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For: Goetze T, Paolucci V. Does laparoscopy worsen the prognosis for incidental gallbladder cancer? Surg Endosc 2005;20:286-93. [PMID: 16362480 DOI: 10.1007/s00464-005-0121-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2005] [Accepted: 07/19/2005] [Indexed: 02/06/2023]

For:	Goetze T, Paolucci V. Does laparoscopy worsen the prognosis for incidental gallbladder cancer? Surg Endosc 2005;20:286-93. [PMID: 16362480 DOI: 10.1007/s00464-005-0121-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2005] [Accepted: 07/19/2005] [Indexed: 02/06/2023]

Number

Cited by Other Article(s)

Miao W, Liu F, Guo Y, Zhang R, Wang Y, Xu J. Research progress on prognostic factors of gallbladder carcinoma. J Cancer Res Clin Oncol 2024;150:447. [PMID: 39369366 PMCID: PMC11456552 DOI: 10.1007/s00432-024-05975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Accepted: 09/24/2024] [Indexed: 10/07/2024]

Silva TS, Firek M, Albini P, Caba Molina D. Laparoscopic Conversion to Open Cholecystectomy: Is Incidental Gallbladder Cancer Any Different? Cureus 2024;16:e62187. [PMID: 38993400 PMCID: PMC11239196 DOI: 10.7759/cureus.62187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open

Abstract

BACKGROUND

A majority of gallbladder cancers present incidentally. Operative risk factors and outcomes for laparoscopic converted to open cholecystectomy in incidental gallbladder cancer are not well characterized.

METHODS

Patients with incidental gallbladder cancer and acute cholecystitis undergoing laparoscopic cholecystectomy and conversion to open cholecystectomy in the National Surgical Quality Improvement Program (NSQIP) database of the American College of Surgeons (ACS) from 2010-2019 were reviewed. The primary endpoint was risk factors for conversion to open cholecystectomy in incidental gallbladder cancer. Chi-squared test or Fisher's exact test was used for categorical variables. Continuous variables were compared using the Mann-Whitney U test.

RESULTS

A total of 5,789 patients undergoing laparoscopic cholecystectomy were identified, of which, 50 (0.9%) had incidental gallbladder cancer. For incidental gallbladder cancer patients, there were no differences in preoperative profile and risk factors between laparoscopic and converted to open cholecystectomy groups. Incidental carcinoma patients undergoing conversion to open cholecystectomy had lower preoperative sodium levels than the laparoscopic cholecystectomy group (P=0.007). Hospital length of stay (days) was longer for those with a conversion to open cholecystectomy for incidental carcinoma compared to non-conversion, 14 (10.8, 18.8) vs 2 (0.3, 5) (P=0.004). The patients converted to open cholecystectomy also had higher rates of postoperative sepsis (50% vs 0%, P<0.001) and reoperation than the laparoscopic cohort (50% vs 2.2%, P<0.001). Readmission and mortality rates, among other complications, were not significantly different between both surgical approaches in incidental gallbladder cancer patients.

CONCLUSIONS

Patients with conversion to open cholecystectomy had worse outcomes including longer hospital stays and higher rates of sepsis and reoperation. It remains difficult to predict which incidental gallbladder patients will require a conversion to open surgery. Further study examining whether more complicated recovery results in worse oncologic outcomes is warranted.

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Yong Z, Ang L, Wen-Zhang Z, Xu-Dong W, Ren-Gen F. Incidental gall bladder cancer in the laparoscopic treatment and magnetic resonance imaging era: A single institution experience. J Minim Access Surg 2024;20:148-153. [PMID: 36695237 PMCID: PMC11095808 DOI: 10.4103/jmas.jmas_117_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/22/2022] [Accepted: 11/15/2022] [Indexed: 01/22/2023] Open

Abstract

BACKGROUND

Incidental gall bladder cancer (IGBC) is often discovered unexpectedly in patients after cholecystectomy. Currently, magnetic resonance imaging (MRI) has been widely applied in the pre-operative diagnosis of gall bladder diseases as laparoscopic cholecystectomy developed into the preferred method.

AIMS AND OBJECTIVES

This study aimed to evaluate the pre-operative MRI application and laparoscopic management in the IGBCs.

MATERIALS AND METHODS

Between January 2011 and January 2020, a total of 7917 patients with gall bladder diseases treated by laparoscopy were enrolled in this study.

RESULTS

Amongst 49 patients diagnosed with IGBCs, the incidence of IGBCs in polypoid lesions, biliary pancreatitis, cholecystitis, cholecystocholedocholithiasis and gall bladder stones was 0.42%, 1.19%, 0.62%, 1.20% and 0.49%, respectively. MRI evaluation showed more remarkable pre-operative imaging as compared to ultrasonographic evaluation (40.8 vs. 26.5, P < 0.05). Furthermore, 14 patients were diagnosed with gall bladder cancer through intraoperative histological examination and 11 received laparoscopic extensive resection after cholecystectomy. MRI findings with diffuse thickening of the gall bladder detected IGBCs with 6.1% sensitivity, 96.02 specificity, 0.95% positive predictive values and 99.4% negative predictive values; diffuse thickening of the gall bladder with suspicion of malignancy detected IGBCs with 12.2% sensitivity, 99.1% specificity, 7.6% positive predictive values and 99.5% negative predictive values; focal thickening of the gall bladder detected IGBCs with 16% sensitivity, 99.8% specificity, 32% positive predictive values and 99.5% negative predictive values; moreover, suspicious lesion detected IGBCs with 6.1% sensitivity, 99.6% specificity, 8.8% positive predictive values and 99.4% negative predictive values.

CONCLUSIONS

Patients with biliary pancreatitis and cholecystocholedocholithiasis have a higher incidence of IGBC. MRI evaluation could provide more accurate information for the IGBCs, which should be recommended for patients accepting cholecystectomy. MRI findings exhibited an unsatisfactory sensitivity when detecting IGBCs, but they represented high specificity. Pre-operative MRI evaluation and intraoperative histological examination may help some IGBCs to achieve one-stage laparoscopic extensive resection.

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Guner M, Kaya T. A Retrospective Analysis of Incidental Gallbladder Cancer on Post-cholecystectomy Pathological Review. Cureus 2023;15:e47249. [PMID: 37859674 PMCID: PMC10583125 DOI: 10.7759/cureus.47249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 10/21/2023] Open

Abstract

Background Gallbladder cancer is a rare cancer with a poor prognosis despite all the advances in treatment options and is mostly detected incidentally. In the current literature, re-excision is performed on patients with stage T1b and above, but high mortality rates are still observed. In this study, we aimed to investigate the reasons affecting the prognosis of incidental gallbladder cancer. Methodology Data from 33 patients were retrospectively analyzed. Patient age, sex, preoperative radiologic findings, surgical procedures, margin status, postoperative results with histologic diagnosis, T stage, complications, and mortality were evaluated. Results Of the 33 patients included in the study, 24 (72.7%) were female, nine (27.3%) were male, and the mean age was 66.4 ± 13.4 years. Seventeen (51.5%) patients in our study were aged over 65 years. Age over 65 years was found to have a significant effect on mortality (p = 0.018). In the preoperative ultrasound imaging, 27 (81.8%) patients had gallstones, two (6.1%) patients had gallbladder polyps, 31 (93.9%) had focal or diffuse thickness increases in the gallbladder wall, and nine (27.3%) patients had pericholecystic fluid. The presence of pericholecystic fluid (p = 0.039) and wall thickness (p = 0.006) were found to be associated with mortality. There was perineural invasion and lymphovascular in 17 patients each. Both perineural invasion (p = 0.016) and lymphovascular invasion (p = 0.007) were associated with mortality. Tumor grade was also associated with mortality (p = 0.001). When the prognosis of the patients was evaluated according to the T stage, the increase in the T stage negatively affected the prognosis (p < 0.001). Overall survival was a median of 17 months (95% confidence interval = 10.6-23.3). Conclusions Incidental gallbladder cancer is detected on routine histologic examination of gallbladder specimens after cholecystectomy. Most patients may require re-excision, but the prognosis is still poor in patients who have undergone re-excision. Age >65 years, pericholecystic fluid, T stage, grade, lymphovascular invasion, and perineural invasion had a significant effect on mortality, the presence of which should trigger the option of re-excision to be examined more carefully.

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Pehlivanoglu B, Akkas G, Memis B, Basturk O, Reid MD, Saka B, Dursun N, Bagci P, Balci S, Sarmiento J, Maithel SK, Bandyopadhyay S, Escalona OT, Araya JC, Losada H, Goodman M, Knight JH, Roa JC, Adsay V. Reappraisal of T1b gallbladder cancer (GBC): clinicopathologic analysis of 473 in situ and invasive GBCs and critical review of the literature highlights its rarity, and that it has a very good prognosis. Virchows Arch 2023;482:311-323. [PMID: 36580138 DOI: 10.1007/s00428-022-03482-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/05/2022] [Accepted: 12/17/2022] [Indexed: 12/30/2022]

Abstract

There are highly conflicting data on relative frequency (2-32%), prognosis, and management of pT1b-gallbladder carcinoma (GBC), with 5-year survival ranging from > 90% in East/Chile where cholecystectomy is regarded as curative, versus < 50% in the West, with radical operations post-cholecystectomy being recommended by guidelines. A total of 473 in situ and invasive extensively sampled GBCs from the USA (n = 225) and Chile (n = 248) were re-evaluated histopathologically per Western invasiveness criteria. 349 had invasive carcinoma, and only 24 were pT1. Seven cases previously staged as pT1b were re-classified as pT2. There were 19 cases (5% of all invasive GBCs) qualified as pT1b and most pT1b carcinomas were minute (< 1mm). One patient with extensive pTis at margins (but pT1b focus away from the margins) died of GBC at 27 months, two died of other causes, and the remainder were alive without disease (median follow-up 69.9 months; 5-year disease-specific survival, 92%). In conclusion, careful pathologic analysis of well-sampled cases reveals that only 5% of invasive GBCs are pT1b, with a 5-year disease-specific survival of > 90%, similar to findings in the East. This supports the inclusion of pT1b in the "early GBC" category, as is typically done in high-incidence regions. Pathologic mis-staging of pT2 as pT1 is not uncommon. Cases should not be classified as pT1b unless extensive, preferably total, sampling of the gallbladder to rule out a subtle pT2 is performed. Critical appraisal of the literature reveals that the Western guidelines are based on either SEER or mis-interpretation of stage IB cases as "pT1b." Although the prognosis of pT1b-GBC is very good, additional surgery (radical cholecystectomy) may be indicated, and long-term surveillance of the biliary tract is warranted.

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Affiliation(s)

Burcin Pehlivanoglu Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA Current affiliation: Department of Pathology, Dokuz Eylul University, Izmir, Turkey
Gizem Akkas Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA Current affiliation: Department of Pathology, Faculty of Medicine, Kutahya University of Health Sciences, Kutahya, Turkey
Bahar Memis Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
Olca Basturk Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
Michelle D Reid Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
Burcu Saka Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
Nevra Dursun Department of Pathology, University of Health Sciences, Istanbul Education and Research Hospital, Istanbul, Turkey
Pelin Bagci Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
Serdar Balci Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
Juan Sarmiento Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
Shishir K Maithel Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
Sudeshna Bandyopadhyay Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
Oscar Tapia Escalona Department of Pathology, Universidad de La Frontera, Temuco, Chile
Juan Carlos Araya Department of Pathology, Hospital Dr. Hernan Henriquez Aravena, Temuco, Chile
Hector Losada Department of Surgery and Traumatology, Universidad de La Frontera, Temuco, Chile
Michael Goodman Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
Jessica Holley Knight Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
Juan Carlos Roa Department of Pathology, Pontificia Universidad Catolica de Chile, Santiago, Chile
Volkan Adsay Department of Pathology, Koç University Hospital, Davutpaşa Caddesi No:4, Topkapi, 34010, Istanbul, Turkey. Koç University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey.

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Cho JK, Kim JR, Jang JY, Kim HG, Kim JM, Kwag SJ, Park JH, Kim JY, Ju YT, Jeong CY. Comparison of the Oncological Outcomes of Open versus Laparoscopic Surgery for T2 Gallbladder Cancer: A Propensity-Score-Matched Analysis. J Clin Med 2022;11:jcm11092644. [PMID: 35566770 PMCID: PMC9099510 DOI: 10.3390/jcm11092644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023] Open

Affiliation(s)

Jin-Kyu Cho Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
Jae-Ri Kim Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, 11, Samjeongja-ro, Changwon-si 51472, Korea; (J.-R.K.); (J.-Y.J.)
Jae-Yool Jang Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, 11, Samjeongja-ro, Changwon-si 51472, Korea; (J.-R.K.); (J.-Y.J.)
Han-Gil Kim Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
Jae-Myung Kim Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
Seung-Jin Kwag Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
Ji-Ho Park Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
Ju-Yeon Kim Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
Young-Tae Ju Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
Chi-Young Jeong Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.) Correspondence: ; Tel.: +82-10-9360-8294

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Oncologic and Long-Term Outcomes of Laparoscopic and Open Extended Cholecystectomy for Gallbladder Cancer. J Clin Med 2022;11:jcm11082132. [PMID: 35456227 PMCID: PMC9027168 DOI: 10.3390/jcm11082132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 12/04/2022] Open

Incidental Carcinoma after Cholecystectomy for Benign Disease of the Gallbladder: A Meta-Analysis. J Clin Med 2020;9:jcm9051484. [PMID: 32423156 PMCID: PMC7290945 DOI: 10.3390/jcm9051484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open

Goetze TO, Bechstein WO, Bankstahl US, Keck T, Königsrainer A, Lang SA, Pauligk C, Piso P, Vogel A, Al-Batran SE. Neoadjuvant chemotherapy with gemcitabine plus cisplatin followed by radical liver resection versus immediate radical liver resection alone with or without adjuvant chemotherapy in incidentally detected gallbladder carcinoma after simple cholecystectomy or in front of radical resection of BTC (ICC/ECC) - a phase III study of the German registry of incidental gallbladder carcinoma platform (GR)- the AIO/ CALGP/ ACO- GAIN-trial. BMC Cancer 2020;20:122. [PMID: 32059704 PMCID: PMC7023745 DOI: 10.1186/s12885-020-6610-4] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/06/2020] [Indexed: 02/06/2023] Open

Abstract

BACKGROUND

Currently, complete surgical resection represents the only potentially curative treatment option for Biliary Tract Cancer (BTC) including Gallbladder Cancer (GBC). Even after curative resection, 5-year OS is only 20-40%. Gallbladder carcinoma is relatively rare, but still the fifth most common neoplasm of the digestive tract and even the most frequent cancer of the biliary system. Gallbladder carcinoma is suspected preoperatively in only 30% of all pts., while the majority of cases are discovered incidentally by the pathologist after cholecystectomy for a benign indication. For improving curative rates in BTC and GBC, early systemic therapy combined with radical resection seems to be a promising approach. The earliest moment to apply chemotherapy would be in front of radical surgery. The encouraging results of neoadjuvant/perioperative concepts in other malignancies provide an additional rationale to use this treatment in the early phase of GBC management and even ICC/ECC. Especially because data regarding pure adjuvant chemotherapy in BTC's are conflicting.

METHODS

This is a multicenter, randomized, controlled, open-label phase III study including pts. with incidentally discovered GBCs after simple cholecystectomy in front of radical liver resection and pts. with resectable/ borderline resectable cholangiocarcinomas (ICC/ ECC) scheduled to receive perioperative chemotherapy (Gemcitabine + Cisplatin 3 cycles pre- and post-surgery) or surgery alone followed by a therapy of investigator's choice. Primary endpoint is OS; secondary endpoints are PFS, R0-resection rate, toxicity, perioperative morbidity, mortality and QoL. A total of N = 333 patients with GBC or BTC will be included. Recruitment has started in August 2019.

DISCUSSION

The current proposed phase III GAIN study investigates whether induction chemotherapy followed by radical resection in ICC/ECC and re-resection in IGBC (and - if possible - postoperative chemotherapy) prolongs overall survival compared to radical surgery alone for incidental gallbladder carcinoma and primary resectable or borderline resectable cholangiocarcinoma. Utilizing a neoadjuvant approach including a second radical surgery will help to raise awareness for the necessity of radical surgery, especially second radical completion surgery in IGBC and improve the adherence to the guidelines.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT03673072 from 17.09.2018. EudraCT number: 2017-004444-38 from 02.11.2017.

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Figueiredo WR, Santos RR, Paula MMDRCD. Comparative incidence of incidental gallbladder cancer in emergency cholecystectomies versus in elective cholecystectomies. ACTA ACUST UNITED AC 2020;46:e20192366. [PMID: 32022114 DOI: 10.1590/0100-6991e-20192366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/29/2019] [Indexed: 01/05/2023]

Singh BP, Khan WF, Rathore YS, Pol MM. Incidental Carcinoma Gallbladder: Incidence, Risk Factors, and Factors Affecting Survival-5-Year Experience from a Tertiary Care Institute. J Gastrointest Cancer 2019;51:980-987. [PMID: 31808057 DOI: 10.1007/s12029-019-00347-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]

Abstract

INTRODUCTION

Carcinoma gallbladder is a very lethal disease. It can get detected incidentally after laparoscopic cholecystectomy. The overall outcome of incidentally detected carcinoma gallbladder is a matter of debate in literature.

