoma of the gallbladder, 1989‐1995 , 1998, Cancer.

[89]  Y. Fong,et al.  Gallbladder carcinoma discovered during laparoscopic cholecystectomy , 1998, Cancer.

[90]  W. Lan,et al.  Adolescents' perceptions of their parents' academic expectations: comparison of American, Chinese-American, and Chinese high school students. , 1998, Adolescence.

[91]  Taizo Kimura,et al.  Is laparoscopic cholecystectomy hazardous for gallbladder cancer? , 1998, Surgery.

[92]  P. Boros,et al.  Differential contribution of graft and recipient to perioperative TNF-alpha, IL-1 beta, IL-6 and IL-8 levels and correlation with early graft function in clinical liver transplantation. , 1997, Clinical transplantation.

[93]  A. Silbergleit,et al.  Impact of laparoscopic cholecystectomy on indications for surgical treatment of gallstones , 1997, Surgical Endoscopy.

[94]  C. Miki,et al.  Influence of intraoperative blood loss on plasma levels of cytokines and endotoxin and subsequent graft liver function. , 1997, Archives of surgery.

[95]  K. Hatakeyama,et al.  Radical surgery is justified for locally advanced gallbladder carcinoma if complete resection is feasible. , 1997, The American journal of gastroenterology.

[96]  D. Castell.  Accurate measurement of gastric acidity. , 1997, The American journal of gastroenterology.

[97]  K. Horgan,et al.  Laparoscopic Cholecystectomy: Incidental Carcinoma of the Gallbladder with Abdominal Wall and Axillary Node Metastasis , 1997, HPB surgery : a world journal of hepatic, pancreatic and biliary surgery.

[98]  M. Brennan,et al.  Long-term results after resection for gallbladder cancer. Implications for staging and management. , 1996, Annals of surgery.

[99]  P. Neuhaus,et al.  The release of cytokines, adhesion molecules, and extracellular matrix parameters during and after reperfusion in human liver transplantation. , 1996, Transplantation.

[100]  D I Watson,et al.  A learning curve for laparoscopic fundoplication. Definable, avoidable, or a waste of time? , 1996, Annals of surgery.

[101]  R. Beart,et al.  Laparoscopic-assisted colectomy learning curve , 1995, Diseases of the colon and rectum.

[102]  D. Henson,et al.  Liver, gallbladder, extrahepatic bile ducts, and pancreas , 1995, Cancer.

[103]  S. Peng,et al.  Explanation of Academic Achievement of Asian American Students. , 1994 .

[104]  E. Roth,et al.  TRANSHEPATIC METABOLISM OF TNF-α, IL‐6, AND ENDOTOXIN IN THE EARLY HEPATIC REPERFUSION PERIOD AFTER HUMAN LIVER TRANSPLANTATION , 1994, Transplantation.

[105]  J. Donohue,et al.  Gallbladder cancer discovered during laparoscopic surgery: potential for iatrogenic tumor dissemination. , 1994, Archives of surgery.

[106]  A. Gainant,et al.  Surgical Treatment of 724 Carcinomas of the Gallbladder Results of the French Surgical Association Survey , 1994, Annals of surgery.

[107]  M. Brennan,et al.  Gallbladder cancer discovered during laparoscopic surgery. Potential for iatrogenic tumor dissemination. , 1993, Archives of surgery.

[108]  W. Helton.  Effect of intraportal glucose infusion on hepatic glycogen content and degradation, and outcome of liver transplantation. , 1993, JPEN. Journal of parenteral and enteral nutrition.

[109]  H. Wanebo,et al.  Carcinoma of the gallbladder , 1993, Journal of surgical oncology. Supplement.

[110]  H. Watanabe,et al.  Radical surgery for gallbladder carcinoma. Long-term results. , 1992, Annals of surgery.

[111]  Y. Shirai,et al.  Identification of the regional lymphatic system of the gallbladder by vital staining , 1992, The British journal of surgery.

[112]  Y. Shirai,et al.  Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. , 1992, Annals of surgery.

[113]  M. Tsuneyoshi,et al.  Subclinical gallbladder carcinoma. , 1992, American journal of surgery.

[114]  J. Capron,et al.  Cutaneous seeding of gallbladder cancer after laparoscopic cholecystectomy. , 1991, The New England journal of medicine.

[115]  Jonathan Liss,et al.  Safety and efficacy of laparoscopic cholecystectomy. A prospective analysis of 100 initial patients. , 1991, Annals of surgery.

[116]  J. Donohue,et al.  Carcinoma of the gallbladder. Does radical resection improve outcome? , 1990, Archives of surgery.

[117]  S. Sakaguchi,et al.  Aggressive surgery for carcinoma of the gallbladder. , 1989, Surgery.

[118]  R. Virtue.  Comparison of local, spinal, and general anesthesia for inguinal herniorrhaphy. , 1988, American journal of surgery.

[119]  I. Silver,et al.  Hypovolaemia and healing in colonic anastomoses , 1985, The British journal of surgery.

[120]  T. Hendriks,et al.  Histological features of wound repair: a comparison between experimental ileal and colonic anastomoses. , 1985, British journal of experimental pathology.

[121]  H. Dudley,et al.  Extracellular fluid volume expansion and third space sequestration at the site of small bowel anastomoses , 1983, The British journal of surgery.

[122]  J. Piehler,et al.  Primary carcinoma of the gallbladder. , 1977, Archives of surgery.

[123]  H. Spjut,et al.  Inapparent carcinoma of the gallbladder. , 1967, The American surgeon.

[124]  Daan Brandenbarg.  The National. , 1892 .