Incidental gallbladder cancer after cholecystectomy: 1990 to 2014

Abstract

IntroductionCancer of the gallbladder is a serious diagnostic and therapeutic problem. According to the literature, 30% of cases are not confirmed before surgery. Other cases are detected incidentally by histopathology. Clinical trials and meta-analyses show that incidental gallbladder cancer (iGBC) occurs in 0.19%–2.8% of patients after cholecystectomy. The aim of this study was to analyze the incidence and severity of iGBC in cholecystectomy procedures performed in the surgical department at the 4th Military Teaching Hospital in Wroclaw during the years 1990–2014.Patients and methodsIn the years 1990–2014, a total of 7,314 cholecystectomies were performed in the surgical department because of cholecystolithiasis: 6,145 were performed using the laparoscopic approach (84.02%), 867 were performed as open surgery (11.8%), and 302 cases required conversion (5.1%). In this group, 5,214 of the patients were females (71.3%) and 2,100 were males (28.7%), with an average age of 54.7 years.ResultsWe found 64 iGBC cases which were confirmed by histopathology. This represented 0.87% of all cases. In this group, 50 patients were females (78.1%) and 14 were males (21.8%), with an average age of 67.1 years. Of this group, 40 patients underwent a classic cholecystectomy, while 24 underwent laparoscopic procedures, out of which 13 cases ultimately required traditional surgery. The histopathology showed 15 carcinomas that were classified as G1 (23.4%), 28 were G2 (43.75%), and 21 were G3 (32.8%).ConclusioniGBC detected after a cholecystectomy due to cholecystolithiasis is a rare disease. We found iGBC in 0.87% of cases, which is on a comparable scale to the world literature. In the case of cancer, we frequently found it necessary to convert to an open surgical procedure. This cancer is more common in females and in people over 60 years of age.

Accuracy of Ultrasound in Diagnosing Gallbladder Polyps at a Community Hospital

“…Most studies report the incidence rate of gallbladder cancer after any cholecystectomy as < 1%; however, the incidence of cancer in cholecystectomy performed in patients with a gallbladder polyp can be as high as 6%. 13 , 14 As the surgical community becomes more experienced and comfortable with laparoscopic cholecystectomy and with the implementation of the “critical view of safety,” the occurrence of common bile duct injuries has become exceedingly rare. Recent large retrospective reviews of elective cholecystectomies performed over the last two decades have reported biliary injuries to occur between 0.08 – 0.22% of cases.…”

When should gallbladder polyps be treated surgically?

“…They performed 7,314 cholecystectomies (1990-2014) and found among them 84 cases (0.87%) of incidental gallbladder carcinoma. 13…”

Complete laparoscopic radical resection of hilar cholangiocarcinoma: technical aspects and long-term results from a single center.

“…As shown in previous studies [ 24 , 25 ], approximately 0.2–3.3% of patients were found to be gallbladder cancer positive postoperatively after laparoscopic cholecystectomy. Moreover, 50% of gallbladder cancers are diagnosed incidentally [ 26 ]. Although their number is not large, the risk of PSM in these patients is estimated to be up to 14–30% [ 27 ].…”