Invited Commentary

Excerpt

In this article Akatsu et al. (DOI: 10.1007/s00268-005-7886-x) report that the diagnosis of gallbladder cancer could be made prior to cholecystecomy in 83 out of 91 patients presenting to Keio University Hospital over a 10-year period. The authors achieved this diagnostic accuracy by performing routine ultrasound, computed tomography (CT), and cholangiography on all patients prior to cholecystectomy, and selectively performing endoscopic ultrasound if the gallbladder was not adequately visualized. Thus 1546 patients with benign gallbladder disease also underwent this extensive preoperative evaluation. The 8 patients with gallbladder cancer that was not identified prior to laparoscopic cholecystectomy all had early stage disease (three Tis, three T1a, two T2), and none have experienced tumor recurrence to date. In each of these cases perforation and spillage during cholecystectomy had been avoided. …