Residual disease in lymph nodes has no influence on survival in patients with incidental gallbladder cancer – institution experience with literature review

Background A better appreciation of the course and factors that influence incidental gallbladder cancer (iGBC) is needed to develop treatment strategies aimed to improve outcomes. The purpose of the study was to determine the influence of residual disease in the liver and lymph nodes on overall survival in re-resected patients with iGBC. Patients and methods Patients undergoing radical re-resection for iGBC from January 2012 to December 2018 were retrospectively identified. Patients with a 5-year follow-up and submitted to complete resection with stage I, II and III disease were analysed. The influence of residual disease (RD) in liver and lymph nodes on survival was assessed using the Kaplan-Meier curves. In addition, the rest of the group was assessed based on type of primary/secondary procedure, number of harvested lymph nodes and RD in liver and/or lymph nodes. Results In this retrospective study 48 out of 58 (83%) patients underwent re-resection. Among the group with a 5-year follow-up (re-operation between 2012–2014), 22 patients out of 28 (79%) were re-resected. Survival analysis showed that patients with no RD in the liver and lymph nodes had statistically significant better 5-year survival than those with RD. Comparing 5-year survival rate in patients with RD in the liver or lymph nodes against no RD group, patients with RD in the liver had statistically significantly worse 5-year survival, while lymph node metastases did not show any statistically significant different in 5-year survival. Besides, a statistically significant better prognosis was found in stage II disease compared to stage III, as expected. Conclusions The most important predictors of a 5-year survival in our study were RD in liver and stage of the disease. Lymph node metastases did not have any impact on the overall 5-year survival rate.

Incidental Gallbladder Cancer with the Laparoscopic Treatment in the MRI Era: An Experience at a Single Institution

Background: Magnetic resonance imaging (MRI) has been widely applied to the preoperative diagnosis of gallbladder diseases, among which laparoscopic cholecystectomy plays a critical role. Incidental gallbladder cancer (IGBC) is an unexpected guest of the patients who underwent cholecystectomy, forcing them to receive reoperation for complete resection. This study aimed to share our experience in pre-operative MRI evaluation and laparoscopic management of the IGBCs. Methods: Between January 2011 and January 2020, 7917 patients with gallbladder diseases and treated by laparoscopy were enrolled in this study. Results: A total of 49 patients were diagnosed as IGBCs. The incidence of IGBCs in polypoid lesions, biliary pancreatitis, cholecystitis, cholecystocholedocholithiasis and gallbladder stones was 0.42%, 1.19%, 0.62%, 1.20% and 0.49%, respectively. Moreover, 73.5% and 59.2% of the IGBCs had unremarkable preoperative imaging during the ultrasonographic and MRI evaluation respectively. Also, 14 of the patients were diagnosed as gallbladder cancer (GBC) via intraoperative histological examination, and 11 received laparoscopic extensive resection after cholecystectomy.Conclusion: The patients with biliary pancreatitis and cholecystocholedocholithiasis have a higher incidence of incidental gallbladder cancer. Preoperative MRI evaluation and intraoperative histological examination may help some incidental gallbladder cancers to achieve one-stage laparoscopic extensive resection.

Incidental Gallbladder Cancer: Routine versus Selective Histological Examination After Cholecystectomy

Background Incidental gallbladder cancer is relatively rare, with an incidence ranging between 0.19 and 5.5% of all the cholecystectomies for benign disease, and carries a poor prognosis. Currently, in the literature, there appears to be some controversy about whether all gallbladder specimens should be sent for routine histopathology. The aim of this study was to investigate the need for either routine or selective histopathological evaluation of all gallbladder specimens following cholecystectomy in our institution. Methods The records of all patients who underwent a cholecystectomy (laparoscopic and open) for gallstone disease over a 5-year period (between January 2011 and January 2016) were reviewed retrospectively in a single university teaching hospital. Patients with radiological evidence of gallbladder cancer preoperatively were excluded. The notes of patients with incidental gallbladder cancer were reviewed and data were collected for clinical presentation and preoperative investigations including blood tests and radiological imaging. Results A total of 1,473 specimens were sent for histopathological evaluation, with two patients being diagnosed with an incidental gallbladder cancer (papillary adenocarcinoma in situ and moderately differentiated invasive adenocarcinoma [stage IIIa]). The incidence rate was 0.14%. All patients with incidental gallbladder cancer had macroscopically abnormal specimens. Conclusion Both patients in our study who were diagnosed with incidental gallbladder cancer had macroscopic abnormalities. A selective rather than routine approach to histological evaluation of gallbladder specimens especially in those with macroscopic abnormalities should be employed. This will reduce the burden on the pathology department with potential cost savings.