AIM

To estimate the overall incidence of the incidental gallbladder carcinoma, the various risk factors associated with it and factors affecting overall survival in patients who underwent laparoscopic cholecystectomy with eventual histology turning out to be carcinoma gallbladder.

METHODS

Data of all the patients undergoing laparoscopic cholecystectomies in one surgical unit under the Department of Surgery at All India Institute of Medical Sciences, New Delhi, India, between January 2014 and December 2018 was retrospectively analyzed. All patients with incidental carcinoma gallbladder were followed up and completion radical cholecystectomy was performed. The demographic profile, preoperative imaging, intra-operative finding, histopathology of primary surgery, and median interval between two surgeries were analyzed to look for various risk factors associated with incidental carcinoma gallbladder and factors affecting overall survival.

RESULTS

Incidence of the incidental carcinoma gallbladder was 0.51% with a female/male ratio of 4:1 and mean age of 47.2 years. Preoperative imaging of most of them was suggestive of chronic cholecystitis; however, one patient had multiple gallbladder polyps. Six patients had uneventful laparoscopic cholecystectomy, while four had bile spillages intraoperatively. All the patients had adenocarcinoma on histopathology. Pathological staging of four patients was pT1b and six patients had pT2 tumor. The median interval between cholecystectomy and completion radical cholecystectomy in this series was 8 weeks. At the end of 19-month median follow-up, overall survival was 55.5%.

CONCLUSION

Incidence of incidental carcinoma gallbladder is 0.51%, most commonly affecting middle-aged females. Risk factors associated with incidental carcinoma gallbladder were found to be multiple gallbladder calculi, single large stone, and gallbladder polyps. Survival is better in males, young patients with uneventful primary surgery and better-differentiated pathology.

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Yu LH, Yuan B, Fu XH, Yu WL, Liu J, Zhang YJ. Does Anatomic Resection Get More Benefits than Wedge Hepatectomy on the Prognosis for pT3 Unsuspected Gallbladder Cancer? J Laparoendosc Adv Surg Tech A 2019;29:1414-1418. [PMID: 31403381 DOI: 10.1089/lap.2018.0690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open

Sinagra E, Garritano S, Iacopinelli SM, Messina M, Raimondo D, Rossi F, Spada M, Martorana G, Spampinato MG. Minimally invasive surgical approach for radicalization of incidental post-cholecystectomy gallbladder carcinoma: safety, feasibility and outcomes. MINIM INVASIV THER 2018;27:217-220. [PMID: 29214888 DOI: 10.1080/13645706.2017.1410489] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 10/23/2017] [Indexed: 01/30/2023]

Abstract

BACKGROUND AND AIMS

Gallbladder carcinoma is a rare but aggressive malignant neoplasm. The incidence of intra- or post-operative incidental gallbladder carcinoma diagnosis following laparoscopic cholecystectomy is estimated to be 1-2%. Aggressive re-resection is warranted as the majority of patients have residual disease either in the liver or the lymph nodes. However the use of a minimally invasive surgical approach (MISA) to perform a radicalization in these patients has not been investigated yet. We retrospectively analyzed surgical and oncologic outcome of a small selected cohort of patients with incidental gallbladder carcinoma whom underwent redo radicalization surgery by MISA.

MATERIAL AND METHODS

From April 2012 to June 2014 at our department six patients (three females and three males) with incidental findings of gallbladder carcinoma pT1b (stage I) following laparoscopic cholecystectomy, and referred to our center from other secondary-level referral hospitals, underwent a redo surgery for radicalization by means of laparoscopic (n. 3) or robotic approach (n. 3). A retrospective analysis of prospective collected data was performed.

RESULTS

The redo procedure consisted of a liver resection (segments IVb + V) and lymph nodes clearance of hepatoduodenal hilum and common hepatic artery. Conversion rate was zero. Median operative time was 290 (250-310) min. Estimate blood loss was 175 (100-350) ml. Total hospital stay was 6 (5-10) days. All liver resections were performed without inflow vascular clamping. One patient was re-operated for hemoperitoneum while peri-operative mortality was zero. Oncologically, an R0 resection was always achieved with a mean number of lymph nodes retrieved of 17,5 (14-22). The stage of the neoplasm was confirmed in all cases but one, who was found to have a pN1 status (stage IIIb). At 21 (6-32) months follow-up all patients are alive and no recurrence has been observed.

CONCLUSIONS

Our data suggest that radicalization of patients with stage I incidental postoperative gallbladder carcinoma can be done by a MISA without compromising the oncologic outcome. Larger studies are needed to validate these results.

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Yoon YS, Han HS, Agarwal A, Belli G, Itano O, Gumbs AA, Yoon DS, Kang CM, Lee SE, Wakai T, Troisi RI. Survey Results of the Expert Meeting on Laparoscopic Surgery for Gallbladder Cancer and a Review of Relevant Literature. Dig Surg 2018;36:7-12. [PMID: 29339658 DOI: 10.1159/000486208] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/10/2017] [Indexed: 12/13/2022]

Gallbladder Carcinoma in the United States: A Population Based Clinical Outcomes Study Involving 22,343 Patients from the Surveillance, Epidemiology, and End Result Database (1973-2013). HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2017. [PMID: 28638176 PMCID: PMC5468561 DOI: 10.1155/2017/1532835] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]

Utsumi M, Aoki H, Kunitomo T, Mushiake Y, Yasuhara I, Arata T, Katsuda K, Tanakaya K, Takeuchi H. Evaluation of surgical treatment for incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy: single center results. BMC Res Notes 2017;10:56. [PMID: 28109315 PMCID: PMC5251282 DOI: 10.1186/s13104-017-2387-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/13/2017] [Indexed: 01/05/2023] Open

Jang JY, Heo JS, Han Y, Chang J, Kim JR, Kim H, Kwon W, Kim SW, Choi SH, Choi DW, Lee K, Jang KT, Han SS, Park SJ. Impact of Type of Surgery on Survival Outcome in Patients With Early Gallbladder Cancer in the Era of Minimally Invasive Surgery: Oncologic Safety of Laparoscopic Surgery. Medicine (Baltimore) 2016;95:e3675. [PMID: 27258495 PMCID: PMC4900703 DOI: 10.1097/md.0000000000003675] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open

Abstract

Laparoscopic surgery has been widely accepted as a feasible and safe treatment modality in many cancers of the gastrointestinal tract. However, most guidelines on gallbladder cancer (GBC) regard laparoscopic surgery as a contraindication, even for early GBC. This study aims to evaluate and compare recent surgical outcomes of laparoscopic and open surgery for T1(a,b) GBC and to determine the optimal surgical strategy for T1 GBC.The study enrolled 197 patients with histopathologically proven T1 GBC and no history of other cancers who underwent surgery from 2000 to 2014 at 3 major tertiary referral hospitals with specialized biliary-pancreas pathologists and optimal pathologic handling protocols. Median follow-up was 56 months. The effects of depth of invasion and type of surgery on disease-specific survival and recurrence patterns were investigated.Of the 197 patients, 116 (58.9%) underwent simple cholecystectomy, including 31 (15.7%) who underwent open cholecystectomy and 85 (43.1%) laparoscopic cholecystectomy. The remaining 81 (41.1%) patients underwent extended cholecystectomy. Five-year disease-specific survival rates were similar in patients who underwent simple and extended cholecystectomy (96.7% vs 100%, P = 0.483), as well as being similar in patients in the simple cholecystectomy group who underwent open and laparoscopic cholecystectomy (100% vs 97.6%, P = 0.543). Type of surgery had no effect on recurrence patterns.Laparoscopic cholecystectomy for T1 gallbladder cancer can provide similar survival outcomes compared to open surgery. Considering less blood loss and shorter hospital stay with better cosmetic outcome, laparoscopic cholecystectomy can be justified as a standard treatment for T1b as well as T1a gallbladder cancer when done by well-experienced surgeons based on exact pathologic diagnosis.

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Surgical treatment of incidental gallbladder cancer discovered during or following laparoscopic cholecystectomy. World J Surg 2015;39:746-52. [PMID: 25403888 DOI: 10.1007/s00268-014-2864-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]

Abstract

BACKGROUND

The optimal surgical management of patients with incidental gallbladder cancer (IGBC) and their long-term survival remains unclear.

OBJECTIVE

The purpose of this study was to examine the long-term prognosis of patients with IGBC diagnosed during or after LC.

METHODS

Between January 2002 and January 2012, a total of 7,582 consecutive patients underwent LC for presumed gallbladder benign disease in the Chinese PLA General Hospital, China. Among them, 69 patients (0.91%) were diagnosed to have IGBC. Their medical records, imaging data, surgery records, pathological findings, and survival data were retrospectively reviewed.

RESULTS

Median age was 61 years (range: 34-83). After a median follow-up period of 61 months, the 1-, 3-, and 5-year survival rates of patients were 89.9, 78.3, and 76.8%, respectively. The 5-year survival rates of patients with T1a, T1b, T2, and T3 stages were 95.5, 93.8, 69.2, and 44.4%, respectively. The 5-year survival rates in simple LC (n = 45), converted to open extended cholecystectomy (n = 16), and radical second resection (n = 8) groups were 91.1, 37.5, and 75.0%, respectively. Local port-site tumor recurrence was identified in one patient. Prognostic factors including depth of invasion, lymph node status, vascular or neural invasion, tumor differentiation, extent of resection, bile spillage, and type of surgery were statistically significant (p < 0.05).

CONCLUSIONS

Simple LC is appropriate for T1a patients with clear margin and unbroken gallbladder, whereas extended radical resection is recommended for patients with T1b or more advanced IGBC. An intact surgical specimen and the use of plastic retrieval bags are important to reduce the risk of port-site recurrences and disease relapse. Early diagnosis, meticulous perioperative assessment, and precise surgery are essential factors to obtain good results in IGBC treatment.

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Is Laparoscopy Contraindicated for Gallbladder Cancer? A 10-Year Prospective Cohort Study. J Am Coll Surg 2015;221:847-53. [PMID: 26272017 DOI: 10.1016/j.jamcollsurg.2015.07.010] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/09/2015] [Indexed: 02/06/2023]

Düzköylü Y, Bektaş H, Kozluklu ZD. Incidental gallbladder cancers: Our clinical experience and review of the literature. Turk J Surg 2015;32:107-10. [PMID: 27436934 DOI: 10.5152/ucd.2015.2750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/10/2014] [Indexed: 11/22/2022]

Yoon JH, Lee YJ, Kim SC, Lee JH, Song KB, Hwang JW, Lee JW, Lee DJ, Park KM. What is the better choice for T1b gallbladder cancer: simple versus extended cholecystectomy. World J Surg 2015;38:3222-7. [PMID: 25135174 DOI: 10.1007/s00268-014-2713-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]

Cavallaro A, Piccolo G, Di Vita M, Zanghì A, Cardì F, Di Mattia P, Barbera G, Borzì L, Panebianco V, Di Carlo I, Cavallaro M, Cappellani A. Managing the incidentally detected gallbladder cancer: algorithms and controversies. Int J Surg 2014;12 Suppl 2:S108-S119. [PMID: 25182380 DOI: 10.1016/j.ijsu.2014.08.367] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 02/06/2023]

Abstract

INTRODUCTION

Gallbladder cancer (GBC) is the fifth most common neoplasm of the gastrointestinal tract and the most common cancer of the biliary tract. GBC is suspected preoperatively in only 30-40% of patients. The other 60-70% are discovered incidentally (IGBC) by the pathologist on a gallbladder specimen following cholecystectomy for benign diseases such as polyps, gallstones, and cholecystitis.

