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

• R
• Haldeniya K
• Singh A
• Bhatt N
• Mishra P
• Singh RK
• Saxena R

• KMID: 2523053
• DOI: http://doi.org/10.14701/ahbps.2021.25.4.492

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.

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