Ann Hepatobiliary Pancreat Surg.  2021 Nov;25(4):492-499. 10.14701/ahbps.2021.25.4.492.

Determinants of curative resection in incidental gallbladder carcinoma with special reference to timing of referral

Affiliations
  • 1Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  • 2Department of Biostatistics & Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Abstract

Backgrounds/Aims
Re-resection of incidental gallbladder carcinoma (IGBC) is possible in a select group of patients. However, the optimal timing for re-intervention lacks consensus.
Methods
A retrospective analysis was performed for a prospective database of 91 patients with IGBC managed from 2009 to 2018. Patients were divided into three groups based on the duration between the index cholecystectomy and re-operation or final staging: Early (E), < 4 weeks; Intermediate (I), > 4 weeks and < 12 weeks; and Late (L), > 12 weeks. Demographic data, tumor characteristics, and operative details of patients were analyzed to determine factors affecting the re-resectability of IGBC.
Results
Twenty-two patients in ‘E’, 48 in ‘I’, and 21 in ‘L’ groups were evenly matched. Nearly two thirds were asymptomatic. Curative resection was possible in 48 (52.7%) patients. Metastasis was detected during staging laparoscopy (SL)/laparotomy in 26 (28.6%) patients. The yield of SL was more in the ‘L’ group (30.8%) than in the ‘I’ (11.1%) or ‘E’ (nil) group, avoiding unnecessary laparotomy in 13.6%. Only 28.5% of patients in the ‘L’ group could undergo curative resection (R0/R1 resection), significantly less than that in the ‘E’ (50.0%) or ‘I’ group (64.6%) (both p < 0.001). On multivariate analysis, presentation in intermediate period and tumor differentiation increased the chance of curative resection (p < 0.05).
Conclusions
Asymptomatic patients in the ‘I’ group with well differentiated IGBC have the best chance of obtaining a curative resection.

Keyword

Incidental gall bladder cancer; Curative resection determinants; Post-cholecystectomy interval

Figure

  • Fig. 1 Flow diagram of patient management. E, early; I, intermediate; L, late; IGBC, incidental gallbladder carcinoma; CECT, contrast-enhanced computed tomography; PET-CT, positron emission tomography–computed tomography; IAC, inter-aorto-caval.


