Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2015; 21(4): 1315-1323
Published online Jan 28, 2015. doi: 10.3748/wjg.v21.i4.1315
Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: A systematic review and meta-analysis
Kui Sun Choi, Sae Byeol Choi, Pyoungjae Park, Wan Bae Kim, Sang Yong Choi
Kui Sun Choi, Sae Byeol Choi, Pyoungjae Park, Wan Bae Kim, Sang Yong Choi, Department of Surgery, Korea University College of Medicine, Seoul 152-703, South Korea
Author contributions: Choi SB, Choi SY and Choi KS acquisition of data; Choi SB and Choi KS analysis and interpretation of data; Choi SB, Park P and Kim WB drafting the article or revising it critically for important intellectual content; Choi SB, Choi KS and Choi SY final approval of the version to be published.
Supported by Faculty research grant of Korea University No. K1300131.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sae Byeol Choi, MD, PhD, Department of Surgery, Korea University College of Medicine, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul 152-703, South Korea. csbroad@hanmail.net
Telephone: +82-2-26263080 Fax: +82-2-26261148
Received: June 2, 2014
Peer-review started: June 3, 2014
First decision: July 9, 2014
Revised: July 23, 2014
Accepted: September 18, 2014
Article in press: September 19, 2014
Published online: January 28, 2015
Processing time: 238 Days and 19.8 Hours
Abstract

AIM: To perform a systematic review of incidental or unsuspected gallbladder (GB) cancer diagnosed during or after cholecystectomy.

METHODS: Data in PubMed, EMBASE, and Cochrane Library were reviewed and 26 publications were included in the meta-analysis. The inclusion criterion for incidental GB cancer was GB cancer diagnosed during or after cholecystectomy that was not suspected at a preoperative stage. Pooled proportions of the incidence, distribution of T stage, and revisional surgery of incidental GB cancer were analyzed.

RESULTS: The final pooled population comprised 2145 patients with incidental GB cancers. Incidental GB cancers were found in 0.7% of cholecystectomies performed for benign gallbladder diseases on preoperative diagnosis (95%CI: 0.004-0.012). Nearly 50% of the incidental GB cancers were stage T2 with a pooled proportion of 47.0% (95%CI: 0.421-0.519). T1 and T3 GB cancers were found at a similar frequency, with pooled proportions of 23.0% (95%CI: 0.178-0.291) and 25.1% (95%CI: 0.195-0.317), respectively. The pooled proportion that completed revisional surgery for curative intent was 40.9% (95%CI: 0.329-0.494). The proportion of patients with unresectable disease upon revisional surgery was 23.0% (95%CI: 0.177-0.294).

CONCLUSION: A large proportion of incidental GB cancers were T2 and T3 lesions. Revisional surgery for radical cholecystectomy is warranted in T2 and more advanced cancers.

Keywords: Gallbladder cancer; Laparoscopic surgery; Cholecystectomy; Revisional surgery; Incidental diagnosis

Core tip: A low incidence of gallbladder (GB) cancer was diagnosed incidentally during or after cholecystectomy. In incidental GB cancers, revisional surgery for radical resection is inevitable. This systematic review provides clinical information of incidental GB cancers based on a relatively large number of patients. Approximately three-quarters of incidental GB cancers were T2 and more advanced cancers. Therefore, a large proportion of the patients with incidental GB cancers required revisional surgery to achieve R0 resection. However, more than 20% of patients demonstrated unresectable disease when revisional surgery was attempted. Therefore, additional imaging studies are necessary in patients with GB cancers diagnosed following cholecystectomy.