title: Adenocarcinoma of the Gallbladder: Incidental Finding in Patients following Laparoscopic Sleeve Gastrectomy and Cholecystectomy.
abstract: BACKGROUND
  Gallbladder (GB) cancer is rare. Most cases are incidentally found in specimens after a cholecystectomy. Cholelithiasis is almost always present when this diagnosis is made. Obesity is a known risk factor for gallstone formation and thus may be related to GB cancer.
  
  
  OBJECTIVE
  To highlight the importance of evaluating the gallbladder before surgery, resecting the gallbladder whenever required, and screening the resected tissue for malignancy.
  
  
  METHODS
  We retrospectively searched a prospectively maintained database of all bariatric procedures during the last 8 years for cases of concomitant laparoscopic sleeve gastrectomy (LSG) and laparoscopic cholecystectomy (LC). Pathologic reports of the gallbladders were reviewed. Demographic data and perioperative parameters were documented.
  
  
  RESULTS
  Of 2708 patients reviewed, 1721 (63.55%) were females and 987 (36.45%) males. Excluded were 145 (5.35%) who had a previous cholecystectomy. Of the remaining 2563, 180 (7.02%) had symptomatic gallbladder disease and underwent LSG with LC. Of these, two females (BMI 53 kg/m2 and 47 kg/m2, both age 60) were found by histological examination to have adenocarcinoma in their GB specimens (1.11%). Both were reoperated, which included partial hepatectomy of the GB bed, resection of the cystic stump, lymph node dissection, and resection of the port sites. One patient is doing well, with no evidence of disease at a postoperative follow-up of 4 years. The second patient had recurrent disease with peritoneal spread and ascites 20 months post-surgery and died 18 months later.
  
  
  CONCLUSIONS
  GB cancer is a rare finding in cholecystectomy specimens. The incidence of this entity might be higher in obese older females owing to the higher incidence of cholelithiasis in these patients.
authors.forename: Asnat
authors.initials: A
authors.lastname: Raziel
authors.forename: Nasser
authors.initials: N
authors.lastname: Sakran
authors.forename: Amir
authors.initials: A
authors.lastname: Szold
authors.forename: Judith
authors.initials: J
authors.lastname: Sandbank
authors.forename: Dan
authors.initials: D
authors.lastname: Hershko
authors.forename: David
authors.initials: D
authors.lastname: Goitein
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D033162:Incidental Findings; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors