Unexpected Gallbladder Cancer Research Articles

Multimodality Imaging of Cholecystectomy Complications.

Cholecystectomy is one of the most common surgeries performed in the United States. Although complications are uncommon, the high incidence of this surgery means that a radiologist will likely encounter these complications in practice. Complications may arise in the immediate postoperative period or can be delayed for weeks, months, or years after surgery. Vague and nonspecific symptoms make clinical diagnosis challenging. As a result, multimodality imaging is important in postoperative evaluation. US and multidetector CT are the usual first-line imaging modalities. Hepatobiliary scintigraphy, SPECT/CT, and MRI with conventional or gadoxetate hepatobiliary contrast material are important and complementary modalities that are used for workup. The authors begin with a brief discussion of surgical technique and expected postoperative findings and then describe complications organized into four groups: (a) biliary complications, (b) stone-related complications, (c) iatrogenic complications, and (d) gallbladder complications. Biliary complications include bile leaks and bilomas, acute biliary obstruction, and biliary stricture. Stone-related complications include retained and recurrent stones and spillage of stones into the peritoneum. Iatrogenic complications include hemorrhage, vasculobiliary injury, arterial pseudoaneurysms, duodenal injury, and migration of clips. Gallbladder complications include recurrent cholecystitis after subtotal reconstituting cholecystectomy and unexpected gallbladder cancer. An invited commentary by Mullens and Ibrahim is available online. Online supplemental material is available for this article. ©RSNA, 2022.

Unexpected gallbladder cancer as the source of some unknown primary cancers.

e16177 Background: CUP (Cancer of Unknown Primary) represents a frequent cancer type causing incomparable difficulties in pathological diagnosis as compared to other tumor types. To explore and analyze the causes of CUP (Cancer of Unkown Primary) patients with misdiagnosis in patients after laparoscopic cholecystectomy with cholecystitis or cholecystolithiasis. Methods: 13 patients with CUP (Cancer of Unkown Primary) were recruited in this research, who accepted the multidisciplinary discussion of the CMUP (Cancer of Multiple or Unknown Primary) multidisciplinary team. Our team analyzed the clinical data and pathological characteristics of these patients, and tried to find the common characteristics of the CUP patients whose primary site is the gallbladder that has been already removed. Results: 13 patients were received laparoscopic cholecystectomy because of previously considered cholecystitis or cholecystolithiasis. The gallbladder is considered as the primary organ supported by the pathological features of the metastatic sites. Importantly, all these patients have local abdominal wall and/or local perigallbladder lymph node metastases. Among them, 3 cases were diagnosed as gallbladder cancer, and 1 case was considered as high-grade intraepithelial neoplasia after pathological consultation, which were recognized as benign disease. Among the 13 cases, 9 cases showed local thickening of the gallbladder wall by preoperative CT or B-ultrasound. The median recurrence time was 16.4 months (9-48 months). Of the 13 patients, 5 received radical resection again, and received GP (gemcitabine plus platinum) chemotherapy after surgery. Of the 8 patients who were unable to undergo radical surgery, 5 received first-line GP based chemotherapy, 2 received first-line PD-1 immunotherapy combined with anti-vascular targeted drugs, and 1 received tegafur monotherapy due to poor physical condition. Till now, these patients are still under follow-up. Conclusions: Unexpected gallbladder cancer is the source of some unknown primary cancers. For these patients with cholecystitis or cholecystolithiasis, B-ultrasound examination should not be performed alone, and CT or MRI examination should be performed when necessary. We should pay high attention to the patients with cholecystitis or gallstone thickening of the gallbladder wall or other high-risk gallbladder cancer. Before surgery, clinical data should be analyzed comprehensively, and rapid frozen examination should be performed on patients suspected of having cancer. In order to avoid misdiagnosis, we should pay attention to the principle of none tumor and avoid the risk of incision implantation. If unexpected gallbladder cancer is found, radical operation should be performed as soon as possible.

Preoperative diagnoses and identification rates of unexpected gallbladder cancer.

Unexpected gallbladder cancer (UGBC) is sometimes found in the resected gallbladder of patients during or after surgery. Some reports have indicated UGBC identification rates for all gallbladder surgeries, but scarce data are available for the UGBC identification rates for specific gallbladder diseases. The present study was performed to clarify UGBC rates and the factors suspicious for UGBC categorized according to preoperative diagnoses, in patients undergoing laparoscopic cholecystectomy (LSC). We recorded data for all LSC surgeries performed in the Department of Surgery, Sada Hospital, Japan since 1991, and analyzed the 28-year data. We used the chi-square test and Kaplan-Meier analysis for this retrospective case-control study. The UGBC identification rate was 0.69% (63/9186 patients). The UGBC identification rates categorized according to the preoperative diagnoses were 1.3% (13/969) for acute cholecystitis, 2.4% (16/655) for benign tumor, 2.0% (28/1383) for chronic cholecystitis or cholecystitis, and 0.054% (3/5585) for cholecystolithiasis. The percentage of older patients (≥ 60 years) was significantly higher in UGBCs compared with cases finally diagnosed as benign in each group categorized according to the preoperative diagnoses (p≤0.0014), except for cholecystolithiasis. In cases pre-diagnosed as benign tumor, UGBCs were associated with higher rates of thickened gallbladder wall compared with benign tumor (69.2% vs. 27.9%, respectively; p = 0.0011). UGBCs pre-diagnosed as acute cholecystitis had higher T2-T4 rates (100% vs. 64.3%, respectively; p<0.05) and lower survival rates (p = 0.0149) than UGBCs pre-diagnosed with chronic cholecystitis. UGBC identification rates depend on the preoperative diagnosis and range from 0.054% to 2.4%. Older age (≥ 60 years) could be related to UGBC, and a pre-diagnosis of acute cholecystitis might indicate more advanced cancer compared with a pre-diagnosis of chronic cholecystitis.

Unexpected Gallbladder Cancer during or after Laparoscopic Cholecystectomy: Risk Factors and Experience of Diagnosis and Treatment of 22 Cases

This study aims to provide some experience in diagnosis and treatment of unexpected gallbladder cancer (UGBC) and find the major risk factors. Retrospective data were collected and analyzed on 22 patients who were diagnosed with UGBC during or after laparoscopic cholecystectomy from January 2013 to January 2018 at our hospital. Average age of the patients was (60.2 ± 12.8) years (range, 42-83 years). Among them, there were 6 men and 16 women. Gallbladder stones, atrophic gallbladder, uneven thickened wall of the gallbladder, and choledocholithiasis were found to be the major risk factors. Eight patients (36.4%) were diagnosed intraoperatively. Seven cases (31.8%) were at the T1 stage; of these, three were treated with laparoscopic cholecystectomy; two were converted to cholecystectomy; and two underwent cholecystectomy, lymph node dissection, and liver resection. Eight (36.4%) T2 patients, five (22.7%) T3 patients, and one T4 patient had radical cholecystectomy. Partial cholecystectomy and cholecystotomy were carried out in another T4 patient. T1 patients did not receive chemotherapy or radiotherapy. Eleven had chemotherapy and four received chemoradiotherapy. The follow-up period ranged from six months to five years. The one-year survival rate for T1 to T4 patients was 100 per cent, 75 per cent, 40 per cent, and 0 per cent, respectively. A high index of clinical suspicion of UGBC is needed if one patient suffered from both gallbladder stones and choledocholithiasis with atrophic gallbladder or uneven thickened wall of the gallbladder preoperatively. To avoid more UGBC and reoperation, imaging examinations combined with tumor marker tests and intraoperative histopathologic examination are highly recommended.

Problems and reflections on the diagnosis and treatment of gallbladder cancer

Although more and more attention has been paid on the diagnosis and treatment of gallbladder cancer, the patients' survival were still unsatisfied.Increasing the early diagnosis rate, the raise of awareness and treatment of unexpected gallbladder cancer, performing radical surgery for early stage patients and utilizing comprehensive treatment with adjuvant therapy for aggressive T2 or higher stage cases were the key points to improve patients' prognosis of gallbladder cancer.

Importance of routine histopathological examination of a gallbladder surgical specimen: Unexpected gallbladder cancer.

Cholecystectomy performed for benign diseases of the gallbladder is important for the diagnosis of gallbladder cancer. This is done by pathological examination of the removed specimens for patients with no detected or suspected complications before surgery. Although some centers undertake selective approaches for histopathological examination of gallbladder specimens, many centers perform this examination routinely. In our study, we investigated results of pathological examinations carried out on cholecystectomy specimens, in respect to unexpected cases of gallbladder cancer. We reviewed cholecystectomy cases performed for benign diseases of gallbladder from January 2012 to February 2016 by investigating pathological specimens from the gallbladder. We evaluated demographical properties and their association with the pathological diagnosis and frequency of unexpected gallbladder cancer cases. We reported additional treatment and survival information of the malignancy cases after surgery. We reviewed 1294 cases of cholecystectomy, and the mean patient age was 47.5 ± 14.3 years. The most frequent diagnosis was chronic cholecystitis (92.3%), and it was more prevalent among younger patients and female sex (P < 0.0001). Five patients (0.4%) were determined to have gallbladder cancer, and the mean age of these cases was 65.6 ± 18.2 years. Two cases were Stage 2, two cases were Stage 3B, and one case was Stage 3A. There was no T1 or Tis tumor. Routine histopathological examination of gallbladder is significant with respect to the determination of additional interventions at the postoperative period required for cancer cases coincidentally diagnosed.

Histological examination of frozen sections for patients with acute cholecystitis during cholecystectomy

Unexpected gallbladder cancer may present with acute cholecystitis-like manifestations. Some authors recommended that frozen section analysis should be performed during laparoscopic cholecystectomy for all cases of acute cholecystitis. Others advocate selective use of frozen section analysis based on gross examination of the specimen by the surgeon. The aim of the present study was to evaluate whether surgeons could effectively identify suspected gallbladder with macroscopic examination alone. If not, is routine frozen section analysis worth advocating? A total of 1162 patients with acute cholecystitis who had undergone simple cholecystectomy in our hospital from February 2009 to February 2014 were enrolled in the study. The data of patients with acute cholecystitis especially those with concurrent gallbladder cancer in terms of clinical characteristics, operative records, frozen section diagnosis and histopathology reports were analyzed. Thirteen patients with acute cholecystitis were found to have concurrent gallbladder cancer, with an incidence of 1.1% in acute cholecystitis. Forty patients with acute cholecystitis were suspected to have gallbladder cancer by macroscopic examination and specimens were taken for frozen section analysis. Six patients with gallbladder cancer were correctly identified by macroscopic examination alone but 7 patients with gallbladder cancer missed, including 3 patients with advanced cancer (2 T3 and 1 T2). Meanwhile, in 6 gallbladder cancer specimens sent for frozen section analysis, 3 early gallbladder cancers (2 Tis and 1 T1a) were missed by frozen section analysis. However, the remaining 3 patients with advanced gallbladder cancers (2 T3 and 1 T2) were correctly diagnosed. The incidence of comorbidity of gallbladder cancer and acute cholecystitis is higher than that of non-acute cholecystitis. The accurate diagnosis of gallbladder cancer by surgeons is poor and frozen section analysis is necessary.

Progress of laparoscopic technique in treatment of gallbladder cancer

Gallbladder cancer is a common malignant tumor in the bile duct system with high malignant degree and poor prognosis. Although it is still controversial, important progress has been made in clinical application of laparoscopic technique for diagnosis and staging of gallbladder cancer, treatment of early stage and laparoscopic unexpected gallbladder cancer in recent years. In this article we review the current status of application of laparoscopic technique and its value in diagnosis and treatment of gallbladder cancer.

Incidental Gall Bladder Carcinoma in Laparoscopic Cholecystectomy: A Report of 6 Cases and a Review of the Literature

Gall bladder carcinoma accounts for 98% of all the gall bladder malignancies and it is the sixth most common malignancy of the gastrointestinal tract worldwide. The incidence of incidental gall bladder carcinoma which is diagnosed during or after a laparoscopic cholecystectomy is reported to be around 0.19-3.3% in the literature. This study was aimed at detecting the incidence of gall bladder carcinomas which were diagnosed incidentally during or after laparoscopic cholecystectomies which were done for gall stone disease and cholecystitis. We analyzed the medical records of patients with symptomatic gallstone disease and acute or chronic cholecystitis, who underwent laparoscopic cholecystectomies at the Hakeem Abdul Hameed Centenary Hospital during the period from January 2007 to June 2012. A total of 622 laparoscopic cholecystectomies were performed at our institute during the study period of five and a half years. In 6 (0.96%) cases, incidental carcinomas of the gallbladder were discovered. A laparoscopic cholecystectomy which is performed for benign gall bladder disease rarely results in a diagnosis of unexpected gallbladder cancer. The microscopic examination of the specimens, with special attention to the depth of invasion, range of the mucosal spread and the lymphovascular involvement, is critical in diagnosing the incidental malignancies as well as for the subsequent management of the cases.

Unexpected Gallbladder Cancer after Laparoscopic Cholecystectomy for Acute Cholecystitis: A Worrisome Picture

ObjectiveThe objective of this study is to assess the prognosis of unexpected gallbladder cancer diagnosed after laparoscopic cholecystectomy for acute cholecystitis. MethodsData of all patients treated for unexpected gallbladder cancer after laparoscopic cholecystectomy at a tertiary care surgical center between January 1998 and December 2009 were reviewed. Demographics and clinical and pathological data of patients submitted to adjunctive revisional surgery were analyzed. Survival was calculated by the Kaplan–Meier method, and log-rank test was used to compare the survival curves. The Cox proportional hazard model was used to determine the effect on survival of urgent surgery for acute cholecystitis and of the other common factors such as age, gender, tumor grading, pT stage, nodal involvement, residual disease at re-exploration, and American Joint Committee on Cancer stage. ResultsIn the considered period, 34 patients with pT1b, pT2, or pT3 unexpected gallbladder cancer underwent a second standard revisional procedure including resection of liver segments 4b and 5, lymphadenectomy, and port-sites excision. Thirteen patients had previously undergone urgent surgery for acute cholecystitis; 21 had undergone a routine operation. The 5-year overall survival was 63.3 %. At multivariate analysis, G3 tumor grading (hazard ratio, 12.261; p = 0.002), residual disease at re-exploration [hazard ratios (HR) = 7.760, p = 0.004], and urgent surgery for acute cholecystitis (HR = 5.436, p = 0.012) were independent predictors of poor prognosis. ConclusionsThe prognosis of unexpected gallbladder cancer is worsened when laparoscopic cholecystectomy is performed for acute cholecystitits. The unfavorable impact of emergency surgery on prognosis might be related to intraoperative gallbladder emptying with bile spillage and cancer dissemination.

Diagnosis and treatment of incidental gallbladder cancer

Unexpected gallbladder cancer (UGC) is a sort of gallbladder cancer discovered during or after laparoscopic cholecystectomy (LC) which was diagnosed as benign gallbladder disease before surgery. With the high incidence of gallstones in China, the number of patients with UGC increases as well.However, due to the lack of randomized controlled trials on UGC, unified treatment has not been established, and argues on how LC will influence the prognosis of UGC still exist. Surgery for gallbladder cancer is technically challenging. The extent of resection varies based on a number of factors, and controversy exists regarding what constitutes an acceptable resection. We believe that satisfying treatment results are based on the surgical techniques, acute evaluation of different cases and wisely-chosen surgical procedures. This paper summarized therapeutic strategies for UGC based on our clinical experiences. Key words: Gallbladder neoplasms, unexpected; Diagnosis; Treatment

Analysis of the treatment of unexpected gallbladder cancer

To investigate the secondary operation methods and the effects on the prognosis of unexpected gallbladder cancer (UGC). A retrospective analysis on the clinical data was made for 41 patients who underwent extended radical excision from June 1995 to December 2002. Among the patients, 12 were male, 29 were female. The average age was 51 years old. The 41 patients had undergone gallbladder excision because of cholecystitis complicated lithiasis of gallbladder (32 cases), polypi of gallbladder or adenoma (9 cases). Postoperative pathology showed that 32 cases were adenocarcinoma of gallbladder, 6 cases were squamous carcinoma, 3 cases were squamous adenocarcinoma. Six cases were on the stage of Nevin I, 16 on Nevin II, 17 on Nevin III, 2 on Nevin IV. The second operation was performed after 6-30 d of the first operation. The second operation chose the improved method of Glenn excision of carcinoma of gallbladder. On the second operation, 14 cases were with lymphatic metastasis, 14 with gallbladder metastasis, 6 with bile duct metastasis, 2 with pancreas metastasis. Fourteen cases were on the stage of Nevin IV, 9 on Nevin V, none on Nevin I, II and III. After the second operation, 1 year survival rate was 100% (41 cases); The three-year survival rate was 53.8% (22 cases); The five-year survival rate was 17.5% (7 cases). Extended radical excision is one of the most important methods for the treatment of UGC.

Unexpected gallbladder cancer during laparoscopic cholecystectomy

In the present study, we investigated the effectiveness of surgeons in determining incidental gallbladder pathologies at laparoscopic cholecystectomy (LC). This study included 548 patients with gallstones who underwent LC between May 1, 2001 and October 15, 2003. The surgeon made an incision on the gallbladder wall for inspection, and palpated the mucosa after removing the gallbladder from the abdominal cavity to look for unsuspected pathologies. If an abnormal mucosa was observed or palpated, it was marked with a silk suture and then histopathologic examination was performed. Fifty of 548 LC specimens were found to be suspi-cious by the surgeon. Histopathological examination of frozen sections revealed incidental pathologies in 15 of these specimens. Strikingly, 5 of these specimens were considered to have gallbladder cancer (GBC). The other incidental pathologies were consistent with adenomyomatosis, xanthogranulomatous cholecystitis, and fibroepithelial and hyperplastic polyps. Four of the other 498 specimens revealed incidental pathologies at definitive histopathological examination, and all of them were consistent with gastric metaplasia. The sensitivity and specificity of the procedure was 78.9% and 93%, respectively. A simple prosedure; that is, incision and inspection, and palpation of the gallbladder, seems to be useful for the diagnosis of incidental gallbladder pathologies.

Characteristics of Unexpected Gallbladder Cancer Diagnosed by Cholecycstectomy

Characteristics of Unexpected Gallbladder Cancer Diagnosed by Cholecycstectomy

Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer?

Laparoscopy is thought to worsen the prognosis of gallbladder cancer (GBC) discovered unexpectedly at laparoscopic cholecystectomy (LC). However, laproscopy has never been shown to have an influence on patient survival in clinical series. We Performed a two-center retrospective analysis of 28 patients with GBC (11 previously known, 17 unexpectedly discovered by LC) to determine whether laparoscopy and complications related to LC had any influence on the prognosis of GBC. Resectability for cure after LC, survival, and recurrence related to both the procedure itself and complications associated with LC were analyzed. Of the 17 patients with unexpected GBC, 16 were considered resectable for cure at the time of LC. Advanced disease was detected in eight patients by re staging (n = 5) or exploration (n = 3). Seven patients (43.8%) underwent reoperation for cure. Mean survival of patients with unexpected GBC was 26.5 months. Mean survival was shorter when complications (bile spillage, injury of common bile duct, or tumor violation) occurred during LC (10.2 vs 33 months, p = 0.016). If bile spillage was the only complication at LC, there was also a trend to shorter survival (12 vs 33 months, p = 0.061). Complications during LC significantly worsen the prognosis of GBC. Therefore, bile spillage and excessive manipulation of the gallbladder should be avoided.

Port site recurrences after laparoscopic cholecystectomy.