MATERIALS AND METHODS

Between 1995 and 2011, 30 cases of GBC, who underwent resection with curative intent in our institutions, were retrospectively reviewed. They were analyzed for demographic data, and type of operation, surgical morbidity and mortality, histopathological classification, and survival. Incidental GBC was compared with suspected or preoperatively diagnosed GBC. Overall survival, disease-free survival (DFS) and the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention were analyzed. The authors also present a systematic review to evaluate the role of extended surgery in the treatment of the incidental GBC.

RESULTS

GBC was diagnosed in 30 patients, 16 women and 14 men. The M/F ratio was 1:1.14 and the mean age was 69.4 years (range 45-83 years). A preoperative diagnosis was possible only in 14 cases; fourteen of the incidental cases were diagnosed postoperatively after the pathological examination; two were suspected intraoperatively at the opening of the surgical specimen and then confirmed by frozen sections. The ratio between incidental and nonincidental cases was 1, 14/1, with twelve cases discovered after laparoscopic cholecystectomy. Eighty-one per cent of the incidental cases were discovered at an early stage (≤II). The preoperative diagnosis of the 30 patients with GBC was: GBC with liver invasion diagnosed by preoperative CT (nine cases); gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum (one case); porcelain gallbladder (three cases); gallbladder adenoma (four cases); and chronic cholecystolithiasis (thirteen cases). Every case, except one, with a T1b or more advanced invasion underwent IVb + V wedge liver resection and pericholedochic/hepatoduodenal lymphoadenectomy. One patient refused further surgery. Cases with Tis and T1a involvement were treated with cholecystectomy alone. Nine of the sixteen patients with incidental diagnosis reached 5-year DFS (56.25%) and eight of them are recurrence free. Surprisingly, one patient reached 38 mo survival despite a port-site recurrence (the only one in our experience) 2 years after the original surgery requiring further resection. Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5 years DFS (Tables 2 and 3).

CONCLUSION

Laparoscopic cholecystectomy does not affect survival if implemented properly. Reoperation should have two objectives: R0 resection and clearance of the lymph nodes.

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Affiliation(s)

Andrea Cavallaro General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy.
Gaetano Piccolo General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy.
Maria Di Vita General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy.
Antonio Zanghì General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy.
Francesco Cardì General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy.
Paolo Di Mattia General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy.
Giuseppina Barbera General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy
Laura Borzì Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Catania, Italy.
Vincenzo Panebianco Department of Surgery, General Surgery Unit, "San Vincenzo" Hospital, Taormina, ME, Italy.
Isidoro Di Carlo Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, Catania, Italy.
Marco Cavallaro Department of Radiology, Radiology Unit, Guzzardi Hospital, Via Papa Giovanni XXIII°, 97019 Vittoria, RG, Italy.
Alessandro Cappellani General Surgery and Senology Unit, Department of Surgery, "Policlinico - Vittorio Emanuele" Hospital, University of Catania Medical School, Via S. Sofia 78, 95123 Catania, Italy.

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Ye LY, Liu DR, Li C, Li XW, Huang LN, Ye S, Zheng YX, Chen L. Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer. J Zhejiang Univ Sci B 2014;14:468-78. [PMID: 23733423 DOI: 10.1631/jzus.b1200197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]

Argon A, Yağcı A, Taşlı F, Kebat T, Deniz S, Erkan N, Kitapçıoğlu G, Vardar E. A different perspective on macroscopic sampling of cholecystectomy specimens. KOREAN JOURNAL OF PATHOLOGY 2013;47:519-25. [PMID: 24421844 PMCID: PMC3887153 DOI: 10.4132/koreanjpathol.2013.47.6.519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/26/2013] [Accepted: 10/28/2013] [Indexed: 02/06/2023]

Goetze TO, Paolucci V. Prognosis of incidental gallbladder carcinoma is not influenced by the primary access technique: analysis of 837 incidental gallbladder carcinomas in the German Registry. Surg Endosc 2013;27:2821-8. [PMID: 23404149 DOI: 10.1007/s00464-013-2819-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/28/2012] [Indexed: 02/06/2023]

Lee HY, Kim YH, Jung GJ, Roh YH, Park SY, Kang NU, Yoon SH, Cho JH, Roh MH, Han SY, Lee SW, Baek YH, Jeong JS. Prognostic factors for gallbladder cancer in the laparoscopy era. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012;83:227-36. [PMID: 23091795 PMCID: PMC3467389 DOI: 10.4174/jkss.2012.83.4.227] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 08/08/2012] [Accepted: 08/23/2012] [Indexed: 02/06/2023]

Cavallaro A, Piccolo G, Panebianco V, Menzo EL, Berretta M, Zanghì A, Vita MD, Cappellani A. Incidental gallbladder cancer during laparoscopic cholecystectomy: managing an unexpected finding. World J Gastroenterol 2012;18:4019-4027. [PMID: 22912553 PMCID: PMC3419999 DOI: 10.3748/wjg.v18.i30.4019] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Revised: 05/22/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open

Abstract

AIM

To evaluate the impact of incidental gallbladder cancer on surgical experience.

METHODS

Between 1998 and 2008 all cases of cholecystectomy at two divisions of general surgery, one university based and one at a public hospital, were retrospectively reviewed. Gallbladder pathology was diagnosed by history, physical examination, and laboratory and imaging studies [ultrasonography and computed tomography (CT)]. Patients with gallbladder cancer (GBC) were further analyzed for demographic data, and type of operation, surgical morbidity and mortality, histopathological classification, and survival. Incidental GBC was compared with suspected or preoperatively diagnosed GBC. The primary endpoint was disease-free survival (DFS). The secondary endpoint was the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention.

RESULTS

Nineteen patients (11 women and eight men) were found to have GBC. The male to female ratio was 1:1.4 and the mean age was 68 years (range: 45-82 years). Preoperative diagnosis was made in 10 cases, and eight were diagnosed postoperatively. One was suspected intraoperatively and confirmed by frozen sections. The ratio between incidental and nonincidental cases was 9/19. The tumor node metastasis stage was: pTis (1), pT1a (2), pT1b (4), pT2 (6), pT3 (4), pT4 (2); five cases with stage Ia (T1 a-b); two with stage Ib (T2 N0); one with stage IIa (T3 N0); six with stage IIb (T1-T3 N1); two with stage III (T4 Nx Nx); and one with stage IV (Tx Nx Mx). Eighty-eight percent of the incidental cases were discovered at an early stage (≤ II). Preoperative diagnosis of the 19 patients with GBC was: GBC with liver invasion diagnosed by preoperative CT (nine cases), gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum (one case), porcelain gallbladder (one case), gallbladder adenoma (one case), and chronic cholelithiasis (eight cases). Every case, except one, with a T1b or more advanced invasion underwent IVb + V wedge liver resection and pericholedochic/hepatoduodenal lymphadenectomy. One patient with stage T1b GBC refused further surgery. Cases with Tis and T1a involvement were treated with cholecystectomy alone. One incidental case was diagnosed by intraoperative frozen section and treated with cholecystectomy alone. Six of the nine patients with incidental diagnosis reached 5-year DFS. One patient reached 38 mo survival despite a port-site recurrence 2 years after original surgery. Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5-year DFS.

CONCLUSION

Laparoscopic cholecystectomy does not affect survival if implemented properly. Reoperation should have two objectives: R0 resection and clearance of the lymph nodes.

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Moisan F, Norero E, Slako M, Varas J, Palominos G, Crovari F, Ibañez L, Pérez G, Pimentel F, Guzmán S, Jarufe N, Boza C, Escalona A, Funke R. Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study. Surg Endosc 2011. [PMID: 22011940 DOI: 10.1007/s00464-011-1933-5.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]

Abstract

INTRODUCTION

The application of laparoscopic gastric surgery has rapidly increased for the treatment of early gastric cancer. However, laparoscopic gastrectomy for advanced tumor remains controversial, particularly in terms of oncologic outcomes. This study was designed to compare 3-year survival of laparoscopic versus open curative gastrectomy in early and advanced gastric cancer.

METHODS

This was a retrospective matched cohort study. We included patients between 2003 and 2010 with an R0 resection. A totally laparoscopic technique was used and D2 lymph node dissection was practiced routinely. We performed an intracorporeal hand-sewn esophagojejunostomy in all laparoscopic total gastrectomy cases. We matched all laparoscopic cases 1:1 with open cases according to TNM AJCC seventh edition. We used Mann-Whitney or t test and Chi-square test to compare both groups. Kaplan-Meier analysis with log-rank test was performed to compare survival.

RESULTS

We included 31 open and 31 laparoscopic cases (mean age 63 ± 14 years; 66% males). Both groups were identical in type of gastrectomy (71% total and 29% subtotal). There were no statistical difference between laparoscopic and open groups in age, sex, N category, tumor location and size, histological differentiation, and T category (48% T1, 13% T2, 16% T3, and 23% T4 in both groups), with 48% early and 52% advanced tumors. The median number of resected lymph nodes was similar: 35 (23-53) for laparoscopic and 39 (23-45) for open cases (P = 0.81). The median follow-up was 50 months. The overall 3-year survival was 82% for laparoscopic surgery and 87% for the open surgery group (P = 0.56). There were no difference in 3-year survival for the laparoscopic versus the open surgery groups for advanced tumors (74 vs. 75%, P = 0.88), N+ tumors (73 vs. 73%, P = 0.99) and for the different AJCC stages (stage 1: 94 vs. 100%, stage 2: 89 vs. 82%, and stage 3: 50 vs. 50%, P = 0.32, 0.83, and 0.98 respectively).

CONCLUSIONS

In this preliminary report, with 52% of advanced tumor, the 3-year overall and stage-by-stage survival was comparable for laparoscopic and open curative gastrectomy.

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Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study. Surg Endosc 2011;26:661-72. [PMID: 22011940 DOI: 10.1007/s00464-011-1933-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 08/08/2011] [Indexed: 12/12/2022]

Abstract

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

In this preliminary report, with 52% of advanced tumor, the 3-year overall and stage-by-stage survival was comparable for laparoscopic and open curative gastrectomy.

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Isambert M, Leux C, Métairie S, Paineau J. Incidentally-discovered gallbladder cancer: When, why and which reoperation? J Visc Surg 2011;148:e77-84. [PMID: 21478068 DOI: 10.1016/j.jviscsurg.2011.02.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]

Gallbladder carcinoma incidentally encountered during laparoscopic cholecystectomy: how to deal with it. Clin Transl Oncol 2011;13:25-33. [DOI: 10.1007/s12094-011-0613-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]

Bucher P, Pugin F, Morel P. Laparoscoendoscopic single-site cholecystectomy and occult gallbladder cancer. Surg Endosc 2010;24:1791-2. [PMID: 20054569 DOI: 10.1007/s00464-009-0843-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]

Glauser PM, Strub D, Käser SA, Mattiello D, Rieben F, Maurer CA. Incidence, management, and outcome of incidental gallbladder carcinoma: analysis of the database of the Swiss association of laparoscopic and thoracoscopic surgery. Surg Endosc 2010;24:2281-6. [PMID: 20177918 DOI: 10.1007/s00464-010-0952-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 01/18/2010] [Indexed: 02/06/2023]

Abstract

BACKGROUND

Little is known about the long-term survival of patients with incidental gallbladder carcinoma (IGBC). The role of radical resection for this disease is discussed controversially in the literature. We present the long-term survival and the results of re-resection versus simple cholecystectomy of the database of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) from 1994 to 2004.

METHODS

Eighty-nine patients with histologically confirmed carcinoma of the gallbladder were identified out of 30,960 patients undergoing laparoscopic cholecystectomy. Sixty-nine patients were included in our study. Long-term survival by different T-stage and comparison of patients with extended resection versus simple cholecystectomy were calculated using the log-rank test. The time-to-event data are demonstrated by Kaplan-Meier curves.

