Management of incidental and suspicious gallbladder cancer: focus on early referral to a tertiary centre

Yip, Vincent; Gomez, Dhanny; Brown, Sean; Byrne, Clare; White, David C.; Fenwick, Stephen; Poston, Graeme J.; Malik, Hassan

doi:10.1111/hpb.12189

Cited by 29 publications

(26 citation statements)

References 32 publications

(45 reference statements)

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“…The proportion of patients with unresectable advanced disease at reoperation varies, but the systematic review by Choi and colleagues reported an overall pooled rate of 23 per cent. Some recent studies from the UK suggest the unresectability rate is twice as high, at about 50 per cent.…”

Section: Resultsmentioning

confidence: 98%

“…However, there are few data to support a need for an emergency referral and immediate redo surgery if an incidental cancer is detected, although the timing of surgery remains debated. In several studies, the unresectability rate at restaging (before redo surgery) is as high as 50 per cent for incidental cancers, despite early referral. Indeed, in one study early referral was a strong predictor of unresectability.…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of management of incidental gallbladder cancer after cholecystectomy

Søreide

Guest

Harrison

et al. 2018

British Journal of Surgery

107

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Background Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer. Methods A systematic PubMed search of the English literature to May 2018 was conducted. Results The search identified 12 systematic reviews and meta‐analyses, in addition to several consensus reports, multi‐institutional series and national audits. Some 0·25–0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one‐third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5‐year survival rates of up to 100 per cent after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent and timing of reresection remain controversial. Observation time may be used for new cross‐sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of disease dissemination. Gallbladder cancers are PET‐avid, and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. The incidence of port‐site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. Conclusion Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Systematic review of management of incidental gallbladder cancer after cholecystectomy

Søreide

Guest

Harrison

et al. 2018

British Journal of Surgery

107

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“…Prompt surgical treatment of such patients with segment 4b/5 hepatectomy and portal lymph node dissection may confer a comparable survival benefit to initial radical cholecystectomy . However, time from cholecystectomy to referral has been shown to be a negative prognostic factor, as many patients will be unresectable at the time of evaluation by a specialist . The optimal time between operations has been estimated to be 4‐8 weeks to minimize interval disease progression .…”

Section: Discussionmentioning

confidence: 99%

Intraoperative bile spillage is associated with worse survival in gallbladder adenocarcinoma

Blakely

Wong

Warner

et al. 2019

Journal of Surgical Oncology

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Background: Gallbladder adenocarcinoma is often incidentally identified following cholecystectomy. We hypothesized that intraoperative bile spillage would be a negative prognostic factor.Methods: A retrospective review of patients treated at a cancer center with histologically confirmed gallbladder adenocarcinoma, 2009-2017, was performed.Patient, disease, and treatment factors were analyzed in terms of progression-free survival (PFS) and overall survival (OS).Results: Sixty-six patients were identified. Tumor stage was T1 (n = 8, 12%), T2 (n = 23, 35%), T3 (n = 35, 53%). Node stage was N0 (n = 22, 33%), N1+ (n = 26, 39%), Nx (n = 18, 27%). Operations included cholecystectomy alone (n = 27, 36%), cholecystectomy and partial hepatectomy (n = 30, 45%), or hepaticojejunostomy (n = 9, 14%). Median PFS was 7 months (interquartile range [IQR], 2-19); median OS was 16 months (IQR, 10-31). Subset multivariate proportional hazards regression of 41 patients who underwent initial cholecystectomy showed decreased PFS was associated with intraoperative spillage (n = 12, 29%; hazard ratio [HR], 5.5; P = .0014); decreased OS was associated with drain placement (n = 21, 51%; HR, 8.1; P = .006). Conclusions: Intraoperative bile spillage and surgical drain placement at initial cholecystectomy are negatively associated with PFS and OS in gallbladder adenocarcinoma. Explicit documentation of spillage and drain placement rationale is critical, possibly indicating locally advanced disease and prompting stronger consideration of systemic therapy before definitive resection. K E Y W O R D S bile spillage, cholecystectomy, gallbladder cancer, outcomes

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“…Survival outcomes have been shown to depend on surgical strategy, pathologic stage, comorbidities, and experience of the surgical unit. 3 …”

Section: Introductionmentioning

confidence: 99%

Impact of Type of Surgery on Survival Outcome in Patients With Early Gallbladder Cancer in the Era of Minimally Invasive Surgery

et al. 2016

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Laparoscopic surgery has been widely accepted as a feasible and safe treatment modality in many cancers of the gastrointestinal tract. However, most guidelines on gallbladder cancer (GBC) regard laparoscopic surgery as a contraindication, even for early GBC. This study aims to evaluate and compare recent surgical outcomes of laparoscopic and open surgery for T1(a,b) GBC and to determine the optimal surgical strategy for T1 GBC.The study enrolled 197 patients with histopathologically proven T1 GBC and no history of other cancers who underwent surgery from 2000 to 2014 at 3 major tertiary referral hospitals with specialized biliary-pancreas pathologists and optimal pathologic handling protocols. Median follow-up was 56 months. The effects of depth of invasion and type of surgery on disease-specific survival and recurrence patterns were investigated.Of the 197 patients, 116 (58.9%) underwent simple cholecystectomy, including 31 (15.7%) who underwent open cholecystectomy and 85 (43.1%) laparoscopic cholecystectomy. The remaining 81 (41.1%) patients underwent extended cholecystectomy. Five-year disease-specific survival rates were similar in patients who underwent simple and extended cholecystectomy (96.7% vs 100%, P = 0.483), as well as being similar in patients in the simple cholecystectomy group who underwent open and laparoscopic cholecystectomy (100% vs 97.6%, P = 0.543). Type of surgery had no effect on recurrence patterns.Laparoscopic cholecystectomy for T1 gallbladder cancer can provide similar survival outcomes compared to open surgery. Considering less blood loss and shorter hospital stay with better cosmetic outcome, laparoscopic cholecystectomy can be justified as a standard treatment for T1b as well as T1a gallbladder cancer when done by well-experienced surgeons based on exact pathologic diagnosis.

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Management of incidental and suspicious gallbladder cancer: focus on early referral to a tertiary centre

Abstract: The majority of patients with incidental gallbladder cancer were not amenable to further potentially curative resection. The radiological suspicion of gallbladder cancer should lead to prompt referral to a tertiary hepatobiliary unit for further management.

Cited by 29 publications

References 32 publications

Systematic review of management of incidental gallbladder cancer after cholecystectomy

Systematic review of management of incidental gallbladder cancer after cholecystectomy

Intraoperative bile spillage is associated with worse survival in gallbladder adenocarcinoma

Impact of Type of Surgery on Survival Outcome in Patients With Early Gallbladder Cancer in the Era of Minimally Invasive Surgery

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