Port site metastasis is a well-documented event after laparoscopic procedures in cancer patients. We summarize current epidemiological knowledge about the risk of this complication after laparoscopic/conventional cholecystectomy in patients with unexpected gallbladder cancer as well as other intraabdominal malignancies. We found 174 cases of port site metastasis after laparoscopic cholecystectomy and 12 recurrences in the surgical scar after converted or open cholecystectomy. A review of all case reports and its comparison with four international surveys show a 14% incidence of port site metastases 7 months after laparoscopic cholecystectomy for cancer. Similar numbers are available for open cholecystectomy. Our data suggest that abdominal wall metastases of gallbladder cancer are not a specific complication of laparoscopy. The long-term prognosis of patients with unknown gallbladder cancer however seems to be worsened by laparoscopy. The registry of the German Society of Surgery, which prospectively compares follow-up and prognosis of all cases of cholecystectomy, laparoscopic as well as open, in patients with incidental gallbladder cancer will definitively clarify whether laparoscopy affects the prognosis of patients with unsuspected gallbladder cancer.

Long-term prognosis of gallbladder cancer diagnosed after laparoscopic cholecystectomy.

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). 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). 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. 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.

Port Site Recurrence of Gallbladder Cancer After Laparoscopic Surgery: Two Case Reports of Long-term Survival

More than 100 patients with port site recurrence after laparoscopic procedures have been reported, and in most cases recurrence has had a fatal outcome. Two patients who survived port site recurrence of unexpected gallbladder cancer after laparoscopic cholecystectomy are reported. Abdominal wall excision was performed in one patient, and thermoradiotherapy was performed in the other. Both patients have remained free of disease during long-term follow-up (82 and 45 months).

A model of port-site metastases of gallbladder cancer: The influence of peritoneal injury and its repair on abdominal wall metastases

Background: Recent surgical literature contains several reports of wound metastases of unexpected gallbladder cancer after laparoscopic cholecystectomy. We hypothesized that peritoneal injury caused by trocar insertion potentiates wound metastases. This study was designed to determine the effect of peritoneal injury on tumor implantation. Methods: Cultured human gallbladder cancer cells were injected into the peritoneal cavity of mice immediately after surgical procedures. In a peritoneal injury group muscle and the peritoneum were perforated; in a peritoneal injury and repair group each muscle and peritoneal wound was sutured carefully; in a laparoscopic model group animals underwent peritoneal insufflation with carbon dioxide gas and tumor cell injection and then the abdominal wall was perforated. Some mice (controls) were not subjected to any surgical procedure. All mice (n = 178) were killed 2 weeks after tumor cell injection and were examined for tumor implantation. Results: Although no control mice showed intraperitoneal tumor, all mice in the peritoneal injury group showed tumors at the injured sites. In the laparoscopic model group, 90% of injured sites had tumors. The traumatized site-specific implantation rate in the peritoneal injury and repair group was only 40%, whereas it was 100% in the peritoneal injury group ( P < .001). Conclusions: Peritoneal injury enhances peritoneal implantation of carcinoma cells. Repair of injured peritoneum at trocar sites may reduce the frequency of wound metastases in laparoscopic surgery for unexpected gallbladder carcinoma. (Surgery 1999;125:553-9.)

Is laparoscopic cholecystectomy hazardous for gallbladder cancer?

Background: There have been several case reports of unexpected gallbladder cancer diagnosed after laparoscopic cholecystectomy (LC) being associated with fatal recurrence of cancer in the abdominal wall. Therefore there is a risk that LC might worsen the prognosis of gallbladder cancer. The objective of this study was to examine the frequency of recurrence of cancer in the abdominal wall and the prognosis of patients with unexpected gallbladder cancer diagnosed after LC. Methods: A clinicopathologic study was performed on 30 patients with postoperatively diagnosed gallbladder cancer among 3566 patients undergoing LC at 19 institutions. The cumulative survival rate was compared with that reported for gallbladder cancer diagnosed after open cholecystectomy. Results: Recurrence of cancer in the abdominal wall occurred in three patients, and two of them died. The 3-year survival rate was 100% for early gallbladder cancer and 70% for advanced tumors. These results were comparable to the 3-year survival rates for gallbladder cancer diagnosed after open cholecystectomy. Conclusions: The incidence of recurrence of cancer in the abdominal wall was increased, but the medium-term prognosis was not worsened by laparoscopy. It does not appear necessary to exclude patients with cholecystitis or gallbladder wall hypertrophy from undergoing laparoscopic procedures on the grounds that they might have gallbladder cancer. (Surgery 1998;123:311-4.)