Ann Surg Treat Res.  2022 Apr;102(4):185-192. 10.4174/astr.2022.102.4.185.

Incidental gallbladder cancer: a retrospective clinical study of 40 cases

• Altiok M
• Özdemir HG
• Kurt F
• Gul MO
• Gumus S

• KMID: 2527835
• DOI: http://doi.org/10.4174/astr.2022.102.4.185

Abstract

Purpose
Cholecystectomy is one of the most common surgeries today due to gallbladder diseases. The most prevalent malignancy of the biliary tract is gallbladder cancer. We aimed to discuss the results of our patients who underwent cholecystectomy for benign reasons in our clinic and who had gallbladder cancer due to pathology.
Methods
The results of cholecystectomy performed in General Surgery Clinic of Seyhan Government Hospital were evaluated. Cases diagnosed as gallbladder as a result of histopathological examination were included. Preoperative ultrasonography, laboratory findings, and postoperative pathology results of the patients were reviewed retrospectively. The pathologist repeated histopathological evaluations.
Results
Between 2010 and 2019, incidental gallbladder cancer (IGBC) was detected in 40 patients (0.3%) in 11,680 cholecystectomy operations. Of the patients diagnosed with IGBC, 14 (35.0%) were T1a, 11 (27.5%) were T1b, 11 (27.5%) were T2, and 4 (10.0%) were T3. T4 tumor was not seen in any patient. Three patients who were T1b at initial evaluation were identified as T2 at evaluation for the study. The pathology results of 37 patients (92.5%) were adenocarcinoma, 2 (5.0%) were adenosquamous type, and 1 (0.5%) was squamous cell carcinoma.
Conclusion
There has been a remarkable increase in the number of IGBCs over the past 20 years. Appropriate staging and histopathological evaluation are essential in guiding the surgeon’s operation. It is crucial to accurately determine the T stage, the most influential parameter on patient survival and residual recurrences. The distinction between pathologic (p) T1a and pT1b should be made carefully. Surgery is the only potentially curative method.

Keyword

Cholecystectomy; Gallbladder; Gallbladder neoplasms; Gallstones

Figure

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  Fig. 1 (A) Hepatoduodenal ligament dissection. (B) Diaphragmatic facial tumor implants (arrows). (C) Determination of hepatic resection line. (D) Hepatic parenchyma resection. Ch, choledochus; HA, hepatic artery; PV, portal vein.

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  Fig. 2 Kaplan-Meier survival curves by the depth of invasion (pathologic [p] T) in all incidental gallbladder cancer (IGBC) patients (n = 40). pT1a, tumor invades the lamina propria; pT1b, tumor invades the muscular layer; pT2, tumor invades the perimuscular connective tissue on the peritoneal side, without the involvement of the serosa or tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver; pT3, tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or 1 other adjacent organ or structure.

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