Incidental Gallbladder Cancer on Cholecystectomy: Strategy for Re-resection of Presumed Benign Diseases from a Retrospective Multicenter Study by the Yokohama Clinical Oncology Group

Matsuyama, Ryusei; Matsuo, Keitaro; Mori, Rintaro; Sugita, Mitsutaka; Yamaguchi, Naotaka; Kubota, Takeshi; Kameda, Kunio; Mochizuki, Yoshinari; Takagawa, Ryo; Kadokura, Toshiaki; Matsuda, Goro; Kamiya, Noriyuki; Endo, Itaru

doi:10.21873/invivo.12372

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…The present study confirms that referral to a tertiary care centre is an important factor associated with survival benefit for patients eligible for re-resection 3 , 6 , 7 , 20 , 21 . All patients with iGBC who are eligible for re-resection must be referred to a tertiary care centre for further evaluation.…”

Section: Discussionsupporting

confidence: 87%

Referral rate of patients with incidental gallbladder cancer and survival: outcomes of a multicentre retrospective study

van Dooren,

de Savornin Lohman,

van der Post

et al. 2024

BJS Open

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Background Treatment outcomes of incidental gallbladder cancer generally stem from tertiary referral centres, while many patients are initially diagnosed and managed in secondary care centres. Referral patterns of patients with incidental gallbladder cancer are poorly reported. This study aimed to evaluate incidental gallbladder cancer treatment in secondary centres, rates of referral to tertiary centres and its impact on survival. Methods Medical records of patients with incidental gallbladder cancer diagnosed between 2000 and 2019 in 27 Dutch secondary centres were retrospectively reviewed. Patient characteristics, surgical treatment, tumour characteristics, referral pattern and survival were assessed. Predictors for overall survival were determined using multivariable Cox regression. Results In total, 382 patients with incidental gallbladder cancer were included. Of 243 patients eligible for re-resection (pT1b–pT3, M0), 131 (53.9%) were referred to a tertiary centre. The reason not to refer, despite indication for re-resection, was not documented for 52 of 112 non-referred patients (46.4%). In total, 98 patients underwent additional surgery with curative intent (40.3%), 12 of these in the secondary centre. Median overall survival was 33 months (95% c.i. 24 to 42 months) in referred patients versus 17 months (95% c.i. 3 to 31 months) in the non-referred group (P = 0.019). Referral to a tertiary centre was independently associated with improved survival after correction for age, ASA classification, tumour stage and resection margin (HR 0.60, 95% c.i. 0.38 to 0.97; P = 0.037). Conclusion Poor incidental gallbladder cancer referral rates were associated with worse survival. Age, performance status, resection margin or tumour stage should not preclude referral of a patient with incidental gallbladder cancer to a tertiary centre.

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Section: Discussionsupporting

confidence: 87%

Referral rate of patients with incidental gallbladder cancer and survival: outcomes of a multicentre retrospective study

van Dooren,

de Savornin Lohman,

van der Post

et al. 2024

BJS Open

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“…2) were able to correctly define true iGBC (Question 24). ►Supplementary Table 3 describes the inci-dence of iGBC and knowledge and practices of management of these cases among the responding surgeons (Questions 19 and [25][26][27][28][29]. When asked about the survival of a patient in whom no reoperation was done for iGBC (Question 30), the median longest survival reported was 4.5 years (mean: 3.3. years; range: 2 months to 20 years).…”

Section: Resultsmentioning

confidence: 99%

“…25 In a recent study, bile spillage at prior cholecystectomy was an independent factor associated with a poor prognosis on multivariate analysis. 26 Bile spill has been shown to shorten the disease-free survival as well as overall survival in many studies 27,28 hence, utmost care should be taken to prevent it and in case bile spill has occurred, it should always be mentioned in the operative findings by the surgeon, as it helps in further decision making, management, and prognosticating the patients. Thirteen percent of the respondents did not find it important to mention bile spillage in the operative findings, while most (87%) respondents recorded a bile spill; only about 1/2 to 2/3rd recorded the use of bag and the port of extraction in their operation notes.…”