RESULTS

The overall incidence of IGBC in patients who underwent laparoscopic cholecystectomy was 0.28% (89 of 30,960). Fifty patients underwent simple cholecystectomy [n = 2: carcinoma in situ (CIS); n = 2: pT1a; n = 10: pT1b; n = 23: pT2; n = 8: pT3; n = 5: pT4], whereas extended resection was performed in 19 cases (n = 2: pT1b; n = 11: pT2; n = 6: pT3). The comparison of simple cholecystectomy versus extended re-resection of the gallbladder bed and regional lymph node resections showed a significant benefit in overall survival for the pT2 and pT3 group (p < 0.05). The pT1b group showed no significant benefit in overall survival (p = 0.34).

CONCLUSION

IGBC has a low incidence (0.28%). We present a large study of patients with IGBC, comparing the overall survival by different histological findings. We observed a significant benefit for the group with pT2 and pT3. Therefore we recommend extended resection of the gallbladder bed and the regional lymph nodes for patient with incidental histologically confirmed pT2 and pT3 carcinoma of the gallbladder after performance of laparoscopic cholecystectomy. For patients with pT1b stage no recommendations can be given based on this study.

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Goetze TO, Paolucci V. Adequate extent in radical re-resection of incidental gallbladder carcinoma: analysis of the German Registry. Surg Endosc 2010;24:2156-64. [PMID: 20177938 DOI: 10.1007/s00464-010-0914-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 10/09/2009] [Indexed: 12/13/2022]

Abstract

BACKGROUND

Complete surgical resection is the only potentially curative treatment of gallbladder cancer. Gallbladder carcinoma is suspected preoperatively in 30% of patients, and 70% are incidentally discovered by the pathologist (incidental gallbladder carcinoma, IGBC). If IGBC is detected postoperatively, a re-resection, including liver resection and lymph node dissection, in T2 tumor cases and more advanced stages is recommended. It remains unclear whether the prognosis of wedge resection (2-3-cm margin) of the gallbladder bed is the same as that of resection of segments IVb/V.

METHODS

The German Registry, founded in 1997, aims to prospectively record all IGBC cases in Germany. In this study patients with a radical re-resection were treated according to the S3 Guidelines in Germany. The aim of this study was to clarify whether different techniques of liver re-resection show comparable results or if they differ depending on the tumor stage in IGBC patients (n = 624).

RESULTS

A significant survival advantage in patients who have an early re-resection was observed. There was a trend of better survival in T1 tumor stage patients who undergo the less radical re-resection, especially the wedge-resection technique of 3 cm in the gallbladder bed. In T2 tumor stage patients there is a tendency for better survival with the IVb/V-resection technique compared to the 3-cm wedge resection in the gallbladder bed, and a significant survival benefit for these two techniques compared to less radical resection was evident. T3 tumor cases showed better survival with the more radical resection techniques.

CONCLUSIONS

The wedge-resection technique combined with lymph node dissection may be the surgical strategy of choice in T1 tumor cases. For T2 tumors, IVb/V resection combined with lymph node dissection of the hepatoduodenal ligament appears to be the minimum volume of resection required. More radical procedures are needed for tumors infiltrating the serosa or beyond.

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Abramson MA, Pandharipande P, Ruan D, Gold JS, Whang EE. Radical resection for T1b gallbladder cancer: a decision analysis. HPB (Oxford) 2009;11:656-63. [PMID: 20495633 PMCID: PMC2799618 DOI: 10.1111/j.1477-2574.2009.00108.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 05/19/2009] [Indexed: 12/12/2022]

Pilgrim CHC, Usatoff V, Evans P. Consideration of anatomical structures relevant to the surgical strategy for managing gallbladder carcinoma. Eur J Surg Oncol 2009;35:1131-6. [PMID: 19297118 DOI: 10.1016/j.ejso.2009.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 01/24/2009] [Accepted: 02/02/2009] [Indexed: 12/12/2022] Open

Pilgrim C, Usatoff V, Evans PM. A review of the surgical strategies for the management of gallbladder carcinoma based on T stage and growth type of the tumour. Eur J Surg Oncol 2009;35:903-7. [PMID: 19261430 DOI: 10.1016/j.ejso.2009.02.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 12/18/2008] [Accepted: 02/02/2009] [Indexed: 02/06/2023] Open

Yeu KJ, Choi JW, Lee DS, Kim HJ. Should the Extrahepatic Bile Duct be Resected for T2 Gallbladder Cancer? JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.77.2.113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]

Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, Souda H, Gunji H, Miyazaki A, Ikeda A, Matsumoto I. Total laparoscopic resection of the gallbladder together with the gallbladder bed. ACTA ACUST UNITED AC 2008;15:585-8. [PMID: 18987927 DOI: 10.1007/s00534-008-1363-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 03/20/2008] [Indexed: 02/06/2023]

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Recurrence of cholangiogenous carcinoma in port-sites two years after laparoscopic removal of noncancerous gallbladder. Eur J Gastroenterol Hepatol 2008;20:474-7. [PMID: 18403952 DOI: 10.1097/meg.0b013e3282f16421] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]

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Tuveri M, Tuveri A. Isolated metastatic melanoma to the gallbladder: is laparoscopic cholecystectomy indicated?: a case report and review of the literature. Surg Laparosc Endosc Percutan Tech 2007;17:141-4. [PMID: 17450099 DOI: 10.1097/sle.0b013e31803c766a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]

Xu LN, Zou SQ. A clinicopathological analysis in unsuspected gallbladder carcinoma: A report of 23 cases. World J Gastroenterol 2007;13:1857-60; discussion 1860-1. [PMID: 17465481 PMCID: PMC4149967 DOI: 10.3748/wjg.v13.i12.1857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open

Shukla HS, Tewari M. Laparoscopy and gallbladder cancer. J Surg Oncol 2007;96:91-2. [PMID: 17458907 DOI: 10.1002/jso.20809] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]