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Aloraini, A, Alshehri K, Alshammari, R, Bin Onayq, A, Ayesh, M, Alzahrani, M, AlShammari, SA, Alsaif, F. Late port-site metastasis of unexpected gallbladder carcinoma after laparoscopic cholecystectomy: A case report. Medicine (Baltimore) 2024; 103:e37880. [PMID: 38701302 PMCID: PMC11062704 DOI: 10.1097/md.0000000000037880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/21/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Incidental gallbladder carcinoma refers to a discovery of gallbladder cancer during or after cholecystectomy. Late port-site metastasis (PSM) following Laparoscopic cholecystectomy (LC) is rare with an incidence rate of 10.3%. PATIENT CONCERNS We report a case of a 58-year-old man who presented with a painful abdominal wall mass for 6 weeks. He had a history of LC for symptomatic cholelithiasis, 8 years prior. DIAGNOSIS Histopathological examination revealed a positive result for metastatic adenocarcinoma from the abdominal wall mass. Moreover, Positron emission tomography (PET) showed a small focus of intense fluorodeoxyglucose (FDG) uptake in the gallbladder bed, which was highly suspicious for malignancy. INTERVENTION Decision was to proceed with surgery owing to uptake in the gallbladder bed with single-site metastasis to the previous port site. In addition, in the board meeting, an agreement was reached for performing distal pancreatectomy with splenectomy owing to uncertainty of malignancy based on what was discovered during the full metastatic workup. Diagnostic laparoscopy followed by midline laparotomy performed. Radical completion cholecystectomy with lymphadenectomy was done. Followed by complete resection of the anterior abdominal wall. Distal pancreatectomy and splenectomy were then performed. OUTCOME Pathological diagnosis showed metastatic/invasive, moderately differentiated adenocarcinoma with positive margins on the posterior surface of excised port-site mass. The positive margins necessitated further chemoradiotherapy, followed by adjuvant chemotherapy until lung metastasis was identified. After this, the patient was scheduled for palliative chemotherapy. CONCLUSION Presence of PSM is often associated with peritoneal metastasis. For this reason, it is advised to evaluate the patient for possible metastasis.
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Affiliation(s)
- Abdullah Aloraini,
- General, HPB & Transplant Surgeon, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khaled Alshehri
- Bachelor of Medicine and Bachelor of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rahaf Alshammari,
- Bachelor of Medicine and Bachelor of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdulhakim Bin Onayq,
- Bachelor of Medicine and Bachelor of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Ayesh,
- Department of Radiology, King Khalid University Hospital, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Malak Alzahrani,
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sulaiman A. AlShammari,
- Bachelor of Medicine and Bachelor of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faisal Alsaif,
- General, HPB & Transplant Surgeon, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Gallbladder carcinoma incidentally encountered during laparoscopic cholecystectomy: how to deal with it. Clin Transl Oncol 2011; 13:25-33. [DOI: 10.1007/s12094-011-0613-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
INTRODUCTION Accidental intraoperative gallbladder perforation is a problem in laparoscopic surgery, especially in cases with incidental gallbladder carcinoma (IGBC). The question is whether intraoperative gallbladder perforation has a prognostic disadvantage or a retrieval bag provides protection against tumor dissemination. METHODS A standardized questionnaire was sent to all German surgical clinics based on the central register of "incidental gallbladder carcinoma" of the German Society of Surgery founded in 1997. RESULTS In 592 IGBC-registered cases, there were 330 laparoscopies, 154 open surgeries, and intraoperative conversion was performed in 106 cases. Of laparoscopic surgeries (n = 330), the recurrence rate was 30%. The recurrence rate for cases with (174/330) and without (156/330) the use of retrieval bag was 32.2% and 27%, respectively. In laparoscopies with intraoperative gallbladder perforation (73/330 cases), the recurrence rate was 38.4%. Of these cases the recurrence rate with (51/73) and without (22/73) the use of retrieval bags was 39.2% and 36.4%, respectively. In 257 cases without intraoperative perforation, tumor recurrence rate was 27.2%, and it was 29.3% or 25.4% with (123/257) and without (134/257) the use of retrieval bags. CONCLUSIONS According to the registry data, the intraoperative gallbladder perforation results in significant (P = 0.047) prognostic disadvantage and in these cases retrieval bags were used more often (P = 0.001). However, in IGBC cases if intraoperative gallbladder perforation has already happened, the use of retrieval bags had no protective effects.
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Yano H, Okada K, Kinuta M, Iwazawa T, Kanoh T, Monden T. Use of non-powder surgical glove for extraction of gallbladder in laparoscopic cholecystectomy. Dig Endosc 2003. [DOI: 10.1046/j.1443-1661.2003.00263.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Wullstein C, Woeste G, Barkhausen S, Gross E, Hopt UT. Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer? Surg Endosc 2002; 16:828-32. [PMID: 11997831 DOI: 10.1007/s00464-001-9085-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2001] [Accepted: 09/27/2001] [Indexed: 01/03/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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). CONCLUSION Complications during LC significantly worsen the prognosis of GBC. Therefore, bile spillage and excessive manipulation of the gallbladder should be avoided.
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Affiliation(s)
- C Wullstein
- Department of General, Thoracic, Vascular, and Transplantation Surgery, University of Rostock, Schillingallee 35, D-18055 Rostock, Germany
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Abstract
Advances in laparoscopic surgery have revolved not only around new methods of tissue excision and repair, but also around specimen extraction. At the center of these recent advances is the need to be cost-effective and safe. Two particularly important advances in laparoscopic tissue extraction are use of electronic power morcellators, to cut up and remove large masses, and specimen bags to remove the extracted tissue safely. Although morcellators offer tremendous time savings, and can actually reduce the risk of hernia formation because fascia need not be torn or stretched, the use of power morcellators is not without concern. The sharp rotating blade can damage normal organs. Furthermore, one must watch closely so that morcellated specimens are not inadvertently misplaced. Specimen bags are also important, both in malignant and in benign conditions. Ultimately, the problem is spillage of tissue, whether it be cancer cells or products of conception. Although some specimen bags are equipped with self-opening devices, the largest bags must be opened manually.
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Affiliation(s)
- C E Miller
- Department of Obstetrics and Gynecology, University of Illinois at Chicago, Chicago, Illinois, USA.
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Liberal Use of a Bag Made From a Surgical Glove During Laparoscopic Surgery for Specimens Retrieval. Surg Laparosc Endosc Percutan Tech 2000. [DOI: 10.1097/00129689-200008000-00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Iino K, Oki Y, Sasano H. A case of adrenocortical carcinoma associated with recurrence after laparoscopic surgery. Clin Endocrinol (Oxf) 2000; 53:243-8. [PMID: 10931107 DOI: 10.1046/j.1365-2265.2000.01036.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Laparoscopic adrenalectomy has become increasingly popular because of its minimally invasive nature, but guidelines for selection of cases suitable for this surgical procedure have not been established. We report a 52-year-old woman with adrenocortical carcinoma, manifesting as Cushing's syndrome, treated with laparoscopic adrenalectomy. The tumour was removed in toto and had been histologically diagnosed as adrenocortical adenoma. However, the patient developed intra-abdominal peritoneal dissemination of carcinoma 15 months after surgery. Review of the histopathological findings of the resected adrenocortical tumour revealed that the neoplasm met five out of nine histological criteria for adrenocortical malignancy, and was diagnosed as adrenocortical carcinoma. Histopathological examination of the tumour was also consistent with adrenocortical carcinoma. The patient responded extremely well to chemotherapy, including carboplatin, etoposide and o,p'-DDD (1,1-dichlorodiphenyldichloroethane), and a subsequent CT (computed tomography) scan 12 months after the start of chemotherapy demonstrated no evidence of disease. However, the patient developed neurological impairment, including dysarthria, as a side-effect of o, p'-DDD. The patient died of aspiration pneumonia due to a decreased pharyngeal reflex. Postmortem examination revealed no foci of residual carcinoma. This case report emphasizes the importance of excluing possible adrenocortical malignancy in patients considered for laparoscopic adrenalectomy, histopathological diagnosis of adrenocortical malignancy and careful monitoring for neurotoxicity during o,p'-DDD treatment.
