Incidental gallbladder cancer: Analysis of surgical findings and survival

Butte, Jean M.; Waugh, Enrique; Meneses, Manuel; Parada, Hugo; Fuente, Hernán A. De La

doi:10.1002/jso.21681

Cited by 55 publications

(56 citation statements)

References 19 publications

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“…Despite rigorous restaging using cross-sectional imaging and laparoscopy, inoperable disease is diagnosed at either restaging or re-exploration in 24-60.3% of cases. 12,13,16 Consequently, unnecessary exploratory laparotomies are performed frequently and are known to have a detrimental impact on survival. 17,18 Positive resection margins after the index cholecystectomy, depth of invasion, lymphatic invasion, bile spillage and a poorly differentiated tumour have been associated previously with dissemination of IGBC.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 However, the index cholecystectomy more often than not complicates the management of these patients and nearly half of them do not undergo radical resection owing to disseminated disease. 11,13 First, the depth of invasion through the dissection plane during cholecystectomy and the commonly misleading inflammation may result in incomplete resection or a breach of the tumour plane with occult or overt seeding during the initial operation. 14,15 Second, the initial pathological staging can be inaccurate because of missing information such as invasion of the cystic artery lymph node and the cystic duct margin.…”

mentioning

confidence: 99%

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Implications of the Index Cholecystectomy and Timing of Referral for Radical Resection of Advanced Incidental Gallbladder Cancer

Tsirlis

Ausania

White

et al. 2015

annals

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INTRODUCTION Advanced (pT2/T3) incidental gallbladder cancer is often deemed unresectable after restaging. This study assesses the impact of the primary operation, tumour characteristics and timing of management on re-resection. METHODS The records of 60 consecutive referrals for incidental gallbladder cancer in a single tertiary centre from 2003 to 2011 were reviewed retrospectively. Decision on re-resection of incidental gallbladder cancer was based on delayed interval restaging at three months following cholecystectomy. Demographics, index cholecystectomy data, primary pathology, CA19-9 tumour marker levels at referral and time from cholecystectomy to referral as well as from referral to restaging were analysed. RESULTS Thirty-seven patients with pT2 and twelve patients with pT3 incidental gallbladder cancer were candidates for radical re-resection. Following interval restaging, 24 patients (49%) underwent radical resection and 25 (51%) were deemed inoperable. The inoperable group had significantly more patients with positive resection margins at cholecystectomy (p=0.002), significantly higher median CA19-9 levels at referral (p=0.018) and were referred significantly earlier (p=0.004) than the patients who had resectable tumours. On multivariate analysis, urgent referral (p=0.036) and incomplete cholecystectomy (p=0.048) were associated significantly with inoperable disease following restaging. CONCLUSIONS In patients with incidental, potentially resectable, pT2/T3 gallbladder cancer, inappropriate index cholecystectomy may have a significant impact on tumour dissemination. Early referral of breached tumours is not associated with resectability.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Implications of the Index Cholecystectomy and Timing of Referral for Radical Resection of Advanced Incidental Gallbladder Cancer

Tsirlis

Ausania

White

et al. 2015

annals

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“…However, major resection does not improve survival over nonanatomical liver resection and only increases the risk of postoperative complications [54,55]. Furthermore, major hepatectomies are associated with higher morbidity rates than partial hepatectomies are, with no added survival beneit [56][57][58]. Therefore, achieving R0 with limited liver resection and fewer complications is the recommended procedure for GBC [26,41].…”

Section: Updates In Gallbladder Diseasesmentioning

confidence: 99%

Incidental Gallbladder Cancer

Al-Alem¹,

Mattar²,

Madkhali³

et al. 2017

Updates in Gallbladder Diseases

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Gallbladder cancer (GBC) is a rare but fatal disease with an incidence of less than 5000 new cases per year in the United States. Less than 20% of GBC cases are diagnosed preoperatively. The remaining cases are diagnosed either after laparoscopic cholecystectomy or intraoperatively. GBC is discovered incidentally during histopathology following 0.25-3.0% of laparoscopic cholecystectomies; however, this constitutes 74-92% of all GBC. The most pivotal and important step is accurate patient staging. Staging dictates disease management and treatment options and predicts survival. Because of the fatality of GBC and its poor prognosis, atempts of curative surgery are limited to localized resectable disease.

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“…Zaawansowanie TNM i czas rozpoznania determinują odpowiedni sposób postepowania u chorych na GBC [4,6]. Jedynym potencjalnie leczącym sposobem postępowania w GBC jest radykalna resekcja [3,6,7].…”

Section: Wprowadzenieunclassified

“…Chemioterapia i radioterapia są nieskuteczne jako leczenie pierwotne, jedynym potencjalnie leczącym sposobem postępo-wania pozostaje resekcja chirurgiczna R0 [3,[6][7][8]. Choroba przebiega w sposób bezobjawowy, najczęściej wykrywana jest przypadkowo w trakcie cholecystektomii laparoskopowej z powodu kamicy żółciowej [3,6].…”

Section: Omówienieunclassified

Chirurgiczne leczenie chorych na raka pęcherzyka żółciowego: doświadczenia własne na podstawie 16 przypadków

Stojčev¹,

Maliszewski²,

Pytka³

et al. 2013

Nowotwory. Journal of Oncology

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Wprowadzenie. Rak pęcherzyka żółciowego (gallbladder cancer -GBC) jest piątym z kolei, najczęstszym rakiem w obrębie przewodu pokarmowego. Celem naszego badania było określenie właściwej rozległości leczenia chirurgicznego u chorych na raka pęcherzyka żółciowego w zależności od wielkości guza pierwotnego, określenie właściwego postępowania z przewodem żółciowym wspólnym, zakresu resekcji wątroby i usunięcia węzłów chłonnych. Materiał i metody. Badanie przeprowadzono w oparciu o ocenę grupy 16 chorych operowanych z powodu raka pęcherzyka żółciowego w Oddziale Chirurgii Onkologicznej Wojewódzkiego Szpitala Specjalistycznego im. Janusza Korczaka w Słupsku w latach 2006-2009. Wyniki. Średni wiek w badanej grupie 16 chorych na raka pęcherzyka żółciowego wynosił 67 (55-87) lat. Było 15 kobiet i 1 mężczyzna. U 15 chorych stwierdzono kamicę żółciową, 1 miał pęcherzyk porcelanowy. Badana grupa stanowiła 1% chorych, u których wykonano cholecystektomię. Badanie histopatologiczne u 14 chorych wykazało obecność adenocarcinoma, u 1 -carcinoma mucinosum, a u 1 -oba te utkania. Cechę G1 stwierdzono u siedmiu chorych, G2 -u pięciu, G3 -u czterech. Cechę T1 stwierdzono u pięciu chorych (T1a u 4 i T1b -u 1), cechę T2 -u trzech, T3 -u siedmiu i T4 -u jednego. Dziesięciu chorych zakwalifi kowano do rozszerzenia resekcji (4 konwersje, 6 relaparotomii). Cechę N1 stwierdzono u sześciu chorych, M1 synchronicznie -u dziesięciu, metachronicznie -u czterech. 5-letnie przeżycie obserwowano u 3/16 (18%) chorych, średni okres przeżycia wyniósł 6 miesięcy. Podsumowanie. Podstawowym zadaniem operacyjnego leczenia chorych na raka pęcherzyka żółciowego jest osią-gnięcie resekcji R0. Powtórne wkroczenie i poszerzenie zakresu resekcji jest wskazane we wszystkich guzach ≥ pT1b (pT1a+); grupa o zaawansowaniu T4 wymaga indywidualnych decyzji. W większości przypadków wystarczającym zakresem leczenia operacyjnego jest resekcja klinowa wątroby i regionalna limfadenektomia; nie stwierdzono korzyści w postaci dłuższego przeżycia po resekcji przewodu żółciowego wspólnego i żyły wrotnej. Surgical treatment of gallbladder carcinoma: clincal study of 16 cases and a literature reviewIntroduction. Gallbladder cancer (GBC) is the fi fth most common cancer involving the gastrointestinal tract. The aim of our study was to determinate the proper extent of surgical treatment in patients with GBC according to extent of the tumor (T) and to determine the exact common bile duct management and extent of hepatectomy and lymph node resection. Material and methods. We examined 16 patients operated on for GBC in the Surgical Oncology Department of Janusz Korczak Provincial Specialist Hospital in Slupsk between 2006 and 2009. Results. In the 16 patients operated on for GBC, the median age was 67 (55-87). In this group there was 1 man and 15 women. With regard to symptoms, in 15 patients gallstones were present, in 3 porcelain gallbladder. 1% of all choleocystectomy was GBC. With regard to histology there were 14 -adenocarcinoma, 1 -mucinous carcinoma, 1 -adenocarcinoma + muci...

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Incidental gallbladder cancer: Analysis of surgical findings and survival

Abstract: Patients with IGBCA have a high chance of intra-abdominal metastases or local residual disease. In CRC patients, intra-abdominal metastases were associated with a worse prognosis.

Cited by 55 publications

References 19 publications

Implications of the Index Cholecystectomy and Timing of Referral for Radical Resection of Advanced Incidental Gallbladder Cancer

Implications of the Index Cholecystectomy and Timing of Referral for Radical Resection of Advanced Incidental Gallbladder Cancer

Incidental Gallbladder Cancer

Chirurgiczne leczenie chorych na raka pęcherzyka żółciowego: doświadczenia własne na podstawie 16 przypadków

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