Long-term prognosis of gallbladder cancer diagnosed after laparoscopic cholecystectomy

Background: Several clinical and laboratory studies concerning port-site recurrence have raised the concern that laparoscopic procedures might worsen the prognosis of malignant disease. However, the long-term prognosis of patients with malignancy who undergo laparoscopic surgery is still unknown. The purpose of this study was to examine the long-term prognosis of patients with unexpected gallbladder cancer diagnosed after laparoscopic cholecystectomy (LC). Methods: A clinicopathologic study was performed on 41 patients with postoperatively diagnosed gallbladder cancer from among 5,027 patients undergoing LC at 24 institutions. The cumulative survival rate was compared with that reported for gallbladder cancer diagnosed after open cholecystectomy (OC). Results: Of 26 patients with early gallbladder cancer (pTis or pT1), 23 were simply followed up, and 9 of 15 patients with advanced cancer (pT2 or pT3) had additional resection after the diagnosis of gallbladder cancer. Port-site recurrence occurred in four patients, and two of them died of the cancer. However, at this writing, the other two are still alive after abdominal wall resection or radiation therapy, having survived for 31 and 71 months, respectively. The 5-year survival rate was 92% for early cancer and 59% for advanced cancer. These results were comparable with 5-year survival rates for gallbladder cancer diagnosed after OC. Conclusions: Although port-site recurrence occurred in four patients with advanced gallbladder cancer, the long-term prognosis of patients with undiagnosed gallbladder cancer who underwent LC was not worsened by the laparoscopic procedure. We conclude that surgeons can perform LC with reasonable confidence, even if the lesion is possibly malignant.