Evaluation of surgical treatment for incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy: single center results

Abstract

BackgroundLaparoscopic cholecystectomy (LC) is the accepted standard management for benign gallbladder disease. LC rarely results in a diagnosis of incidental gallbladder carcinoma (IGBC). The aim of our study was to report our experience with IGBC diagnosed during or following LC.MethodsBetween January 2008 and January 2015, 352 patients underwent LC at Iwakuni Clinical Center. Among these patients, 8 (2.3%) were diagnosed with IGBC. We evaluated their characteristics, surgical related variables, histopathological findings and surgical outcomes.ResultsPatient median age was 71 (range 49–88) years, and 3 out of 8 were female. All patients with IGBC were Japanese. The grade of cancer was as follows: pT1a (3 cases), pT2 (4 cases) and pT3 (1 case). Two patients with pT2 disease underwent radical surgery. The median follow-up time of these patients was 24 (range 11–80) months. All patients are still alive and two of three patients who refused radical surgery have developed recurrence (liver metastases and recurrence in the peritoneum).ConclusionsAlthough the number of cases was small, the results of this study further support the suggestion that gallbladder carcinoma may be curable if diagnosed as IGBC at an early stage. If the cancer has reached an advanced stage, radical surgery should be performed.

Relationship between clinical and histopathological features of patients undergoing cholecystectomy

“…Only 30% of gallbladder cancers are suspected preoperatively, and the remaining 70% are incidentally diagnosed during or after surgery by pathological diagnosis. The estimated incidence of cancer diagnosis after cholecystectomy is around 1-2% [27,28]. This rate was found to be 0.6% in our study.…”

“…Gallbladder cancer is rare, aggressive, and causes higher mortality. It is the fifth most common of the gastrointestinal tumours [27]. Only 30% of gallbladder cancers are suspected preoperatively, and the remaining 70% are incidentally diagnosed during or after surgery by pathological diagnosis.…”

“…There is consensus that simple cholecystectomy or LC is adequate for pT1a tumours. Tumours at pT2 and higher stages require additional radical surgery, such as a hepatic S4a + S5 resection and hepatic pedunculated lymphadenectomy [27,29,30].…”

Analysis of Incidental Gallbladder Cancer in Cholecystectomies

“…It should also be noted that the socioeconomic level in the region where Tatli et al conducted their study is relatively low. It is seen that IGBC rates are generally higher in Asian studies [13]. We believe that the higher rates of GBCs reported in the studies conducted in Asia are probably due to dietary habits and environmental conditions.…”

“…In our study, the numbers of GBC and IGBC were found to be two (0.03%) and seven (0.11%), respectively, whilst the total number was nine (0.14%). The number of IGBCs was reported to be seven (2.05%) in 341-case series by Tatli et al, 20 (0.41%) in 4800-case series by Jha et al, eight (2.3%) in 352case series by Utsumi et al, and six (0.15%) in 4024-case cholecystectomy series by Patel et al [6,[12][13][14]. In the study conducted by Patel et al, the number of cases was 4024, being 6314 in our study, whereas the IGBC rates in both studies are close to each other.…”