Clinical Analysis Of Unsuspected Gallbladder Carcinoma During Or After Laparoscopic Cholecystectomy

ObjectiveThe aim of this study is to analyze clinical characters of unsuspected gallbladder carcinoma in laparoscopic cholecystectomy and to discuss the methods of avoiding loss of diagnosis and improving the treatment.MethodsWe performed a retrospectively analysis of 51 patients who were treated from January 2000 to December 2007 in our hospital for unsuspected gallbladder carcinoma during or after laparoscopic cholecystectomy.ResultsIn the 51 cases,the clinical characters were all in accordance with high-risk of gallbladder carcinoma.22 cases were diagnosed intraoperation by frozen section examination.29 cases were diagnosed postoperation.4 cases were stageⅠ,5 were stageⅡ,24 were stageⅢ,5 were stageⅣ,13 were stageⅤ,according to Nevin classification,respectively.Two cases lose after outpatient,49 cases follow up from 2 to 92 months,meadian time of follow-up is 12 months,mean time of follow-up is (20.8±21.7)months.6 cases lose during follow-up,they only follow-up from 2 to 18 months.The meadian survival time of 49 cases was 24 months;All cases of stageⅠare alive during the follow-up,The meadian and mean survival time of stageⅡis 20 months and(19.7±4.7)months,stageⅢis 27months and(34.5±4.9)months,stageⅣis 11months and(33.3±12.4)months,stageⅤis 5 months and(5.1±1.1)months.For the cases of stageⅢ,10 cases were performed radical reoperation,12 cases only LC were performed.The survival time between radical reoperation and LC group is difference,(P=0.010).For the cases in stageⅤ,5 cases were performed extend radical reoperation,3 cases were performed palliative operation,5 cases were only performed biopsy.The survival time between extend radical reoperation,palliative operation and biospy group is similar(P=0.182,P=0.916,P=0.156).ConclusionsThe surgeon should pay attention to the diagnosis of unsuspected gallbladder carcinoma for laparoscopic cholecystectomy patients.To analyze the preoperative clinical data of patients and to inspect,palpate the specimen carefully,and frozen section examination for any suspicion of cancer,seems to be useful for the diagnosis of unsuspected gallbladder carcinoma.For the cases of stageⅠ,only LC is enough;For the cases ofⅡ,Ⅲ,Ⅳstage,radical reoperation can improve the prognosis;For the cases of stageⅤ,extend radical or palliative operation can not improve the prognosis.