Abstract
Gallbladder cancer (GBC) represents 3.8% of all gastrointestinal cancers and usually known to be of a poor prognosis. In 0.2–2.9% of cases, this cancer is found in cholecystectomy specimens. A better understanding of spread mode of this tumor helps a better surgical management. The aim of the present review is to underline the management of GBC based on the comprehension of risk factors and anatomic features. A Medline, PubMed database search was performed to identify articles published from 2000 to 2011 using the keywords ‘carcinoma of gallbladder’, ‘incidental gallbladder cancer’, ‘gallbladder neoplasm’ and ‘cholecystectomy’. Some pathological situations such as chronic lithiasis and biliopancreatic junction abnormalities have been clearly identified as predisposing to GBC. Laparoscopy increases peritoneal and parietal tumor dissemination, thus, it should not be performed when GBC is suspected. Most determinant prognostic factors are nodal, perineural and venous involvement, invasion of the cystic duct and the tumor differentiation. The simple cholecystectomy is sufficient for tumors classified as T1a; for other cancers exceeding the muscularis, radical re-resection is required due to the high risk of recurrence. This aggressive surgery improved the overall survival of patients. There is still no standard adjuvant treatment; patients should be included in prospective trials.
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References
Toyonaga T, Chijiiwa K, Nakano K et al (2003) Completion radical surgery after cholecystectomy for accidentally undiagnosed gallbladder carcinoma. World J Surg 27(3):266–271
Kayahara M, Nagakawa T (2007) Recent trends of gallbladder cancer in Japan: an analysis of 4, 770 patients. Cancer. 110(3):572–580
Miller G, Jarnagin WR (2008) Gallbladder carcinoma. Eur J Surg Oncol 34(3):306–312
Duffy A, Capanu M, Abou-Alfa GK et al (2008) Gallbladder cancer : 10-year experience at Memorial Sloan-Kettering Cancer Centre (MSKCC). J Surg Oncol 98(7):485–489
Pawlik TM, Gleisner AL, Vigano L et al (2007) Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection. J Gastrointest Surg. 11(11):1478–1486
Fong Y, Jarnagin W, Blumgart LH (2000) Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg 232(4):557–569
Kianmanesh R, Scaringi S, Castel B, Flamant Y, Msika S (2007) Precancerous lesions of the gallbladder. J Chir 144(4):278–286
Randi G, Franceschi S, La Vecchia C (2006) Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer 118(7):1591–1602
Zou S, Zhang L (2000) Relative risk factors analysis of 3, 922 cases of gallbladder cancer. Zhonghua Wai Ke Za Zhi 38:805–808
Csendes A, Becerra M, Rojas J, Medina E (2000) Number and size of stones in patients with asymptomatic and symptomatic gallstones and gallbladder carcinoma: a prospective study of 592 cases. J Gastrointest Surg 4:481–485
Strom BL, Soloway RD, Rios-Dalenz JL et al (1995) Risk factors for gallbladder cancer. An international collaborative case-control study. Cancer 76:1747–1756
Chattopadhyay D, Lochan R, Balupuri S, Gopinath BR, Wynne KS (2005) Outcome of gall bladder polypoidal lesions detected by transabdominal ultrasound scanning: a nine year experience. World J Gastroenterol 11(14):2171–2173
Hu B, Gong B, Zhou DY (2003) Association of anomalous pancreaticobiliary ductal junction with gallbladder carcinoma in Chinese patients: an ERCP study. Gastrointest Endosc 57:541–545
Buckles DC, Lindor KD, Larusso NF, Petrovic LM, Gores GJ (2002) In primary sclerosing cholangitis, gallbladder polyps are frequently malignant. Am J Gastroenterol 97:1138–1142
