We read with interest the article by Fong et al1 entitled "Gallbladder Cancer Discovered During Laparoscopic Surgery: Potential for latrogenic Tumor Dissemination." We would agree with the authors' concerns regarding the dissemination of cancer at the time of laparoscopic surgery if the tumor is violated. There have been several disturbing reports of port site recurrence following the resection of malignant neoplasms2 and at sites distant from unsuspected tumors.3
In reviewing the authors' operative findings at the time of reexploration, only two of the patients had gallbladder carcinomas resectable for cure (those patients lacking hepatic or peritoneal metastases). Physicians in our practice and others who advocate aggressive treatment for gallbladder cancer, including Shirai and colleagues,4 would not consider the seven patients with liver metastases as candidates for resection.
Patients with a violation of their tumor can be cured, as we have shown in two of our own