Unsuspected gallbladder carcinoma discovered during or after cholecystectomy: focus on appropriate radical re-resection according to the T-stage.
BACKGROUND
The long-term survival of patients with unsuspected gallbladder carcinoma (UGC) and the role of radical re-resection for this disease remain unclear.


METHODS
A retrospective study was carried out on 38 UGC patients. The time-to-event data were demonstrated by Kaplan-Meier curves. Comparing survival curves of two groups using the log-rank test.


RESULTS
The overall incidence of UGC in patients underwent cholecystectomy in our hospital was 0.18 % (25 of 14,073). Distribution according to actual pT-stage (the UICC) was: pT1a: n = 3; pT1b: n = 11; pT2: n = 4; pT3: n = 12; pT4: n = 8. The preoperative diagnosis included a high rate of acute biliary tract inflammation (24 of 38, 63.2 %). Compared with other gallbladder carcinoma patients, UGC group had significantly higher proportion of early stages (pT1) (36.8 %, 14 of 38 cases) (p < 0.01), and better prognosis. The comparison of radical re-resection versus simple cholecystectomy showed a significant benefit in overall survival for the pT3 group (22.0 ± 5.48 vs. 5.0 ± 0.9 months; p = 0.02). There are median survival differences between the two subgroups of patients with pT1b tumors whether received re-resection or not. Median survival was 62.0 months and 24.0 ± 8.5 months, respectively, though the differences are not statistically significant (p = 0.131).


CONCLUSIONS
Radical re-resection is strongly recommended for patients with pT1b-stage cancer. The reoperation should be performed as soon as possible, preferably within 10 days after the initial operation.
Department of Radiology, Xiangya Hospital, Central South University, Changsha, 410008, China.
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Yi
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Long
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H
Zai
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D
Xiao
W
W
Li
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Y
Li
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D002763:Cholecystectomy; D005260:Female; D005704:Gallbladder / Q000473:pathology / Q000601:surgery*; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate