Profile and Number of Residual Tumor Worsen the Prognosis of Incidental Gallbladder Cancer

Abstract

Introduction: Incidental gallbladderr cancer (IGC) has an overall 5-year survival of around 40% but this figure concerns patients with secondary resection. The pT1b, pT2 and pT3 tumors especially require a surgical revision in order to resect the tumor residue left in place after cholecystectomy. The latter represents on average 48% depending on the series. The chances of secondary resection depend mainly on the tumor residue and the majority of patients will not benefit from it. The aim of this work is to analyze the impact of the tumor residue (sites and its profile) on the prognosis of a histological finding of IGC treated by secondary radical surgery. Material and Method:Retrospective study of all pT1b, pT2 and pT3 tumors which benefited from radical secondary resection and we analyzed the tumor residue in them and divided the patients into 4 groups. Group A (Without visceral residue or lymph node), group B (patients with only lymph node tumor residue), group C (patients with visceral tumor residue only) and group D (patients with visceral and lymph node tumor residue).Results: Ninety-nine women and 13 men, with a mean age of 57 years (26 -75 years) were included. The time of surgical revision was 93.5days (30 -387days). Fifty-two patients (46.4%) presented with tumor residue. Dissemination of the disease was noted in 23 patients (20.5%). The first 3 tumor sites are the lymph nodes, the liver and the peritoneal serosa. The patients are divided into 60 for the group A (53.6%), 18 for the group B (16%), 19for the group C (17%) and 15 for the group D (13.4%). It should also be noted that the presence of double and triple tumor foci mainly concerns the group D (double and triple foci only) while for the group C, single foci are more frequent than double and triple foci. Overall survival at 5 years in group A is 66.7%, that of groups B and C is respectively 33.3% and 31.6% while it is zero in group D. Moreover and beyond of a tumor residue equal or greater than 2 residual tumor foci, survival is zero. Conclusion:The profile and number of the tumor residue is a good indicator of survival in patients with IGC. These result could help oncological team to choose patients for secondary radical surgery.