Journal of Gastrointestinal Surgery

, Volume 11, Issue 11, pp 1478–1487

Incidence of Finding Residual Disease for Incidental Gallbladder Carcinoma: Implications for Re-resection

  • Timothy M. Pawlik
  • Ana Luiza Gleisner
  • Luca Vigano
  • David A. Kooby
  • Todd W. Bauer
  • Andrea Frilling
  • Reid B. Adams
  • Charles A. Staley
  • Eduardo N. Trindade
  • Richard D. Schulick
  • Michael A. Choti
  • Lorenzo Capussotti
Article

DOI: 10.1007/s11605-007-0309-6

Cite this article as:
Pawlik, T.M., Gleisner, A.L., Vigano, L. et al. J Gastrointest Surg (2007) 11: 1478. doi:10.1007/s11605-007-0309-6

Abstract

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.

Keywords

Gallbladder carcinomaIncidentalResectionResidual diseaseCommon bile duct

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Timothy M. Pawlik
    • 1
    • 7
  • Ana Luiza Gleisner
    • 1
  • Luca Vigano
    • 2
  • David A. Kooby
    • 3
  • Todd W. Bauer
    • 4
  • Andrea Frilling
    • 5
  • Reid B. Adams
    • 4
  • Charles A. Staley
    • 3
  • Eduardo N. Trindade
    • 6
  • Richard D. Schulick
    • 1
  • Michael A. Choti
    • 1
  • Lorenzo Capussotti
    • 2
  1. 1.Department of SurgeryJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Department of SurgeryInstitute for Research and the Cure of CancerCandioloItaly
  3. 3.Department of SurgeryEmory University School of MedicineAtlantaUSA
  4. 4.Department of SurgeryUniversity of Virginia Medical CenterCharlottesvilleUSA
  5. 5.Department of SurgeryUniversity Hospital EssenEssenGermany
  6. 6.Department of SurgeryUniversidade Federal do Rio Grande do SulPorto AlegreBrazil
  7. 7.Department of SurgeryJohns HopkinsBaltimoreUSA