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May 1994

Gallbladder Cancer Discovered During Laparoscopic Surgery: Potential for latrogenic Tumor Dissemination

Author Affiliations

Rochester, Minn

Arch Surg. 1994;129(5):561. doi:10.1001/archsurg.1994.01420290107016

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We read with interest the article by Fong et al1 entitled "Gallbladder Cancer Discovered During Laparoscopic Surgery: Potential for latrogenic Tumor Dissemination." We would agree with the authors' concerns regarding the dissemination of cancer at the time of laparoscopic surgery if the tumor is violated. There have been several disturbing reports of port site recurrence following the resection of malignant neoplasms2 and at sites distant from unsuspected tumors.3

In reviewing the authors' operative findings at the time of reexploration, only two of the patients had gallbladder carcinomas resectable for cure (those patients lacking hepatic or peritoneal metastases). Physicians in our practice and others who advocate aggressive treatment for gallbladder cancer, including Shirai and colleagues,4 would not consider the seven patients with liver metastases as candidates for resection.

Patients with a violation of their tumor can be cured, as we have shown in two of our own

Fong Y, Brennan MF, Turnbull A, Coit DG, Blumgart LH.  Gallbladder cancer discovered during laparoscopic surgery: potential for iatrogenic tumor dissemination . Arch Surg . 1993;128:1054-1056.Article
Pezet D, Fondrinier E, Rotman N, et al.  Parietal seeding of carcinoma of the gallbladder after laparoscopic cholecystectomy . Br J Surg . 1992;79:230.Article
Siriwardena A, Samarji WN.  Cutaneous tumour seeding from a previously undiagnosed pancreatic carcinoma after laparoscopic cholecystectomy . Ann R Coll Surg Engl . 1993;75:199-200.
Shirai Y, Yoshida K, Tsukada K, et al.  Radical surgery for gallbladder carcinoma: long-term results . Ann Surg . 1992;216:565-568.Article
Donohue JH, Nagorney DM, Grant CS, et al.  Carcinoma of the gallbladder: does radical resection improve outcome? Arch Surg . 1990;125:237-241.Article