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Affiliation(s)
- K Iino
- Department of Pathology, Tohoku University School of Medicine, Sendai; Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Pearlstone DB, Feig BW, Mansfield PF. Port site recurrences after laparoscopy for malignant disease. SEMINARS IN SURGICAL ONCOLOGY 1999; 16:307-12. [PMID: 10332776 DOI: 10.1002/(sici)1098-2388(199906)16:4<307::aid-ssu5>3.0.co;2-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Reports of recurrent malignant disease developing at laparoscopic port sites has created considerable controversy among surgeons. Many have implicated the technique of laparoscopy as a cause of metastases and this has led to condemnation of laparoscopy in malignant disease by many surgeons. A review of the case reports, as well as animal studies, reveals the problem to be considerably more complex. Based on experimental models, reported cases, and our experience at the University of Texas M. D. Anderson Cancer Center, we have arrived at some substantive conclusions regarding this phenomenon. Port site recurrences (PSRs) after laparoscopy for malignant disease can occur as the only site of recurrence, but this is an extremely rare event, and the incidence does not appear to be significantly different from the development of wound recurrences after open laparotomy for malignancy. It is likely that port site recurrences reflect the underlying biology of the malignant disease, rather than an effect of the technique of laparoscopy.
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Affiliation(s)
- D B Pearlstone
- Department of Surgical Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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Weber A, Vazquez J, Valencia S, Cueto J. Surg Laparosc Endosc Percutan Tech 1998; 8:457-459. [DOI: 10.1097/00019509-199812000-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Ohtani T, Takano Y, Shirai Y, Hatakeyama K. Surg Laparosc Endosc Percutan Tech 1998; 8:58-62. [DOI: 10.1097/00019509-199802000-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Ricardo AE, Feig BW, Ellis LM, Hunt KK, Curley SA, MacFadyen BV, Mansfield PF. Gallbladder cancer and trocar site recurrences. Am J Surg 1997; 174:619-22; discussion 622-3. [PMID: 9409585 DOI: 10.1016/s0002-9610(97)00178-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Critics of laparoscopic surgery cite an increased incidence of tumor recurrence at the trocar sites following laparoscopic cholecystectomy in patients incidentally found to have carcinoma of the gallbladder. The purpose of this review was to determine if laparoscopic cholecystectomy performed in patients with gallbladder cancer results in an increased incidence of abdominal wall recurrences. METHODS The charts of all patients with gallbladder cancer registered at the University of Texas M. D. Anderson Cancer Center from January 1991 through April 1996 were retrospectively reviewed. Data were collected on initial and subsequent surgical procedures, tumor grade and histology, T stage, adjuvant therapy, and survival. These data were analyzed with regard to abdominal wall recurrences and outcome. RESULTS Ninety-three patients with gallbladder cancer were seen during this period; 79 patients with complete follow-up information comprised the study population. Comparison of the incidence of abdominal wall recurrences among the categories of surgical procedure (laparoscopic versus open versus laparoscopic converted to open) did not reveal any statistically significant differences. Overall 5-year survival was 10%. CONCLUSIONS Gallbladder cancer is an aggressive malignancy with few long-term survivors. In addition, these data show that the incidence of abdominal wall implantation is not increased with laparoscopic surgery but is more likely a manifestation of the aggressive nature of this tumor.
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Affiliation(s)
- A E Ricardo
- Department of Surgery, The University of Texas Medical School at Houston, USA
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Shirai Y, Ohtani T, Hatakeyama K. Tumor dissemination during laparoscopic cholecystectomy for gallbladder carcinoma. Surg Endosc 1997; 11:1224-5. [PMID: 9373301 DOI: 10.1007/s004649900576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Y Shirai
- Department of Surgery, Niigata University School of Medicine, 1 Asahimachi-dori, Niigata City 951, Japan
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Milsom JW, Marchesa P, Vignali A. Minimally invasive surgery in surgical oncology. Cancer Treat Res 1997; 90:309-29. [PMID: 9367090 DOI: 10.1007/978-1-4615-6165-1_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- J W Milsom
- Cleveland Cl. Foundation, OH 44195-5044, USA
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Shirai Y, Ohtani T, Hatakeyama K. Surg Laparosc Endosc Percutan Tech 1997; 7:435-436. [DOI: 10.1097/00019509-199710000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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