Management of cancer gallbladder found as a surprise on a resected gallbladder specimen

Misra, Mahesh Chandra; Guleria, Sandeep

doi:10.1002/jso.20537

Cited by 80 publications

(51 citation statements)

References 37 publications

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“…On the other hand, accompanying GB stones are a well known independent risk factor for malignancy in western countries. [24][25][26] However, the presence of a GB stone was not found to be an independent risk factor for the presence of a malignant GB polyp in the present study (Table 4). This result implies that the presence of a GB stone is not a strong risk factor for GB cancer in the Korean population.…”

Section: Discussioncontrasting

confidence: 66%

Management Strategies for Gallbladder Polyps: Is It Possible to Predict Malignant Gallbladder Polyps?

Park

Yoon²,

Kim³

et al. 2008

Gut Liver

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Background/Aims: Gallbladder (GB) polyps are commonly encountered in clinical practice, and are found more frequently as the number of medical screening examinations increases. The aim of this study was to determine optimal practice guideline for surgical treatment and follow-up of GB polyps. Methods: Data from healthy subjects of Seoul National University Hospital (SNUH) Health Care System of Gangnam Center were used to investigate the true prevalence of GB polyps. We also enrolled 689 patients with GB polyps diagnosed at SNUH from The GB polyp prevalence was 6.1% (7.1% in males and 4.8% in females). The median follow-up duration in the 689 study patients was 60 months, and 139 (20%) of them had polyps ≥10 mm in size. Twenty-five of the 180 patients who underwent cholecystectomy had adenocarcinomas. The χ 2 test was used to identify which of the following were risk factors of malignancy: age, sex, symptoms, size, rate of growth, multiplicity, accompanying stones, and shape. Age (≥57 years), presence of symptoms, size (≥10 mm), and shape (sessile) were found to be statistically significant risk factors by univariate analysis. However, multivariate analysis identified only age (≥57 years) and size (≥10 mm) as independent predictors of malignancy. Conclusions:The present study shows that GB polyps ≥10 mm in size in patients aged ≥57 years are the independent factors predicting malignancy of the GB. (Gut and Liver 2008;2:88-94)

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Section: Discussioncontrasting

confidence: 66%

Management Strategies for Gallbladder Polyps: Is It Possible to Predict Malignant Gallbladder Polyps?

Park

Yoon²,

Kim³

et al. 2008

Gut Liver

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“…The difficulty in early diagnosis of gallbladder carcinoma results from its poor specificity in clinical symptoms and ambiguous early symptoms, which seriously affects prognosis [1][2][3][4][5][6] . Some patients were found having gallbladder carcinoma only when they were diagnosed and treated because of other diseases [7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

A clinicopathological analysis in unsuspected gallbladder carcinoma: A report of 23 cases

Zou²

2007

WJG

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AIM:To study the clinicopathological characteristics of unsuspected gallbladder carcinoma (UGC). METHODS:We retrospectively studied 23 cases of UGC in Tongji Hospital, and compared their clinicopathological characteristics with 33 cases of preoperatively diagnosed gallbladder carcinoma (PDGC). RESULTS:The proportion of UGC coexisting with cholecystolithiasis was significantly higher than that of PDGC (χ 2 = 13.53, P < 0.01). The infection rate of hepatitis B virus was 21.74% (5/23) in UGC and 30.30% (10/33) in PDGC. Nine (39.13%) of 23 patients with UGC and 8/33 (24.24) PDGC had contact with schistosome pestilent water. The rate of multiple pregnancies was 56.52% (13/23) in the patients with UGC and 42.42% (14/33) in PDGC. The primary location of the UGC was mostly in the neck and body of the gallbladder, and that of the PDGC was often in the body and bottom. The incidence of Nevin stageⅠand Ⅱ UGC was significantly higher than that of PDGC (χ 2 = 4.44, P < 0.05 and χ 2 = 4.96, P < 0.05) while that of Nevin stage Ⅴ UGC was significantly lower than that of PDGC (χ 2 = 7.59, P < 0.01).According to the grading of carcinoma, the incidence of well-differentiated UGC was significantly higher than that of PDGC (χ 2 = 4.16, P < 0.05), and that of poorlydifferentiated UGC was significantly lower than that of PDGC (χ 2 = 4.48, P < 0.05). CONCLUSION:There are different characteristics between UGC and PDGC, such as in primary location, malignant degree and incidence of coexistence with cholecystolithiasis. Cholecystolithiasis, hepatitis B, schistosome and multiple pregnancies were high risk factors for gallbladder carcinoma.

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“…Additional investigations are then required to determine which patients with localised disease would benefit from potentially curative resection. 8 Currently, there is no consensus concerning the optimal preoperative staging and selection process for radical resection in patients with potentially resectable pT2/T3 IGBC. Early post-cholecystectomy cross-sectional imaging with computed tomography (CT) or magnetic resonance imaging is generally the standard restaging policy often considered in conjunction with laparoscopy given the high rate of occult disseminated disease.…”

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confidence: 99%

Implications of the Index Cholecystectomy and Timing of Referral for Radical Resection of Advanced Incidental Gallbladder Cancer

Tsirlis

Ausania

White

et al. 2015

annals

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INTRODUCTION Advanced (pT2/T3) incidental gallbladder cancer is often deemed unresectable after restaging. This study assesses the impact of the primary operation, tumour characteristics and timing of management on re-resection. METHODS The records of 60 consecutive referrals for incidental gallbladder cancer in a single tertiary centre from 2003 to 2011 were reviewed retrospectively. Decision on re-resection of incidental gallbladder cancer was based on delayed interval restaging at three months following cholecystectomy. Demographics, index cholecystectomy data, primary pathology, CA19-9 tumour marker levels at referral and time from cholecystectomy to referral as well as from referral to restaging were analysed. RESULTS Thirty-seven patients with pT2 and twelve patients with pT3 incidental gallbladder cancer were candidates for radical re-resection. Following interval restaging, 24 patients (49%) underwent radical resection and 25 (51%) were deemed inoperable. The inoperable group had significantly more patients with positive resection margins at cholecystectomy (p=0.002), significantly higher median CA19-9 levels at referral (p=0.018) and were referred significantly earlier (p=0.004) than the patients who had resectable tumours. On multivariate analysis, urgent referral (p=0.036) and incomplete cholecystectomy (p=0.048) were associated significantly with inoperable disease following restaging. CONCLUSIONS In patients with incidental, potentially resectable, pT2/T3 gallbladder cancer, inappropriate index cholecystectomy may have a significant impact on tumour dissemination. Early referral of breached tumours is not associated with resectability.

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Management of cancer gallbladder found as a surprise on a resected gallbladder specimen

Cited by 80 publications

References 37 publications

Management Strategies for Gallbladder Polyps: Is It Possible to Predict Malignant Gallbladder Polyps?

Management Strategies for Gallbladder Polyps: Is It Possible to Predict Malignant Gallbladder Polyps?

A clinicopathological analysis in unsuspected gallbladder carcinoma: A report of 23 cases

Implications of the Index Cholecystectomy and Timing of Referral for Radical Resection of Advanced Incidental Gallbladder Cancer

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