Surgical treatment of incidental gallbladder cancer discovered during or following laparoscopic cholecystectomy.
BACKGROUND
The optimal surgical management of patients with incidental gallbladder cancer (IGBC) and their long-term survival remains unclear.


OBJECTIVE
The purpose of this study was to examine the long-term prognosis of patients with IGBC diagnosed during or after LC.


METHODS
Between January 2002 and January 2012, a total of 7,582 consecutive patients underwent LC for presumed gallbladder benign disease in the Chinese PLA General Hospital, China. Among them, 69 patients (0.91%) were diagnosed to have IGBC. Their medical records, imaging data, surgery records, pathological findings, and survival data were retrospectively reviewed.


RESULTS
Median age was 61 years (range: 34-83). After a median follow-up period of 61 months, the 1-, 3-, and 5-year survival rates of patients were 89.9, 78.3, and 76.8%, respectively. The 5-year survival rates of patients with T1a, T1b, T2, and T3 stages were 95.5, 93.8, 69.2, and 44.4%, respectively. The 5-year survival rates in simple LC (n = 45), converted to open extended cholecystectomy (n = 16), and radical second resection (n = 8) groups were 91.1, 37.5, and 75.0%, respectively. Local port-site tumor recurrence was identified in one patient. Prognostic factors including depth of invasion, lymph node status, vascular or neural invasion, tumor differentiation, extent of resection, bile spillage, and type of surgery were statistically significant (p < 0.05).


CONCLUSIONS
Simple LC is appropriate for T1a patients with clear margin and unbroken gallbladder, whereas extended radical resection is recommended for patients with T1b or more advanced IGBC. An intact surgical specimen and the use of plastic retrieval bags are important to reduce the risk of port-site recurrences and disease relapse. Early diagnosis, meticulous perioperative assessment, and precise surgery are essential factors to obtain good results in IGBC treatment.
Hospital & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China, tianyh301@163.com.
Yuan-Hu
YH
Tian
Xu
X
Ji
Bo
B
Liu
Guang-Yun
GY
Yang
Xiang-Fei
XF
Meng
Hong-Tian
HT
Xia
Jing
J
Wang
Zhi-Qiang
ZQ
Huang
Jia-Hong
JH
Dong
D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000379:methods; D017081:Cholecystectomy, Laparoscopic; D061887:Conversion to Open Surgery; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate