Is Port Site Resection Necessary in the Surgical Management of Gallbladder Cancer?

Maker, Ajay V.; Butte, Jean M.; Oxenberg, Jacqueline; Kuk, Deborah; Gönen, Mithat; Fong, Yuman; DeMatteo, Ronald P.; D’Angelica, Michael I.; Allen, Peter J.; Jarnagin, William R.

doi:10.1245/s10434-011-1850-9

Cited by 126 publications

(77 citation statements)

References 20 publications

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“…Paolucci et al reported an incidence of 17.1 % port site recurrence over a median period of 6 months after LC [14]. In a recent retrospective study from Memorial Sloan Kettering Cancer Centre, 69 patients after LC underwent definitive surgery with port site resection [18]. Port site recurrence was found in 13 patients (19 %) with T2 and T3 tumours.…”

Section: Laparoscopic Cholecystectomy and Port Site Recurrencementioning

confidence: 99%

Incidentally Detected Gallbladder Cancer- The Controversies and Algorithmic Approach to Management

et al. 2012

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Incidentally discovered gallbladder cancer (IGBC) is defined as the gallbladder cancer (GBC) diagnosed during or after the cholecystectomy done for unsuspected benign gallbladder disease. Laparoscopic cholecystectomy (LC) is the most common procedure performed for benign gallbladder disease worldwide. Majority of GBC patients have associated gallstones. With the advent of ultrasonography more patients are being diagnosed with gallstones and are being subjected to cholecytectomy. IGBC is found in 0.2-2.9 % of all cholecytectomies done for gallstone disease. It represents 27-41 % of all GBC. Patients with IGBC having Tis and T1a stage, with negative cystic duct margin can be treated by simple cholecystectomy alone. Patients with stage T1b and beyond should undergo restaging, and should be treated with radical re -resection (R0). Residual disease is found in 40-76 % patients on re-exploration. The survival rates of patients undergoing re resection for IGBC is similar to those undergoing primary radical surgery. LC is contraindicated in patients with GBC. Patients presenting post LC should undergo radical re-resection and additional port site excision, as they have a high incidence of port site metastasis. At cholecystectomy for benign gallbladder disease all gallbladder specimens should be opened before closing abdomen and if available all suspicious specimens should be sent for immediate frozen section. All gallbladder specimens should be subjected to histopathology examination to avoid missing GBC. The surgeon should have a high index of suspicion for GBC if encountering difficult cholecystectomy for a benign disease, and in patients with atypical clinical and ultrasound findings in high incidence areas.

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Section: Laparoscopic Cholecystectomy and Port Site Recurrencementioning

confidence: 99%

Incidentally Detected Gallbladder Cancer- The Controversies and Algorithmic Approach to Management

et al. 2012

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“…We read with great interest the article by Dr. Maker et al, 1 in which patients undergoing definitive resection for incidental gallbladder carcinoma (GBCA) after laparoscopic cholecystectomy (LC) were divided into two groups: laparoscopic port site resected (group 1, n = 69) and laparoscopic port site not resected (group 2, n = 44). The authors reported that the incidence of port-site metastases (PSMs) was as high as 19%, and median survival of patients with T2/T3 tumors without PSMs was 42 months compared with 17 months in patients with PSMs (P = 0.005), while excision of port sites did not affect overall survival or disease recurrence, so that port-site resection should not be considered mandatory during definitive surgical treatment of incidental GBCA.…”

Section: To the Editorsmentioning

confidence: 99%

Port-Site Resection in Surgical Management of Incidental Gallbladder Cancer: A Still Unresolved Question

Liu

Zhou

2017

Ann Surg Oncol

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“…Port site resection does not seem to improve survival and carries a 15% risk of incisional hernia. Patients with documented port site metastasis after resection develop peritoneal disease soon after [57,65]. Therefore, routine port site resection is not recommended [41].…”

Section: Updates In Gallbladder Diseasesmentioning

confidence: 99%

Incidental Gallbladder Cancer

Al-Alem¹,

Mattar²,

Madkhali³

et al. 2017

Updates in Gallbladder Diseases

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Gallbladder cancer (GBC) is a rare but fatal disease with an incidence of less than 5000 new cases per year in the United States. Less than 20% of GBC cases are diagnosed preoperatively. The remaining cases are diagnosed either after laparoscopic cholecystectomy or intraoperatively. GBC is discovered incidentally during histopathology following 0.25-3.0% of laparoscopic cholecystectomies; however, this constitutes 74-92% of all GBC. The most pivotal and important step is accurate patient staging. Staging dictates disease management and treatment options and predicts survival. Because of the fatality of GBC and its poor prognosis, atempts of curative surgery are limited to localized resectable disease.

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Is Port Site Resection Necessary in the Surgical Management of Gallbladder Cancer?

Abstract: In patients with incidental GBCA, port site metastases were associated with peritoneal disease and decreased survival. Port site resection was not associated with improved survival or disease recurrence and should not be considered mandatory during definitive surgical treatment.

Cited by 126 publications

References 20 publications

Incidentally Detected Gallbladder Cancer- The Controversies and Algorithmic Approach to Management

Incidentally Detected Gallbladder Cancer- The Controversies and Algorithmic Approach to Management

Port-Site Resection in Surgical Management of Incidental Gallbladder Cancer: A Still Unresolved Question

Incidental Gallbladder Cancer

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