-Report on Experiments and Clinical Cases-

Occult Gallbladder Carcinoma after Laparoscopic Cholecystectomy: A Report of Four Cases

Shigeki Yokomuro, Yasuo Arima, Yoshiaki Mizuguchi, Tetsuya Shimizu, Yutaka Kawahigashi, Tomohiro Kannda, Masao Arai and Takashi Tajiri

Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School

Eighty-four patients underwent laparoscopic cholecystectomy (LC) from January through August 2006. Of these patients, 4 (4.7%) were found to have occult gallbladder carcinoma (GC) either during or after the procedure. Two of the patients were women and 2 were men. The mean age was 75.0 years. One patient had mucosal tumors, 2 had subserosal tumors, and 1 had a serosal lesion. One of the 2 patients with subserosal tumors underwent radical surgery. In a previous study, 0.83% (10 of 1,195) of patients who had undergone LC were found to have occult GC, either during of after the procedure. The prevalence of gallbladder carcinoma has recently been increasing. GC has been reported in 0.3% to 1.5% of patients who have undergone cholecystectomy. Since the introduction of laparoscopic surgery, the number of cholecystectomies being performed has increased, which may explain why occult GC seems to be occurring more frequently. The prognosis for GC is poor, and surgical resection is the only potentially curative treatment. However, GC is difficult to diagnose at an early stage and difficult to recognize even in the advanced stages. Fifteen percent to 30% of patients show no preoperative or intraoperative evidence of malignancy. Occult GC is also increasing. Because flat infiltrating GC and GC with cholecystitis and numerous stones are difficult to diagnose preoperatively, we recommend taking frozen sections from patients who are of advanced age (older than 70 years), have a long history of stones, or have a thickened gallbladder wall.

J Nippon Med Sch 2007; 74: 300-305

Keywords
occult gallbladder carcinoma, laparoscopic surgery, cholecystectomy

Correspondence to
Shigeki Yokomuro, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
yokomuro@nms.ac.jp

Received, November 20, 2006
Accepted, April 18, 2007