Does laparoscopy worsen the prognosis for incidental gallbladder cancer?

Goetze, Thorsten Oliver; Paolucci, V.

doi:10.1007/s00464-005-0121-x

Cited by 67 publications

(48 citation statements)

References 29 publications

(46 reference statements)

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“…Incidental GBC are usually early stage (T1) tumors (21). Their prognosis is better than GBCs with peroperative diagnosis (18), usually with a lower histologic grade (13,22). In our study, laparoscopic surgery was planned in all cases, and when patients with conversion to open surgery were compared with the remaining patients no significant poor prognostic factors were identified.…”

Section: Discussionmentioning

confidence: 74%

Incidental gallbladder cancers: Our clinical experience and review of the literature

Düzköylü

Bektaş

Kozluklu

2016

UCD

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Objective: Gallbladder carcinomas are rare and aggressive neoplasms. They are usually advanced at the time of diagnosis. We aimed to evaluate incidental gallbladder cancers in our clinic, in terms of patients' demographics, diagnosis, treatment and follow-up, and compared our results with the literature. Material and Methods:Patients who underwent laparoscopic cholecystectomy in the last 9 years were retrospectively reviewed, and features of the patients diagnosed with gallbladder cancer after histopathological evaluation were further evaluated.Results: Thirteen patients were female and two were male. The mean age was 67 years. Additional treatment was applied in seven patients. All patients were operated on laparoscopically, with conversion to open surgery in four patients. The rate of incidental gallbladder cancer was 0.17% in our patients. Survival rates were found to be 22.2% in patients who had been operated at least 5 years ago. Conclusion:Surgery is the only curative treatment in gallbladder cancers; however, they are usually at advanced stages at the time of diagnosis. In incidental gallbladder cancers, survival can be prolonged with appropriate treatment models if they are identified at early stages. The relatively low rates that have been reported in our population may be due to geographical differences and problems in study design. Keywords: Incidental, gallbladder, cancer INTRODUCTIONLaparoscopic cholecystectomy is accepted as the gold standard for the treatment of benign gallbladder diseases in the world due to reduced postoperative pain, early oral intake, early discharge and better cosmetic results for the last 20 years, and is being implemented with low morbidity. There has not been a significant increase in the early detection rate of gallbladder cancer (GBC), which remains asymptomatic in early stages, despite advances in technology and widespread use of techniques such as ultrasound (US) and abdominal computed tomography (CT), with an incidence of 0,54-2,1% (1, 2). Overall, there is preoperative suspicion of GBC in only 30% of patients, while the remaining 70% are diagnosed in the postoperative pathologic examinations (3). In other words, in the literature it has been proven that 1 cancer is detected out of every 100 laparoscopic cholecystectomies (4). Maximillian Stoll has mentioned GBC for the first time in Vienna in 1777 (5). After many years, Nevin et al. (6) has defined the first GBC staging and survival rates after open cholecystectomy. Drouard et al. (7) showed port site metastases in 1991. Gallbladder cancer is a very aggressive disease, with a 5-year survival rate of 3-13% (8), and a mean survival of 3-11 months (9). However, especially with aggressive surgical approaches applied in some centers in Japan, satisfactory results can be obtained (10). The underlying cause of this rate is the too late emergence of symptoms such as pain and jaundice (6), and advanced stage on diagnosis (T3, T4).Incidental GBC refers to cancers that were not diagnosed preoperatively but detected by postoper...

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Section: Discussionmentioning

confidence: 74%

Incidental gallbladder cancers: Our clinical experience and review of the literature

Düzköylü

Bektaş

Kozluklu

2016

UCD

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“…Several in vivo studies have also shown that laparoscopy with carbon dioxide insufflations seems to stimulate the growth of dormant tumor cells into overt liver metastases (Gutt et al, 2001;Kim et al, 2002). However, some studies in colon and gallbladder cancer refuted this risk (Kim et al, 1998;Goetze and Paolucci, 2006). Regard to these results, the possibility of peritoneal or port site seeding of malignant cells remains unknown.…”

Section: Discussionmentioning

confidence: 93%

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Liu

et al. 2013

J. Zhejiang Univ. Sci. B

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Abstract:Objective: The study compared laparoscopy-assisted gastrectomy (LAG) with open gastrectomy (OG) in the management of advanced gastric cancer (AGC). Methods: Literature search was performed in the Medline, Embase, and Cochrane Library databases to identify control studies that compared LAG and OG for AGC. A meta-analysis was conducted to examine the surgical safety and oncologic adequacy, using the random-effect model. Results: Seven eligible studies including 815 patients were analyzed. LAG was associated with less blood loss, less use of analgesics, shorter time of flatus and periods of hospital stay, but longer time of operation. The incidence of most complications was similar between the two groups. However, LAG was associated with a lower rate of pulmonary infection (odds ratio (OR) 0.19; 95% confidence interval (CI) 0.05 to 0.68; P<0.05). No significant differences were noted in terms of the number of harvested lymph nodes (weighted mean difference (WMD) 1.165; 95% CI −2.000 to 4.311; P>0.05), overall mortality (OR 0.65; 95% CI 0.39 to 1.10; P>0.05), cancer-related mortality (OR 0.64; 95% CI 0.32 to 1.25; P>0.05), or recurrence (OR 0.62; 95% CI 0.33 to 1.16; P>0.05). Conclusions: LAG could be performed safely for AGC with adequate lymphadenectomy and has several short-term advantages compared with conventional OG. No differences were found in long-term outcomes. However, these results should be validated in large randomized controlled studies (RCTs) with sufficient follow-up.

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“…It should be emphasized how the prognosis of an incidental cancer, although better than preoperative suspected one, it is still modest: reported survivals at 5 years in the literature are, respectively, 35% vs. 5%, with a median of 26.5 vs. 9.2 months in suspected cases [1].…”

Section: Discussionmentioning

confidence: 97%

“…Gallbladder adenocarcinoma is a rare tumor, but it's burdened by a poor prognosis: long-term survival reported in literature is about 5% at 5 years [1]. Currently, about two thirds of cases are an incidental finding after the removal of the gallbladder for a benign disease [2].…”

Section: Introductionmentioning

confidence: 99%

Radical Surgery for Incidental Gallbladder Carcinoma. Which Subset of Patients is Really Suitable for?

Balcet¹,

Bossotti²,

Paolis³

2015

J Gastrointest Dig Syst

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Background: There is a wide consensus on the fact that surgical treatment of incidental gallbladder carcinoma should be based according to T stage: while simple cholecystectomy is considered an adequate treatment for confined carcinomas to the lamina propria (T1a), it is still being discussed in the case of cancer limited to muscularis mucosae (T1b), and a secondary extended resection is the only curative option for tumors invading the perimuscolar connective tissue (T2), and seems to improve survival in selected advanced cases. However, it is still not clear which subset of patients is really suitable for aggressive reoperations, and their effective impact on the prognosis of incidental neoplasm. The purpose of this study is to evaluate these aspects in a retrospective review of gallbladder carcinomas diagnosed during or after 9284 cholecystectomies performed with a benign indication.

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Does laparoscopy worsen the prognosis for incidental gallbladder cancer?

Abstract: The life expectancy is higher for the laparoscopically treated patients and this cannot be explained by the fact that the laparoscopic technique is used to treat the earlier stages of cancer. The access technique does not seem to influence the prognosis for gallbladder carcinomas.

Cited by 67 publications

References 29 publications

Incidental gallbladder cancers: Our clinical experience and review of the literature

Incidental gallbladder cancers: Our clinical experience and review of the literature

Systematic review of laparoscopy-assisted versus open gastrectomy for advanced gastric cancer

Radical Surgery for Incidental Gallbladder Carcinoma. Which Subset of Patients is Really Suitable for?

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