Reference

1. Piehler JM, Crichlow RW. 1978; Primary carcinoma of the gallbladder. Surg Gynecol Obstet. 147:929–942. PMID: 362580.
Article
2. Misra S, Chaturvedi A, Misra NC, Sharma ID. 2003; Carcinoma of the gallbladder. Lancet Oncol. 4:167–176. DOI: 10.1016/S1470-2045(03)01021-0. PMID: 12623362.
Article
3. Steinert R, Nestler G, Sagynaliev E, Müller J, Lippert H, Reymond MA. 2006; Laparoscopic cholecystectomy and gallbladder cancer. J Surg Oncol. 93:682–689. DOI: 10.1002/jso.20536. PMID: 16724350.
Article
4. Kwon AH, Imamura A, Kitade H, Kamiyama Y. 2008; Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy. J Surg Oncol. 97:241–245. DOI: 10.1002/jso.20944. PMID: 18095299.
Article
5. Agarwal AK, Kalayarasan R, Singh S, Javed A, Sakhuja P. 2012; All cholecystectomy specimens must be sent for histopathology to detect inapparent gallbladder cancer. HPB (Oxford). 14:269–273. DOI: 10.1111/j.1477-2574.2012.00443.x. PMID: 22404266. PMCID: PMC3371214.
Article
6. Chen C, Geng Z, Shen H, Song H, Zhao Y, Zhang G, et al. 2016; Long-term outcomes and prognostic factors in advanced gallbladder cancer: focus on the advanced T stage. PLoS One. 11:e0166361. DOI: 10.1371/journal.pone.0166361. PMID: 27846279. PMCID: PMC5112857.
Article
7. Toyonaga T, Chijiiwa K, Nakano K, Noshiro H, Yamaguchi K, Sada M, et al. 2003; Completion radical surgery after cholecystectomy for accidentally undiagnosed gallbladder carcinoma. World J Surg. 27:266–271. DOI: 10.1007/s00268-002-6609-9. PMID: 12607049.
Article
8. Hueman MT, Vollmer CM Jr, Pawlik TM. 2009; Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol. 16:2101–2115. DOI: 10.1245/s10434-009-0538-x. PMID: 19495882.
Article
9. Ogura Y, Mizumoto R, Isaji S, Kusuda T, Matsuda S, Tabata M. 1991; Radical operations for carcinoma of the gallbladder: present status in Japan. World J Surg. 15:337–343. DOI: 10.1007/BF01658725. PMID: 1853612.
Article
10. Misra MC, Guleria S. 2006; Management of cancer gallbladder found as a surprise on a resected gallbladder specimen. J Surg Oncol. 93:690–698. DOI: 10.1002/jso.20537. PMID: 16724357.
Article
11. Corvera CU, Weber SM, Jarnagin WR. 2002; Role of laparoscopy in the evaluation of biliary tract cancer. Surg Oncol Clin N Am. 11:877–891. DOI: 10.1016/S1055-3207(02)00033-9. PMID: 12607577.
Article
12. Ausania F, Tsirlis T, White SA, French JJ, Jaques BC, Charnley RM, et al. 2013; Incidental pT2-T3 gallbladder cancer after a cholecystectomy: outcome of staging at 3 months prior to a radical resection. HPB (Oxford). 15:633–637. DOI: 10.1111/hpb.12032. PMID: 23458168. PMCID: PMC3731586.
Article
13. Ethun CG, Postlewait LM, Le N, Pawlik TM, Buettner S, Poultsides G, et al. 2017; Association of optimal time interval to re-resection for incidental gallbladder cancer with overall survival: a multi-institution analysis from the US Extrahepatic Biliary Malignancy Consortium. JAMA Surg. 152:143–149. DOI: 10.1001/jamasurg.2016.3642. PMID: 27784058. PMCID: PMC5800764.
14. Patkar S, Ostwal V, Ramaswamy A, Engineer R, Chopra S, Shetty N, et al. 2018; Emerging role of multimodality treatment in gall bladder cancer: outcomes following 510 consecutive resections in a tertiary referral center. J Surg Oncol. 117:372–379. DOI: 10.1002/jso.24837. PMID: 28940502.
Article
15. Mishra PK, Saluja SS, Prithiviraj N, Varshney V, Goel N, Patil N. 2017; Predictors of curative resection and long term survival of gallbladder cancer - a retrospective analysis. Am J Surg. 214:278–286. DOI: 10.1016/j.amjsurg.2017.02.006. PMID: 28233537.
Article
16. Duffy A, Capanu M, Abou-Alfa GK, Huitzil D, Jarnagin W, Fong Y, et al. 2008; Gallbladder cancer (GBC): 10-year experience at Memorial Sloan-Kettering Cancer Centre (MSKCC). J Surg Oncol. 98:485–489. DOI: 10.1002/jso.21141. PMID: 18802958.
Article
17. Singh SK, Talwar R, Kannan N, Tyagi AK, Jaiswal P, Kumar A. 2015; Aggressive surgical approach for gallbladder cancer: a single-center experience from Northern India. J Gastrointest Cancer. 46:399–407. DOI: 10.1007/s12029-015-9766-4. PMID: 26410686.
Article
18. Pawlik TM, Gleisner AL, Vigano L, Kooby DA, Bauer TW, Frilling A, et al. 2007; Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection. J Gastrointest Surg. 11:1478–1486. DOI: 10.1007/s11605-007-0309-6. PMID: 17846848.
Article
19. Corvera CU, Blumgart LH, Akhurst T, DeMatteo RP, D'Angelica M, Fong Y, et al. 2008; 18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer. J Am Coll Surg. 206:57–65. DOI: 10.1016/j.jamcollsurg.2007.07.002. PMID: 18155569.
Article
20. Anderson CD, Rice MH, Pinson CW, Chapman WC, Chari RS, Delbeke D. 2004; Fluorodeoxyglucose PET imaging in the evaluation of gallbladder carcinoma and cholangiocarcinoma. J Gastrointest Surg. 8:90–97. DOI: 10.1016/j.gassur.2003.10.003. PMID: 14746840.
Article
21. Shukla PJ, Barreto SG, Arya S, Shrikhande SV, Hawaldar R, Purandare N, et al. 2008; Does PET-CT scan have a role prior to radical re-resection for incidental gallbladder cancer? HPB (Oxford). 10:439–445. DOI: 10.1080/13651820802286910. PMID: 19088931. PMCID: PMC2597311.
Article
22. Butte JM, Redondo F, Waugh E, Meneses M, Pruzzo R, Parada H, et al. 2009; The role of PET-CT in patients with incidental gallbladder cancer. HPB (Oxford). 11:585–591. DOI: 10.1111/j.1477-2574.2009.00104.x. PMID: 20495711. PMCID: PMC2785954.
Article
23. Weber SM, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR. 2002; Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients. Ann Surg. 235:392–399. DOI: 10.1097/00000658-200203000-00011. PMID: 11882761. PMCID: PMC1422445.
24. Butte JM, Gönen M, Allen PJ, D'Angelica MI, Kingham TP, Fong Y, et al. 2011; The role of laparoscopic staging in patients with incidental gallbladder cancer. HPB (Oxford). 13:463–472. DOI: 10.1111/j.1477-2574.2011.00325.x. PMID: 21689230. PMCID: PMC3133713.
Article
25. Agarwal AK, Kalayarasan R, Javed A, Gupta N, Nag HH. 2013; The role of staging laparoscopy in primary gall bladder cancer--an analysis of 409 patients: a prospective study to evaluate the role of staging laparoscopy in the management of gallbladder cancer. Ann Surg. 258:318–323. DOI: 10.1097/SLA.0b013e318271497e. PMID: 23059504.
26. Yang XW, Yuan JM, Chen JY, Yang J, Gao QG, Yan XZ, et al. 2014; The prognostic importance of jaundice in surgical resection with curative intent for gallbladder cancer. BMC Cancer. 14:652. DOI: 10.1186/1471-2407-14-652. PMID: 25187159. PMCID: PMC4164789.
Article
27. Ethun CG, Postlewait LM, Le N, Pawlik TM, Buettner S, Poultsides G, et al. 2017; A Novel pathology-based preoperative risk score to predict locoregional residual and distant disease and survival for incidental gallbladder cancer: a 10-institution study from the U.S. Extrahepatic Biliary Malignancy Consortium. Ann Surg Oncol. 24:1343–1350. DOI: 10.1245/s10434-016-5637-x. PMID: 27812827. PMCID: PMC6054592.
Article
28. Horkoff MJ, Ahmed Z, Xu Y, Sutherland FR, Dixon E, Ball CG, et al. 2021; Adverse outcomes after bile spillage in incidental gallbladder cancers: a population-based study. Ann Surg. 273:139–144. DOI: 10.1097/SLA.0000000000003325. PMID: 30998534.
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