The time of diagnosis impacts surgical management but not the outcome of patients with gallbladder Carcinoma

Abstract

Background Only 50% of gallbladder cancers (GBC) are recognized before operation and the remaining tumors are diagnosed during surgery or afterwards by the pathologist. These situations may demand substantial modifications of the proceeding during surgery as well as the need for reoperation in some cases. Therefore, the time of diagnosis may strongly influence the surgical management of GBC and the prognosis of the patients. Methods Records and follow-up of 152 patients with gallbladder carcinoma who underwent surgery between 1980 and 2004 were examined according to the time of diagnosis, TNM staging system, surgical procedures, morbidity and predictors of survival. There were 76 patients with preoperative diagnosis of GBC (50%; group1), 44 patients with intraoperative diagnosis (29%; group 2) and 32 patients (21%; group 3) with postoperatively incidental finding of GBC. In all cases radical resection of the GBC was intended, except in 5 patients from group 1. Surgical procedures comprised from simple cholecystectomy to multivisceral resections. Results Overall 5-year survival rate was 7% with a significantly better median survival in group 3 (53.2 month), when compared to only 6.1 month (group 2) and 5.4 month (group 1), respectively. Findings at operation forced significant modifications of the surgical strategy in 85%. Complete resection of GBC was achieved in 38% of the patients. Stage- dependent survival was comparable between the groups following R0 resection. Tumor stage, in particular the nodal status and radicality of the procedure, but not the time of diagnosis were the most powerful predictors of outcome. Conclusions Complete tumor resection may provide long-term survival even in locally advanced GBC. Although the time of diagnosis of GBC causes significant changes of the intended procedures during and after surgery, it has no influence on the prognosis provided that radical (R0) resection was accomplished.

Comparison of overall survival in gallbladder carcinoma at academic versus community cancer centers: An analysis of the National Cancer Data Base

“…The site of care is a notable factor in survival outcomes, and case volume improves patient outcomes in ACCs. Given that at least 30% of patients with GBC are diagnosed preoperatively, selecting the site of care is an important decision and these data should be an informative resource to benefit this population 3,4 …”

“…Sixty to seventy percent of GBC cases are discovered incidentally during surgery or on postoperative histopathology. Thirty to forty percent of patients are suspected preoperatively to have GBC and referral is possible 3,4 …”

An Approach to Soft Tissue Mass In The Gall Bladder

“…The incidence of incidental GBC in gall bladder removed laparoscopically is 0.2-3.3% 9,10 . Approximately 3,700 new cases of GBC are documented annually in USA, 50% of which are diagnosed incidentally either intra-operatively (29%) or after laparoscopic cholecystectomy (21%) [11][12][13] .…”

Preoperative diagnoses and identification rates of unexpected gallbladder cancer

“…Löhe et al [ 10 ] reported that only 50% of gallbladder cancers are recognized preoperatively. There could be several reasons for the difficulty recognizing cancers preoperatively.…”