Incidence of Finding Residual Disease for Incidental Gallbladder Carcinoma: Implications for Re-resection
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Re-resection for gallbladder carcinoma incidentally discovered after cholecystectomy is routinely advocated. However, the incidence of finding additional disease at the time of re-resection remains poorly defined. Between 1984 and 2006, 115 patients underwent re-resection at six major hepatobiliary centers for gallbladder carcinoma incidentally discovered during cholecystectomy. Data on clinicopathologic factors, operative details, TNM tumor stage, and outcome were collected and analyzed. Data on the incidence and location of residual/additional carcinoma discovered at the time of re-resection were also recorded. On pathologic analysis, T stage was T1 7.8%, T2 67.0%, and T3 25.2%. The median time from cholecystectomy to re-resection was 52 days. At the time of re-resection, hepatic surgery most often consisted of formal segmentectomy (64.9%). Patients underwent lymphadenectomy (LND) (50.5%) or LND + common bile duct resection (43.3%). The median number of lymph nodes harvested was 3 and did not differ between LND alone (n = 3) vs LND + common duct resection (n = 3) (P = 0.35). Pathology from the re-resection specimen noted residual/additional disease in 46.4% of patients. Of those patients staged as T1, T2, or T3, 0, 10.4, and 36.4%, respectively, had residual disease within the liver (P = 0.01). T stage was also associated with the risk of metastasis to locoregional lymph nodes (lymph node metastasis: T1 12.5%; T2 31.3%, T3 45.5%; P = 0.04). Cystic duct margin status predicted residual disease in the common bile duct (negative cystic duct, 4.3% vs positive cystic duct, 42.1%) (P = 0.01). Aggressive re-resection for incidental gallbladder carcinoma is warranted as the majority of patients have residual disease. Although common duct resection does not yield a greater lymph node count, it should be performed at the time of re-resection for patients with positive cystic duct margins because over one-third will have residual disease in the common bile duct.
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- Incidence of Finding Residual Disease for Incidental Gallbladder Carcinoma: Implications for Re-resection
Journal of Gastrointestinal Surgery
Volume 11, Issue 11 , pp 1478-1487
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Gallbladder carcinoma
- Residual disease
- Common bile duct
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
- 7. Department of Surgery, Johns Hopkins, 600 North Wolfe Street, Halsted 614, Baltimore, MD, 22187-6681, USA
- 2. Department of Surgery, Institute for Research and the Cure of Cancer, Candiolo, Italy
- 3. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
- 4. Department of Surgery, University of Virginia Medical Center, Charlottesville, VA, USA
- 5. Department of Surgery, University Hospital Essen, Essen, Germany
- 6. Department of Surgery, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil