title: Management of incidentally detected gallbladder carcinomas in a high prevalence area of gallbladder cancer.
abstract: BACKGROUND
  There is an increasing incidence of advanced unresectable gallbladder cancer even in patients who undergo re-exploration and these cases are marked by poor survival even after undergoing curative resection and adjuvant chemotherapy. Lack of suspicion during primary surgery, unavailability of frozen section facilities and delayed referrals are believed to contribute to this high incidence.
  
  
  OBJECTIVE
  Our aim was to evaluate the results of re-surgery in incidental gallbladder cancers detected after open or laparoscopic cholecystectomy and to assess the outcome in patients who underwent complete radical cholecystectomy and adjuvant therapy.
  
  
  METHODS
  We retrospectively analyzed the data from a prospectively maintained computerized database of all patients with incidentally detected gallbladder cancers operated in the Department of Surgical Oncology, from June 2006 to January 2013.
  
  
  RESULTS
  Forty-two patients with incidental gallbladder cancer were re-explored. The median time of re-exploration after initial surgery was 65 days. Eighteen (43%) patients were found inoperable due to locally advanced unresectable or metastatic disease. Among the 24 (57%) patients who underwent completion radical cholecystectomy, 11 developed recurrence over a median time of 11 months.
  
  
  CONCLUSIONS
  Despite the dismal prognosis, more than half of the incidentally detected gallbladder carcinoma patients could receive curative treatment. Identification of patients with incidentally discovered gallbladder cancer and early referral to an oncology center may ensure these patients receive curative resection thereby increasing their chances for long-term disease free survival.
authors.forename: A A
authors.initials: AA
authors.lastname: Kallianpur
authors.forename: N
authors.initials: N
authors.lastname: Gupta
authors.forename: N
authors.initials: N
authors.lastname: Vinod
authors.forename: G
authors.initials: G
authors.lastname: Rakesh
authors.forename: S S
authors.initials: SS
authors.lastname: Samra
authors.forename: S
authors.initials: S
authors.lastname: Goyal
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012086:Reoperation; D012189:Retrospective Studies; D024162:Second-Look Surgery; D016896:Treatment Outcome