Missed malignancies at laparoscopic cholecystecomy: A new emerging problem

Objective: With increase in laparoscopic cholecystectomy (LC) rates the chances of missing a concomitant cancer is high, if the laparoscopic surgeon is focused on gall bladder and does not look around. The aim of the present article therefore is to analyze the unsuspected concomitant cancer, for patients with atypical upper abdominal symptoms and diagnostic delay due to LC.
Materials and Methods: This retrospective study evaluates the clinico- pathological data, diagnostic delay and outcome of patients who presented with intra-abdominal malignancy to our unit within 2-8 months of LC for gallstone disease elsewhere, between June 2003 and June 2005.
Results: Six such patients were identified (age range 38-62 years). Two patients had carcinoma of the stomach, one each had carcinoma of the caecum, ascending colon and left ovary respectively, while one patient presented with malignant ascitis of unknown origin. Five of these 6 patients underwent a subsequent radical oncological procedure at our unit. Mean diagnostic delay was 4 months. The cTNM of tumor at diagnosis was Stage III/ IV in 5 of these 6 patients.
Conclusion: The importance of a good clinical work-up, diagnostic imaging studies and exploration at the time of surgery is re-emphasized. Missing a concomitant lesion is high, if the surgeon focuses only on one organ during an LC.