Section: Discussionmentioning

confidence: 99%

Practices in the Management of Incidental Gallbladder Cancer

Varshney,

Nagar,

Sarin

et al. 2023

South Asian J Cancer

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Background Histopathology of gallbladder removed for stones may reveal incidental gallbladder cancer (iGBC). We conducted this online e-survey to document the knowledge and practices of management of iGBC among surgeons in India. Methods A 38-question online e-survey Results Two-hundred thirty responses were recorded. Ninety-eight out of two-hundred (49%) responses were general surgeons. Two-hundred ten out of two-hundred twenty-one (95%) saw at least one iGBC per year, but only 74/225 (32%) correctly defined true iGBC. One-hundred seventy-eight out of two hundred twenty-two (80%) did computed tomography/magnetic resonance imaging for thick-walled gallbladder (GB) detected on ultrasound, while 25/222 (11%) did laparoscopic cholecystectomy and 14/222 (6%) did open cholecystectomy. For GB mass on laparoscopy, 16/222 (7%) responses went ahead with simple cholecystectomy. Seventy-four out of two-hundred twenty-five (32%) responses routinely used bag while extracting GB. One-hundred ninety-one out of two-hundred twenty-five (86%) mentioned about stone/bile spill, 121/220 (55%) mentioned about use of bag for extraction while 137/220 62% mentioned port used for extraction of GB in operation notes. One-hundred sixty-six out of two-hundred twenty-seven (73%) always cut open GB after cholecystectomy. On encountering a mass/lesion on cut open GB, 111/225 (49%) sent it for frozen section, 89/225 (40%) sent for routine histopathology while 10% (22/225) directly proceeded for extended cholecystectomy. Ten out of two-hundred twenty-seven (4.4%) did not consider it important to send GB for histopathology. T stage on histopathology is most important factor for deciding reoperation by 205/223 (91%). Conclusion There are lacunae in understanding and deficiencies in management of iGBC in India—a high GBC incidence country. The situation is likely to be worse in low GBC incidence areas. There is need for more awareness and knowledge for proper management of iGBC among surgeons.

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“…In our study, 6 patients (35.29%) had reached Tis/T1 stage, and 11 patients were (64.71%) T2, T3, and T4, respectively. At the same time, we collected data from other countries and regions and placed them in Table 4 [7,[11][12][13][14][15][16][17] . Worldwide, a total of 373 patients with uGBC were identi ed, including 121 patients (32.44%) with Tis/T1 stage and 252 patients (67.56%) with T2, T3, and T4 stages.…”

Section: The Stage Of Ugbc At Diagnosismentioning

confidence: 99%

"Unexpected gallbladder cancer" -- was it really an accident?

Sun

Xiang

Cheng

et al. 2023

Preprint

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Background Gallbladder cancer (GBC) is a rare malignant disease. Unexpected gallbladder cancer (uGBC) is a kind of gallbladder cancer diagnosed in a special way that was previously thought to have a good prognosis that is now controversial. The proportion of uGBC, even the terminal stage in GBC, has increased dramatically, but this phenomenon has not received enough attention. Methods Data from all patients with GBC who underwent surgery at the Department of General Surgery of Xinhua hospital between January 1, 2018, and June 30, 2021, were collected. Demographics and clinical and pathological data of patients were analyzed. Prognosis was calculated by the Kaplan–Meier method. A Cox proportional hazards model was used to determine the effect on uGBC of common factors such as age and sex. Results Multivariate Cox regression analysis indicated that American Joint Committee on Cancer (AJCC) stage, CA125 level, and CA199 level were significantly correlated with worse overall survival (OS) (HR = 5.486, 95% CI: 1.165-25.824, P = 0.031, HR = 1.005, 95% CI: 1.001-1.010, P = 0.048 and HR = 1.004, 95% CI: 1.002-1.009, P = 0.0336). uGBC was not an independent prognostic factor (p=0.728). The best cutoff values of serum CA125 and CA199 were 15.59 and 41.20, respectively. The KM curve showed that high expression levels of CA125 (p=0.023) and CA199 (p=0.037) predicted worse survival. However, there was no difference in survival prognosis between uGBC and GBC. The rate of misdiagnosis and underdiagnosis of uGBC exceeds 60%. Conclusion AJCC stage and serum CA125 and CA199 levels are suggestive of the prognosis of gallbladder cancer. The prognosis of unexpected gallbladder cancer was not as good as expected. Underdiagnosis and misdiagnosis of uGBC are common worldwide. A thorough preoperative examination and rigorous intraoperative cytopathology are important.

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Incidental Gallbladder Cancer on Cholecystectomy: Strategy for Re-resection of Presumed Benign Diseases from a Retrospective Multicenter Study by the Yokohama Clinical Oncology Group

Cited by 8 publications

References 29 publications

Referral rate of patients with incidental gallbladder cancer and survival: outcomes of a multicentre retrospective study

Referral rate of patients with incidental gallbladder cancer and survival: outcomes of a multicentre retrospective study

Practices in the Management of Incidental Gallbladder Cancer

"Unexpected gallbladder cancer" -- was it really an accident?

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