Relevance of residual disease after liver resection for incidental gallbladder cancer

Abstract

Objectives: In patients diagnosed with incidental gallbladder cancer (GC), the benefit and optimal extent of further surgery remain unclear. The aims of this study were to analyse outcomes in patients who underwent liver resection following a diagnosis of incidental GC and to determine factors associated with longterm survival. Methods: A retrospective analysis of patients diagnosed with incidental GC between June 1999 and June 2010 was performed. Data covering demographics, clinical and surgical characteristics and local pathological stage were analysed. Results: A total of 24 patients were identified. All patients underwent a resection of segments IVb and V and lymphadenectomy. Histological examination revealed residual disease in 10 patients, all of whom presented with recurrent disease at 3–12 months. Overall 5‐year survival was 53%. Increasing T‐stage (P < 0.001), tumour–node–metastasis (TNM) stage (P= 0.003), and the presence of residual tumour in the resected liver (P < 0.001) were all associated with worse survival. Conclusions: Aggressive re‐resection of incidental GC offers the only chance for cure, but its efficacy depends on the extent of disease found at the time of repeat surgery. The presence of residual disease correlated strongly with T‐stage and was the most relevant prognostic factor for survival in patients treated with curative resection.

Radical Surgery for Incidental Gallbladder Carcinoma. Which Subset of Patients is Really Suitable for?

“…In addition, while patients with in-situ and intramucosal carcinomas are all alive after a mean follow-up of 69 months, T2 and T3 lesions showed, overall, an unsatisfactory prognosis with a median of 19 and 5 months for the two groups, respectively; these findings coincide with those reported by many authors [7,8,[12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

“…Furthermore, the frequent occurrence of the gallbladder carcinoma in the seventh and eighth life decade [3] (8 patients in our group are more than 75 years old) could make problematic the indication to a demanding surgical procedure comprising an extended liver resection and nodal dissection, in which are described postoperative complication rates up to 30-40% [8,9], even in the more recent literature [13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Totally Laparoscopic Hepatic Bisegmentectomy (s4b+s5) and Hilar Lymphadenectomy for Incidental Gallbladder Cancer

“…This approach is similar to that used by other authors. 4,6,9 In a German multicenter study, resection of segments 4b and 5 was associated with improved long-term survival. 12,13 However, in a large cohort of patients from the French registry and Memorial Sloan Kettering Cancer Center, port-site excision was not associated with improved survival and therefore should not be considered mandatory during definitive surgical treatment of incidental gallbladder cancer.…”

“…The incidental diagnosis of gallbladder cancer often requires radical surgery to obtain appropriate oncological treatment surgery to obtain radical treatment. 3,4 This video shows minimally invasive treatment of a patient with an incidental gallbladder cancer diagnosed after laparoscopic cholecystectomy. The operation consisted of totally laparoscopic liver resection (segments 5 and 4b) and regional lymphadenectomy.…”

Benefit of extended radical surgery for incidental gallbladder carcinoma

“…Patients with tumors staged higher than T1b might have residual disease including lymph node involvement, liver bed infiltration, and bile duct involvement. To identify the appropriate surgical procedure and potential prognostic factors, there have been several reports characterizing IGC by the TNM stage, surgical procedure, existence of residual disease, and prognosis [15][16][17][18][19][20][21][22]. With respect to surgical treatment, the three important factors for determining the most appropriate procedure are liver resection, lymph node dissection, and bile duct resection.…”