Management of incidental gallbladder cancer in a national cohort

Abstract

Background Incidental gallbladder cancer is a rare event, and its prognosis is largely affected by the tumour stage and treatment. The aim of this study was to analyse the management, treatment and survival of patients with incidental gallbladder cancer in a national cohort over a decade. Methods Patients were identified through the Swedish Registry of Gallstone Surgery (GallRiks). Data were cross‐linked to the national registry for liver surgery (SweLiv) and the Cancer Registry. Medical records were collected if registry data were missing. Survival was measured as disease‐specific survival. The study was divided into two intervals (2007–2011 and 2012–2016) to evaluate changes over time. Results In total, 249 patients were identified with incidental gallbladder cancer, of whom 92 (36·9 per cent) underwent re‐resection with curative intent. For patients with pT2 and pT3 disease, median disease‐specific survival improved after re‐resection (12·4 versus 44·1 months for pT2, and 9·7 versus 23·0 months for pT3). Residual disease was present in 53 per cent of patients with pT2 tumours who underwent re‐resection; these patients had a median disease‐specific survival of 32·2 months, whereas the median was not reached in patients without residual disease. Median survival increased by 11 months for all patients between the early and late periods (P = 0·030). Conclusion Re‐resection of pT2 and pT3 incidental gallbladder cancer was associated with improved survival, but survival was impaired when residual disease was present. A higher re‐resection rate and more R0 resections in the later time period may have been associated with improved survival.

Re-resection in Incidental Gallbladder Cancer: Survival and the Incidence of Residual Disease

“…Although international guidelines recommend radical cholecystectomy for all iGBC patients, except those with T1a disease, the management of T1b iGBC remains controversial. Results from the literature are conflicting; some studies do not report a survival benefit, [22][23][24] whereas other series show an increase in 5-year survival of up to 30% after radical cholecystectomy. 25,26 Interestingly, although a general survival benefit was shown across the entire reresected cohort, patients with T1b disease did not show superior survival after re-resection.…”

“…In a recent publication from Sweden, 121/201 (60%) non-metastatic iGBC patients received a re-resection. 24 In 27 (13%) of all patients, a re-resection was not performed due to comorbidities. Another study included 218 iGBC patients and reresection was attempted in 188 (86%) patients.…”

Accidental transplantation of hepatic graft with incidental T2 gallbladder carcinoma: a report of 3 cases

“…Cholecystectomy alone is not recommended to treat T2 GBC since several studies have shown that re‐resection is associated with improved survival [9,10]. A residual disease is a strong prognostic factor after re‐resection [10]. Two of our three patients could be retransplanted to remove potentially residual cancer cells.…”

Cost-effectiveness of gallbladder histopathology after cholecystectomy for benign disease

“…The main argument for routine submission of the gallbladder specimen is that not all incidental gallbladder cancers have visible macroscopic abnormalities and patients with undiagnosed disease will be deprived of additional treatment 1, 6,7 . To improve survival, current evidence 8,9 supports reresection, including liver resection and lymph node dissection for T1b, T2 and T3 gallbladder cancer. For patients with Tis and T1a incidental cancers, cholecystectomy appears to suffice [10][11][12] .…”