title: The role of laparoscopic staging in patients with incidental gallbladder cancer.
abstract: BACKGROUND
  The role of staging laparoscopy (SL) in patients with incidental gallbladder cancer (IGBC) is ill defined. This study evaluates the utility of SL with the aim of identifying variables associated with disseminated disease (DD).
  
  
  METHODS
  Consecutive patients with IGBC who underwent re-exploration between 1998 and 2009 were identified from a prospective database. The yield and accuracy of SL were calculated. Demographics, tumour- and treatment-related variables were correlated with findings of DD.
  
  
  RESULTS
  Of the 136 patients submitted to re-exploration for possible definitive resection, 19 (14.0%) had DD. Staging laparoscopy was carried out in 46 (33.8%) patients, of whom 10 (21.8%) had DD (peritoneal disease [n = 6], liver metastases [n = 3], retroperitoneal disease [n = 1]). Disseminated disease was identified by SL in two patients (yield = 4.3%), whereas eight were diagnosed after conversion to laparotomy (accuracy = 20.0%). The likelihood of DD correlated closely with T-stage (T1b, n = 0; T2, n = 5 [7.0%], T3, n = 14 [26.0%]; P = 0.004). A positive margin at initial cholecystectomy (odds ratio [OR] 5.44, 95% confidence interval [CI] 1.51-24.37; P = 0.004) and tumour differentiation (OR 7.64, 95% CI 1.1-NA; P= 0.006) were independent predictors of DD on multivariate analysis.
  
  
  CONCLUSIONS
  Disseminated disease is relatively uncommon in patients with IGBC and SL provides a very low yield. However, patients with poorly differentiated, T3 or positive-margin gallbladder tumours are at high risk for DD and targeting these patients may increase the yield of SL.
authors.affiliation: Departments of Surgery Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Butte
authors.forename: Mithat
authors.initials: M
authors.lastname: Gönen
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Dematteo
authors.forename: Leslie
authors.initials: L
authors.lastname: Blumgart
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012086:Reoperation; D012720:Severity of Illness Index