title: Management of incidental and suspicious gallbladder cancer: focus on early referral to a tertiary centre.
abstract: OBJECTIVE
  This study was conducted to assess the management of incidental gallbladder cancer and indeterminate gallbladder lesions. Its secondary aim referred to the devising of a management pathway for these patients.
  
  
  METHODS
  Patients referred with incidental gallbladder cancer and indeterminate gallbladder lesions during 2002-2011 were identified from a prospectively maintained database. Collated data included operative findings, histopathological data and survival outcomes.
  
  
  RESULTS
  The study included a total of 104 patients, 40 of whom had incidental gallbladder cancer following cholecystectomy. In this group, the index cholecystectomy was considered curative (T-is/T1a stage) in three patients; 11 patients underwent further resection, and 26 patients were inoperable. One-, 3- and 5-year overall survival rates were 91.1%, 91.0% and 60.7%, respectively, in patients who underwent re-resection. Of the 64 patients with indeterminate gallbladder lesions, 54 patients underwent modified radical cholecystectomy. Seven patients were found to have gallbladder cancer. One-, 3- and 5-year overall survival rates were 85.9%, 43.1% and 42.8%, respectively. Five-year overall survival in patients treated with surgery for gallbladder cancer was 59.9%.
  
  
  CONCLUSIONS
  The majority of patients with incidental gallbladder cancer were not amenable to further potentially curative resection. The radiological suspicion of gallbladder cancer should lead to prompt referral to a tertiary hepatobiliary unit for further management.
authors.affiliation: North Western Hepatobiliary Unit, Aintree University Hospital National Health Service Foundation Trust, Liverpool, UK.
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Yip
authors.forename: Dhanwant
authors.initials: D
authors.lastname: Gomez
authors.forename: Sean
authors.initials: S
authors.lastname: Brown
authors.forename: Clare
authors.initials: C
authors.lastname: Byrne
authors.forename: David
authors.initials: D
authors.lastname: White
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Fenwick
authors.forename: Graeme J
authors.initials: GJ
authors.lastname: Poston
authors.forename: Hassan Z
authors.initials: HZ
authors.lastname: Malik
mesh_terms: D000368:Aged; D002763:Cholecystectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005704:Gallbladder / Q000473:pathology / Q000601:surgery*; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012017:Referral and Consultation; D012086:Reoperation; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome