title: Incidental gallbladder cancer by the AFC-GBC-2009 Study Group.
abstract: BACKGROUND
  Incidental gallbladder cancer (GBC) is frequently discovered on the specimen when cholecystectomy for a benign disease is performed. The objective of the present study was to assess the management of incidental GBC patients in a French registry.
  
  
  METHODS
  Data on patients with GBC treated between 1998 and 2008 were retrospectively collated in a French, multicenter database.
  
  
  RESULTS
  The registry contained 218 patients with incidental GBC (67 men and 151 women; median age = 64 years; age range = 31-88). One hundred forty-eight (68%) patients underwent re-resection after a median time interval of 48 days (range = 2-245). The most common complete procedure (66% of cases) was 4b + 5 segmentectomy with lymphadenectomy but not bile duct resection. Port-site excision was performed in 54 patients. The mortality and morbidity rates were 3 and 37%, respectively. Resection of the common bile duct (43%) increased postoperative complications (60 vs. 23%, p = 0.0001). Local residual tumor was found in 83 (56%) patients; it was significantly correlated with the T stage and influenced long-term survival. R0 was obtained in 143 (97%) patients and port-site invasion was histologically confirmed in one patient (1.8%). After a median follow-up period of 34 months, the 1-, 3-, and 5-year survival rates for the 148 patients with re-resection were 76, 54, and 41%, respectively. Re-resection significantly increased survival in patients with T2 (p = 0.0001) and T3 (p = 0.04) disease. Resection of the common bile duct increased neither R0 resection nor overall survival (p = 0.06).
  
  
  CONCLUSIONS
  This study validates the concept of re-resection in T2 and T3 GBC. Bile duct resection increases postoperative morbidity but does not improve survival. There is currently a modification in the surgical management of incidental GBC, with minor liver resection and no common bile duct resection.
authors.affiliation: Department of Digestive Surgery, Hôpital Nord, Amiens, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Regimbeau
authors.forename: Yves-Patrice
authors.initials: YP
authors.lastname: Le Treut
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
authors.forename: Artivas
authors.initials: A
authors.lastname: Raventos
authors.forename: François-René
authors.initials: FR
authors.lastname: Pruvot
authors.forename: Laurence
authors.initials: L
authors.lastname: Chiche
authors.forename: Olivier
authors.initials: O
authors.lastname: Farges
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D003135:Common Bile Duct / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005602:France; D005705:Gallbladder Diseases / Q000473:pathology* / Q000601:surgery*; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006306:Health Surveys; D006498:Hepatectomy; D006801:Humans; D033162:Incidental Findings; D008197:Lymph Node Excision / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery; D012042:Registries; D012086:Reoperation / Q000401:mortality