Yoshimitsu K, Honda H, Kaneko K et al (1997) Anatomy and clinical importance of cholecystic venous drainage: helical CT observations during injection of contrast medium into the cholecystic artery. AJR Am J Roentgenol 169(2):505–510
Kai K, Satoh S, Watanabe T, Endo Y (2010) Evaluation of cholecystic venous flow using indocyanine green fluorescence angiography. J Hepatobiliary Pancreat Sci 17(2):147–151
Uesaka K, Yasui K, Morimoto T, Torii et al (1996) Visualization of routes of lymphatic drainage of the gallbladder with carbon particle suspension. J Am Coll Surg 183:345–350
Shimada H, Endo I, Togo S et al (1997) The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer 79:892–899
Tsukada K, Kurosaki I, Uchida K et al (1997) Lymph node spread from carcinoma of the gallbladder. Cancer 80:661–667
Yokoyama N, Shirai Y, Hatakeyama K (1999) Immunohistochemical detection of lymph node micrometastases from gallbladder carcinoma using monoclonal anticytokeratin antibody. Cancer 85:1465–1469
Wakai T, Shirai Y, Yokoyama N et al (2001) Early gallbladder carcinoma does not warrant radical resection. Br J Surg 88(5):675–678
Wakai T, Shirai Y, Yokoyama N et al (2003) Depth of subserosal invasion predicts long-term survival after resection in patients with T2 gallbladder carcinoma. Ann Surg Oncol 10(4):447–454
Edge SB (2010) American Joint Committee on Cancer: AJCC cancer staging manual, 7th edn. Springer, New York
Kaneoka Y, Yamaguchi A, Isogai M et al (2003) Hepatoduodenal ligament invasion by gallbladder carcinoma: histologic patterns and surgical recommendation. World J Surg 27(3):260–265
Nakata T, Kobayashi A, Miwa S et al (2007) Impact of tumor spread to the cystic duct on the prognosis of patients with gallbladder carcinoma. World J Surg 31(1):155–161
Balachandran P, Agarwal S, Krishnani N et al (2006) Predictors of long-term survival in patients with gallbladder cancer. J Gastrointest Surg. 10(6):848–854
Lundberg O, Kristoffersson A (1999) Port site metastasis from gallbladder cancer after laparoscopic cholecystectomy. Results of a swedish survey and review of published reports. Eur J Surg 165:215–222
Paolucci V, Schaeff B, Schneider M, Gutt C (1999) Tumor seeding following laparoscopy: international survey. World J Surg 23:989–997
Frauenschuh D, Greim R, Kraas E (2000) How to proceed in patients with carcinoma detected after laparoscopic cholecystectomy. Langenbecks Arch Surg 385(8):495–500
Fong Y, Hefferman N, Blumgart LH (1998) Gallbladder carcinoma discovered during laparoscopic cholecystectomy. Aggressive resection is beneficial. Cancer 83:423–427
Chiche L, Metairie S (2001) Le cancer de la vésicule de découverte fortuite. J Chir (Paris). 138(6):336–341
Fuks D, Regimbeau JM, Le Treut YP, Bachellier P, Raventos A, Pruvot FR, Chiche L, Farges O (2011) Incidental gallbladder cancer by the AFC-GBC-2009 study group. World J Surg 35(8):1887–1897
Goetze TO, Paolucci V (2010) Adequate extent in radical re-resection of incidental gallbladder carcinoma: analysis of the German Registry. Surg Endosc 24:2156–2164
Kosuge T, Sano K, Shimada K et al (1999) Should the bile duct be preserved or removed in radical surgery for gallbladder cancer? Hepatogastroenterology 46(28):2133–2137
Araida T, Higuchi R, Hamano M, Kodera Y, Takeshita N, Ota T, Yoshikawa T, Yamamoto M, Takasaki K (2009) Should the extrahepatic bile duct be resected or preserved in R0 radical surgery for advanced gallbladder carcinoma? Results of a Japanese Society of Biliary Surgery Survey: a multicenter study. Surg Today 39:770–779
Goetze TO, Paolucci V (2008) Benefits of reoperation of T2 and more advanced incidental gallbladder carcinoma: analysis of the German registry. Ann Surg 247(1):104–108
Pilgrim C, Usatoff V, Evans PM (2009) A review of the surgical strategies for the management of gallbladder carcinoma based on T stage and growth type of the tumour. Eur J Surg Oncol 35(9):903–907
Eguchi H, Ishikawa O, Ohigashi H et al (2005) Surgical significance of superficial cancer spread in early gallbladder cancer. J Clin Oncol 35(3):134–138
Mekeel KL, Hemming AW (2007) Surgical management of gallbladder carcinoma: a review. J Gastrointest Surg 11(9):1188–1193
Misra MC, Guleria S (2006) Management of cancer gallbladder found as a surprise on a resected gallbladder specimen. J Surg Oncol 93:690–698
Goetze TO, Paolucci V (2011) Immediate radical re-resection of incidental T1b gallbladder cancer and the problem of an adequate extent of resection (results of the German Registry “Incidental gallbladder cancer”). Zentralbl Chir.1
Rodriguez Otero JC, Proske A et al (2006) Gallbladder cancer: surgical results after cholecystectomy in 25 patients with lamina propria invasion and 26 patients with muscular layer invasion. J Hepatobiliary Pancreat Surg 13:562–566
Principe A, Del Gaudio M, Ercolani G (2006) Radical surgery for gallbladder carcinoma: possibilities of survival. Hepatogastroenterology 53:660–664
Cucinotta E, Lorenzini C, Melita G et al (2005) Incidental gall bladder carcinoma: does the surgical approach influence the outcome? A N Z J Surg 75:795–798
Ouchi K, Mikuni J, Kakugawa Y, Organizing committee, the 30th Annual Congress of the Japanese Society of Biliary Surgery (2002) Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patients. J Hepatobiliary Pancreat Surg 9:256–260
Dai M, Fong Y, Lowy A (2009) Treatment of T3 Gallbladder Cancer. J Gastrointest Surg 13(11):2040–2042
Alberts SR, Al-Khatib H, Mahoney MR et al (2005) Gemcitabine, 5-fluorouracil, and leucovorin in advanced biliary tract and gallbladder carcinoma: a North Central Cancer Treatment Group phase II trial. Cancer 103:111–118
Yoneto T, Yoshikawa K, Fujii Y (2005) A patient with recurrent gallbladder cancer responding to chemotherapy with CDDP/CPT-11 and gemcitabine. Gan To Kagaku Ryoho 32(1):99–102
Yehuda Z, Patt MD (2004) Oral capecitabine for the treatment of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder carcinoma. Cancer 101(3):578–586
Takada T, Amano H, Yasuda H et al (2002) Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer. 95(8):1685–1695
Mojica P, Smith D, Ellenhorn J (2007) Adjuvant radiation therapy is associated with improved survival for gallbladder carcinoma with regional metastatic disease. J Surg Oncol 96(1):8–13
Wang SJ, Fuller CD, Kim JS et al (2008) Prediction model for estimating the survival benefit of adjuvant radiotherapy for gallbladder cancer. J Clin Oncol 26(13):2112–2117
Gold DG, Miller RC, Haddock MG et al (2009) Adjuvant therapy for gallbladder carcinoma: the Mayo Clinic experience. Int J Radiat Oncol Biol Phys 75(1):150−155
Cho SY, Kim SH, Park SJ et al (2010) Adjuvant chemoradiation therapy in gallbladder cancer. J Surg Oncol 102(1):87–93
Chijiiwa K, Nakano K, Ueda J et al (2001) Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg 192(5):600–607
Wakai T, Shirai Y, Yokoyama N et al (2001) Early gallbladder carcinoma does not warrant radical resection. Br J Surg 88(5):675–678
Shirai Y, Yoshida K, Tsukada K et al (1992) Early carcinoma of the gallbladder. Eur J Surg 158:545–548
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Bouchentouf, S.M., Raissouni, S., Sall, I. et al. Incidental gallbladder cancer: what management?. Oncol Rev 5, 241–247 (2011). https://doi.org/10.1007/s12156-011-0092-1
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DOI: https://doi.org/10.1007/s12156-011-0092-1