Gallbladder Cancer after laparoscopic cholecystectomy is called as incidental gallbladder cancer. It is generally of low stage cancer as it is diagnosed incidentally. It require completion radical cholecystectomy surgery
What is Incidental Gallbladder Cancer
It is diagnosed on histopathology report when gallbladder specimen is sent for biopsy. It is different from missed gallbladder cancer which has got poor prognosis. Gallbladder cancer can be missed pre-operatively when there is suspicious of gallbladder cancer but it is not worked up further. It can also be missed intra-op if gallbladder specimen is not cut and examined intra-operatively. It is always advised to cut open the specimen during surgery and any suspicious area of cancer is send for frozen section biopsy and proceed accordingly
Does all gallbladder cancer after laparoscopic cholecystectomy require surgery
Not all gallbladder cancer after laparoscopic cholecystectomy require surgery. T1a stage and metastatic disease does not require surgery. Patient fitness for surgery is required
Investigation to be done when biopsy show gallbladder cancer after laparoscopic cholecystectomy
Surgery is not done for metastatic disease. PET scan is done to rule out metastatic disease.
What is completion radical cholecystectomy
In completion radical cholecystectomy liver wedge is removed which is part of gallbladder bed. Lymphadenectomy is also done. Before proceeding to radical surgery if even PET scan is negative for metastatic disease, staging laparoscopy is done. It is done to identify metastatic deposits which are missed even on PET scan
Prognosis & Survival Rate
Prognosis depend on the stage of cancer. Early stage tumor has got good prognosis. Data has shown that patient who undergo radical cholecystectomy after diagnosis of incidental cancer has got good survival rate compared to those who do not. Bile spillage during index surgery also carries a poor prognosis