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Umbilical metastasis after
laparoscopic cholecystectomy:
Case Report
M.ANAJJAR.𝟏 ,S.BENAMMI.𝟐 ,
M-S. BELHAMIDI.𝟏 ,M.BOUZROUD.𝟏 , M.ESSARGHINI.𝟏 , B.AITIDIR.𝟏 ,
M. TARCHOULI.𝟏 , S-M. BOUCHENTOUF.𝟏 , A. AIT AL.𝟏 I, A. BOUNAIM .𝟏
Department of Visceral Surgery I, Military Hospital Mohammed V- Rabat 𝟏,
Pediatric Anesthesiology-Reanimation, Pediatric Hospital .𝟐
CONGRES NATIONAL DE CHIRURGIE MARRAKECH 2017
Introduction
• Late trocar-site neoplastic dissemination following a laparoscopic cholecystectomy of
a primary gallbladder unexpectedly diagnosed is a serious complication associated
with a severe prognosis. Rare cases have been described in the literature since the
breakthrough of laparoscopy .
• The aim is to report a case of neoplastic diffusion after laparoscopic cholecystectomy
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Material and Methods
• We report the case of a 66-year-old
man who underwent laparoscopic
cholecystectomy for chronic lithiasic
cholecystitis with 4 trocar site, 2
years form the observation .
Histological examination revealed a
well-differentiated vesicular
•
adenocarcinoma infiltrating the
vesicular wall arriving to the
perimuscular cellular tissue.
Corresponding to the PT2 stage of the
TNM classification. However the
patient refused the surgical
resumption.
umbilical region with inflammatory
signs (Fig. 1). Palpation revealed a
hard mass with 7 cm of major axis
centered by an inflamed and
squamous umbilicus.
from the umbilical lesion and
carrying the round ligament was
performed (Fig 3). There was no
invasion of the vesicular bed nor
detectable hepatic lesions nor
peritoneal metastases.
A cutaneous biopsy of the lesion was
performed, showing a skin invasion • The histological study revealed an
by a slightly differentiated and
umbilical localization of a moderately
infiltrating adenocarcinoma.
differentiated adenocarcinoma and
Abdominal CT showed secondary
all peri-operative sections were
lesion in the peri-umbilical
lesions free. The patient did not
abdominal wall , with a normal
receive adjuvant chemotherapy. The
hepatic parenchyma and vesicular
patient died four months later due to
bed (Fig. 2).
diffuse parietal carcinoma.
• The patient returned after two years
reporting abdominal pain in the
• A parietal resection passing 5 cm
Figure 1. Umbilical lesion
Figure 2. Abdominal CT
Figure 3. Operative sight
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Results
• Gallbladder cancer is a rare cancer but with a sever
prognosis. It is often fortuitously discovered during or
after cholecystectomy. Its incidence is estimated at 1 to
2% worldwide. Preoperative diagnosis is made in less
than 10% of cases. The seeding of tumor cells on trocar
pathways following laparoscopic cholecystectomy is a
serious complication of vesicular cancer fortuitously
discovered. And this complication have been reported a
few times in the literature since the advent of
laparoscopy . Most of these metastases are seen in
patients with advanced vesicular cancer but may also
be reported after surgery for T1 or T2 stages
• The orifice used for the extraction of the gall bladder is
the most metastatic implantation site encountered. The
survival of patients with this complication is weak,
estimated at 18.5% after 2 years. The risk of occurrence
of such a complication is higher after laparoscopic
cholecystectomy than after open cholecystectomy.
Moreover, laparoscopic surgery is baned in patients
with preoperatively diagnosed gallbladder tumors. In
addition, conversion to open surgery is necessary in the
case of perioperative suspicion of gallbladder tumors.
The development of neoplastic implantation on the
trocar path, sometimes for very early stages, initially
led to baning laparoscopic approach for any type of
cancer. It is often a diffuse peritoneal involvement.
Whereas thephysiopathology of the neoplastic
dissemination on trocar pathways is yet undimmed, it
is speculated that it is multi-factorial :
pneumoperitoneum with carbon dioxide, intraabdominal high pressure, laparoscopic instruments,
intraoperative vesicular manipulation and effraction,
implantation of cancer cells during gallbladder
extraction And immunosuppression. Despite the lack of
a proven impact on survival, there is no consensus on
the need for resection of trocar trajectories.
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Conclusions
Although laparoscopic cholecystectomy is widely used in the treatment of vesicular lithiasis, it may
be a provider of neoplastic dissemination on trocar orifices following unrecognized vesicular cancer.
Despite the lack of scientific evidence of their effectiveness, preventive surgical rules remain
consensual: Avoid any effraction And to minimize vesicular manipulations, systematic use of an
extraction bag and conversion to laparotomy in the case of suspected cancer
References
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Davidson, Prof
2-Late Development of Umbilical Metastasis After Laparoscopic Cholecystectomy for a Gallbladder Carcinoma HM Jeon et al. Oncol Rep 6 (2),
283-287. Mar-Apr 1999.
3-Umbilical port metastasis from gallbladder carcinoma after laparoscopic cholecystectomyin European Journal of Surgical Oncology 23(2):1867 · May 1997
4-Gallbladder carcinoma late metastases and incisional hernia at umbilical port site after laparoscopic cholecystectomy A. CIULLA, G. ROMEO, G.
GENOVA, G. TOMASELLO, G. AGNELLO, G. CASTRONOVOG Chir Vol. 27 - n. 5 - pp. 214-216 Maggio 2006
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MARRAKECH 2017