Purpose: The increased number of patients undergoing laparoscopic cholecystectomy (LC) is associated with a risk of missing concomitant colorectal cancers; however, the incidence and cause have not yet been well recognized. Our aim, therefore, was to evaluate these factors.
Methods: This retrospective study evaluated data on 473 patients with benign gallbladder diseases, who underwent LC between January 1991 and December 1999. Among these 473 patients, 2 (0.4%) were thought to have had detectable cancer at LC.
Results: The first patient was a 59-year-old woman who underwent palliative resection for ascending colon cancer associated with liver and pulmonary metastases 10 months following LC when laboratory data showed a low hemoglobin level (10.0 g/dl). The other patient, a 50-year-old man, underwent resection for Dukes' C sigmoid colon cancer 6 months following LC. At LC, the patient did not present with any symptoms suggesting the existence of colorectal cancer and the laboratory data were normal.
Conclusions: These results indicate that although an extremely low incidence of missed colorectal cancers does not justify routine screening for colorectal cancer before LC in terms of cost-effectiveness, careful attention to preoperative physical findings and laboratory data as well as meticulous techniques and full diagnostic visualization of the large-bowel intraoperatively may reduce the potential risk of missing coexisting colorectal cancers during LC.