title: Is port-site resection necessary in the surgical management of gallbladder cancer?
abstract: BACKGROUND
  Gallbladder carcinoma is frequently discovered incidentally on pathologic examination of the specimen after laparoscopic cholecystectomy (LC) performed for presumed "benign" disease. The objective of the present study was to assess the role of excision of port-sites from the initial LC for patients with incidental gallbladder carcinoma (IGBC) in a French registry.
  
  
  METHODS
  Data on patients with IGBC identified after LC between 1998 and 2008 were retrospectively collated in a French multicenter database. Among those patients undergoing re-operation with curative intent, patients with port-site excision (PSE) were compared with patients without PSE and analyzed for differences in recurrence patterns and survival.
  
  
  RESULTS
  Among 218 patients with IGBC after LC (68 men, 150 women, median age 64 years), 148 underwent re-resection with curative intent; 54 patients had PSE and 94 did not. Both groups were comparable with regard to demographic data (gender, age > 70, co-morbidities), surgical procedures (major resection, lymphadenectomy, main bile duct resection) and postoperative morbidity. In the PSE group, depth of tumor invasion was T1b in six, T2 in 24, T3 in 22, and T4 in two; this was not significantly different from patients without PSE (P = 0.69). Port-site metastasis was observed in only one (2%) patient with a T3 tumor who died with peritoneal metastases 15 months after resection. PSE did not improve the overall survival (77%, 58%, 21% at 1, 3, 5 years, respectively) compared to patients with no PSE (78%, 55%, 33% at 1, 3, 5 years, respectively, P = 0.37). Eight percent of patients developed incisional hernia at the port-site after excision.
  
  
  CONCLUSIONS
  In patients with IGBC, PSE was not associated with improved survival and should not be considered mandatory during definitive surgical treatment.
authors.affiliation: Département de chirurgie digestive et métabolique, université de Picardie, hôpital Nord-Amiens, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 01, France.
authors.forename: D
authors.initials: D
authors.lastname: Fuks
authors.forename: J-M
authors.initials: JM
authors.lastname: Regimbeau
authors.forename: P
authors.initials: P
authors.lastname: Pessaux
authors.forename: P
authors.initials: P
authors.lastname: Bachellier
authors.forename: A
authors.initials: A
authors.lastname: Raventos
authors.forename: G
authors.initials: G
authors.lastname: Mantion
authors.forename: J-F
authors.initials: JF
authors.lastname: Gigot
authors.forename: L
authors.initials: L
authors.lastname: Chiche
authors.forename: G
authors.initials: G
authors.lastname: Pascal
authors.forename: D
authors.initials: D
authors.lastname: Azoulay
authors.forename: A
authors.initials: A
authors.lastname: Laurent
authors.forename: C
authors.initials: C
authors.lastname: Letoublon
authors.forename: E
authors.initials: E
authors.lastname: Boleslawski
authors.forename: M
authors.initials: M
authors.lastname: Rivoire
authors.forename: J-Y
authors.initials: JY
authors.lastname: Mabrut
authors.forename: M
authors.initials: M
authors.lastname: Adham
authors.forename: Y-P
authors.initials: YP
authors.lastname: Le Treut
authors.forename: J-R
authors.initials: JR
authors.lastname: Delpero
authors.forename: F
authors.initials: F
authors.lastname: Navarro
authors.forename: A
authors.initials: A
authors.lastname: Ayav
authors.forename: K
authors.initials: K
authors.lastname: Boudjema
authors.forename: G
authors.initials: G
authors.lastname: Nuzzo
authors.forename: M
authors.initials: M
authors.lastname: Scotte
authors.forename: O
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authors.lastname: Farges
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
keywords: Gallbladder cancer; Long-term survival; NPSE; No port-site excision; PS; PSE; Port-site; Port-site excision; Port-sites