Brazilian Consensus on Incidental Gallbladder Carcinoma

Abstract

Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

What’s New in Infection on Surgical Site and Antibioticoprophylaxis in Surgery?

“…Antibiotic prophylaxis does not replace any of the other preventive care of SSI and should not be seen in isolation in preventing it, but rather as part of a set of factors based on both the patient and the surgical procedures. Examples of the former may be extremes of age, immunosuppression, diabetes mellitus 12 , perioperative glycemic control, chronic disease 14 , smoking, prolonged hospitalization, MRSA (methicillin-resistant Staphylococcus aureus ) colonization, coexisting infections in other locations, poor nutritional status or obesity. Factors inherent to the procedures include skin antisepsis, correct surgical technique, adequate hemostasis, maintenance of body temperature, operating time, sterilization of surgical materials and equipment, and positive pressure ventilation in the operating room 13 , 17 , 26 .…”

Incidental Gallbladder Carcinoma in North Indian Population: Importance of Routine Histopathological Examination of All Benign Gallbladder Specimens

“…The association of wall thickness with pathological stages IGBC is defined as carcinoma of gallbladder diagnosed first time on histopathological examination after cholecystectomy done for benign gallbladder disease without clinico-radiological and intraoperative suspicion of malignancy [4,5]. The incidence of IGBC is reported to be 0.2% to 3.3% of all cholecystectomies specimen of benign gallbladder disease [5,6,[8][9][10][11]. This range is due to the geographical and racial heterogenous distribution of gallbladder malignancies worldwide [3].…”

“…Incidental gallbladder carcinoma (IGBC) is defined as cancer discovered at the time of histopathological examination of the specimen after cholecystectomy done for benign gallbladder disease without clinicoradiological and intraoperative suspicion of malignancy [1,5]. Studies have shown that the incidence of IGBC ranges from 0.2% to 3.3% in all cholecystectomies specimen of benign disease [6].…”

“…Keeping in view the incidence of IGBC, every cholecystectomy specimen should be sent for histopathological examination to increase the detection rate of occult early-stage IGBC in benign gallbladder diseases [7]. IGBC has a good prognosis, prolonged survival and potentially curable disease with an adaptation of adequate surgical strategy as compared to non-incidental or primary gallbladder carcinoma [3,5,7]. The use of routine or selective histopathological examination of gallbladder specimens is still debatable.…”

Is There a Clinical Pathological Correlation of Colorectal Adenocarcinoma With the Immunohistochemical Expression of Opn and Abcb5?

“…Minimally invasive blood markers have gained importance due to the facility for screening and monitoring patients 3 , 4 , 14 . The carcinoembryonic antigen (CEA) is the most used in CCR, however its serum value may suggest, but not confirm the diagnosis or metastasis of cancer 20 , 14 .…”