Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: A systematic review and meta-analysis

Abstract

A large proportion of incidental GB cancers were T2 and T3 lesions. Revisional surgery for radical cholecystectomy is warranted in T2 and more advanced cancers.

Modifiable Factors and Genetic Predisposition Associated with Gallbladder Cancer. A Concise Review

“…Hayes and Muldoon [20] systematically surveyed 2,522 cholecystectomy records from an Irish population and reported similar frequencies of dysplasia (1.15%) and carcinoma (0.48%). These data are in agreement with a Cochrane review on 26 studies including 2,145 patients with a diagnosis of incidental or unsuspected GbCa during or after cholecystectomy, where cancerous lesions were found in 0.7% (95% CI 0.004 -0.012) [21]. In a small study in an Indian population (310 cases), 27 (8.7%) had acute cholecystitis, 280 (91.2%) chronic cholecystitis, 2 out of 290 cases with cholelithiasis (0.7%) were found to have coexistent histologically proven GbCa [22].…”

A retrospective analysis of patients with gallbladder cancer: surgical treatment and survival according to tumor stage

“…However, 47% of these tumors are incidentally diagnosed following the examination of a cholecystectomy specimen (5). The incidence of gallbladder cancer in cholecystectomy specimens ranges from 0.2% to 3% (6)(7)(8)(9).…”

Incidental gallbladder cancer: Missing links in Pakistani population

“…They also revealed that in most studies proper number of lymph nodes were either not resected or not sent which is case with our study as well. A meta-analysis involving 986 articles by Choi et al [8] found that most important clinical dilemma with IGBC is decision of second stage surgery both at clinician as well as patient end. Same dilemma is visible in our series where majority of patients refused definitive surgery in spite of thorough counseling.…”

“…Alterations in oncogenes, tumor suppressor genes, microsatellite instability and methylation of gene promoter areas act in synergy with recurrent or chronic mucosal inflammation to induce cancer although exact cause in not known [30]. Gallstones especially chronic one pose most significant risk although other suspected culprits [31] are advance age, female sex, positive family history, cholelithiasis, obesity (BMI > 30), parasitic infestations, chronic bacterial cholangitis especially by Salmonella and Helicobacter [32], porcelain gallbladder, large polyps >10 mm, heavy metals exposure and abnormal pancreaticobiliary duct junction [33] Clinical features are ominous but those harboring clue include persistent right upper quadrant pain, jaundice, nausea and weight loss [8]. Biochemical investigations are nonspecific.…”

“…Persistent right upper quadrant pain, jaundice, anorexia, nausea and weight loss are most common symptoms while palpable gallbladder is present in a few only. Deranged liver functions represent most common laboratory finding [8]. Though ultrasonography (USG) is most widely used initial screening as well diagnostic tool, it lacks sensitivity and specificity for early cancer.…”