Systematic review of management of incidental gallbladder cancer after cholecystectomy

Abstract

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.

Management of incidental gallbladder cancer in a national cohort

“…Guidelines are usually based on observational studies and registry data, which may lead to a low certainty of evidence 42 . More studies and international collaboration will be needed to increase knowledge of how to improve the management and treatment of incidental gallbladder cancer 43 . The present findings from validated national registries support previous results indicating that re-resection of pT2 and pT3 incidental gallbladder cancers may prolong disease-specific survival, although interpretation of survival data was limited by the fact that the groups being analysed were not comparable in terms of age and co-morbidity.…”

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

“…After re-resection, tumor-free margins were achieved in 19/24 patients (79%). Survival in GBC is primarily determined by the ability to achieve tumor-free margins; 10 therefore, the increased rate of R0 resections after re-resection is the most likely cause for the higher survival in reresected T3 disease.…”

“…[7][8][9] Due to the growing number of laparoscopic cholecystectomies performed, iGBC is an increasingly relevant clinical issue. 10,11 Noticeably, especially in the Western world, many GBCs are detected as an incidental finding. 2,12 In order to prevent early locoregional recurrence, reexploration and definitive resection is currently recommended for patients with tumors invading the muscle layer and no evidence of disseminated disease.…”

“…2,12 In order to prevent early locoregional recurrence, reexploration and definitive resection is currently recommended for patients with tumors invading the muscle layer and no evidence of disseminated disease. 10 Re-resection involves a partial hepatectomy of segments 4b/5, either as a full segmentectomy or wedge excision, and resection of the hepatoduodenal lymph nodes. 13 Re-resection is associated with improved survival in retrospective studies.…”

This month on Twitter

“…Andrew De Beaux, @sbiondo60 and @ksoreide all posted tweets celebrating the high Altmetric scores of their respective papers. This led to a discussion on the value and accuracy of these metrics.…”