Elsevier

Surgery

Volume 124, Issue 5, November 1998, Pages 831-838
Surgery

Original Communications
Incidence of port site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinoma

https://doi.org/10.1016/S0039-6060(98)70005-4Get rights and content

Abstract

Background: We sought to determine the incidence of recurrence of carcinoma at the port site and the outcome of patients with such recurrences after exploratory laparoscopy/laparoscopic cholecystectomy for unsuspected gallbladder carcinoma and analyzed aspects of the laparoscopic procedure associated with recurrences at the port site. Methods: Thirty-seven patients with preoperatively unknown adenocarcinoma of the gallbladder were analyzed. The patients were part of a large prospective study of the Swiss Association of Laparoscopic and Thoracoscopic Surgery including 10,925 patients undergoing laparoscopic cholecystectomy. Results: Preoperatively undiagnosed adenocarcinoma of the gallbladder is rarely encountered in patients undergoing laparoscopic cholecystectomy (0.34%). The incidence of recurrence of carcinoma at the port site in these patients is 14% (5 of 37) and is similar whether the primary tumor is confined to the gallbladder (T1/T2) or locally advanced (T3/T4). The recurrences at the port site were diagnosed within 6 to 16 months (median 10 months) after the operation. Patients with an intraoperative perforation of the gallbladder had a higher incidence of recurrences at the port site (40%) than had patients without perforation (9%; P = .13). All patients with recurrences at the port site had distant metastases and all died of the disease 12 to 35 months (median 19 months) after cholecystectomy; all patients with such recurrences and stage T1/T2 tumors subsequently had peritoneal metastases. Conclusions: Patients with a preoperatively undiagnosed adenocarcinoma of the gallbladder undergoing laparoscopy or laparoscopic cholecystectomy have a high incidence of recurrences at the port site, and the incidence increases when a gallbladder perforation occurs during the operation. All patients with such recurrences died of the disease. The diagnosis of an isolated recurrence at the port site may therefore be an indicator of disseminated disease in most cases. (Surgery 1998;124:831-8.)

Section snippets

Patients and methods

The Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) conducted a prospective 3-year study on laparoscopic cholecystectomy from 1992 to 1995. Eighty-two surgical institutions in Switzerland participated in this study. These surgical units performed approximately 50% of all cholecystectomies in Switzerland during the same period. All patients undergoing laparoscopic cholecystectomy in 1 of the participating surgical departments were enrolled in this study. Data were collected

Patients and indications

Thirty-nine of 10,925 patients who had undergone attempted or completed laparoscopic cholecystectomy had histologically malignant lesions of the gallbladder. Adenocarcinomas were found in 37 of 39 patients; 1 patient had a small cell carcinoma and 1 patient had a carcinoid tumor of the cystic duct. These last 2 patients were not included in our study. The female/male ratio in the 37 patients with adenocarcinoma of the gallbladder was 3.6:1 (29:8). The mean age was 67 years (range 51 to 87

Discussion

Port site recurrences after laparoscopic operations have changed the spectrum of presentation of metastatic gallbladder carcinomas. A preoperatively undiagnosed gallbladder carcinoma is a rare event (0.34%), and little is known about the incidence of port site recurrences after laparoscopic cholecystectomy in these patients.10 The literature suggests that incisional recurrences are more frequent after laparoscopic operation than after open procedures, and patients with gallbladder cancer

Acknowledgements

We and SALTS thank Mrs Franziska Rieben for her relentless effort in the centralized data collection, the Arbeitsgemeinschaft für Osteosynthesefragen in Davos, in particular Martin Buehler, for support in the computer analysis, and Dr Ramon E. Jimenez for reading, correcting, and improving the manuscript. Thanks also go to the following fellow surgeons of the SALTS and their supporting staff, and residents who contributed to this study: Kantonsspital Aarau (P. Aeberhard), Spital Aarberg (C.

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