title: Revision surgery for incidental gallbladder cancer: factors influencing operability and further evidence for T1b tumours.
abstract: OBJECTIVE
  There is a need to increase the available data on revision radical surgery for incidental gallbladder cancer and to determine factors influencing operability. We aimed to assess the impact of stage of disease (pT) and the type of primary surgery (laparoscopy versus open) on resectability rates.
  
  
  METHODS
  The data of 90 consecutive patients referred to the Tata Memorial Hospital between 1 January 2003 and 30 April 2007 for revision radical surgery for incidental gallbladder cancer were reviewed retrospectively.
  
  
  RESULTS
  Of the 90 patients who underwent revision surgery, accurate data on T-stage was available in 76, and of these 76 patients, 44 (57.8%) had prior laparoscopic simple cholecystectomy, while 32 (42.2%) had undergone open surgery. The median time interval between the two surgeries was 2 months (range 4 weeks to 11 months). By T-stage, 23 patients had T1b disease, while 33 and 20 patients had T2 and T3 disease, respectively. Successful revision surgery could be undertaken in 71% of patients (54/76) and 29.6% of these had residual disease confirmed by histopathological examination.
  
  
  CONCLUSIONS
  T-stage is an important factor in determining operability as confirmed by our study. As the T-stage of the disease increased, the chances of finding residual disease increased, while operability decreased. Furthermore, the case for revision surgery is strengthened because the incidence of lymph nodal disease is high even for pT1b cancers. The type of primary surgery does not affect operability in patients undergoing revision radical surgery for incidental gallbladder cancer.
authors.affiliation: Department of Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, India. pjshukla@doctors.org.uk
authors.forename: P J
authors.initials: PJ
authors.lastname: Shukla
authors.forename: G
authors.initials: G
authors.lastname: Barreto
authors.forename: A
authors.initials: A
authors.lastname: Kakade
authors.forename: S V
authors.initials: SV
authors.lastname: Shrikhande