Laparoscopic staging in gallbladder cancer

Purpose: Laparoscopy is beneficial in the staging of pancreatic and upper gastrointestinal malignancies but its role in gallbladder cancer has not been investigated. We evaluated the role of laparoscopy in the staging of gallbladder cancer. Methods: From 1989 through 2001, 91 patients with gallbladder cancer, without any evidence of metastatic disease on imaging (ultrasound and/or computed tomographic scan), underwent staging laparoscopy. Peritoneal and surface liver metastases were looked for and assessment of local spread was done if possible. Assessment was based on visual impression and biopsies were not obtained routinely. Results: At laparoscopy, 34 (37%) patients had disseminated disease in the form of liver and/or peritoneal deposits; no further surgery was performed in 29 of these patients while 5 patients underwent surgical bypass procedures. Liver metastases were missed at laparoscopy in 2 patients and were subsequently found at laparotomy. Assessment of the gallbladder mass was possible in 33 (36%) patients, 6 of these were found to have extensive local disease and did not undergo any further surgery. Laparoscopic staging, thus avoided further surgery in 35 (38%) patients. Of the 51 patients without metastatic disease, who underwent laparotomy, 11 were found to have nonresectable locally advanced disease while 1 had liver metastases, which were missed at laparoscopy; 7 underwent bypass procedures only; 21 underwent simple cholecystectomy and extended cholecystectomy was done in 11 patients. The resectability rate (number of resections/operations) in patients undergoing laparoscopic staging was 57% (32/56) as compared with 43% (142/328) in those who did not undergo laparoscopy. Conclusions: Staging laparoscopy in patients with gallbladder cancer detected liver and peritoneal metastases that were missed on imaging. It reduced the number of unnecessary surgical explorations and improved the resectability rate.