Journal of Gastrointestinal Surgery

, Volume 11, Issue 11, pp 1478–1487 | Cite as

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


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.


Gallbladder carcinoma Incidental Resection Residual disease Common bile duct 


  1. 1.
    Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin 2006;56:106–130.PubMedCrossRefGoogle Scholar
  2. 2.
    Shirai Y, Yoshida K, Tsukada K, Muto T. Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg 1992;215:326–331.PubMedCrossRefGoogle Scholar
  3. 3.
    Thorbjarnarson B, Glenn F. Carcinoma of the gallbladder. Cancer 1959;12:1009–1015.PubMedCrossRefGoogle Scholar
  4. 4.
    Cubertafond P, Gainant A, Cucchiaro G. Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey. Ann Surg 1994;219:275–280.PubMedCrossRefGoogle Scholar
  5. 5.
    Piehler JM, Crichlow RW. Primary carcinoma of the gallbladder. Surg Gynecol Obstet 1978;147:929–942.PubMedGoogle Scholar
  6. 6.
    Tsukada K, Hatakeyama K, Kurosaki I, Uchida K, Shirai Y, Muto T, et al. Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage. Surgery 1996;120:816–821.PubMedCrossRefGoogle Scholar
  7. 7.
    Bartlett DL, Fong Y, Fortner JG, Brennan MF, Blumgart LH. Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann Surg 1996;224:639–646.PubMedCrossRefGoogle Scholar
  8. 8.
    Fong Y, Heffernan N, Blumgart LH. Gallbladder carcinoma discovered during laparoscopic cholecystectomy: aggressive reresection is beneficial. Cancer 1998;83:423–427.PubMedCrossRefGoogle Scholar
  9. 9.
    Henson DE, Albores-Saavedra J, Corle D. Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates. Cancer 1992;70:1493–1497.PubMedCrossRefGoogle Scholar
  10. 10.
    Chijiiwa K, Tanaka M. Carcinoma of the gallbladder: an appraisal of surgical resection. Surgery 1994;115:751–756.PubMedGoogle Scholar
  11. 11.
    Muratore A, Polastri R, Bouzari H, Vergara V, Capussotti L. Radical surgery for gallbladder cancer: a worthwhile operation? Eur J Surg Oncol 2000;26:160–163.PubMedCrossRefGoogle Scholar
  12. 12.
    Foster JM, Hoshi H, Gibbs JF, Iyer R, Javle M, Chu Q, et al. Gallbladder cancer: defining the indications for primary radical resection and radical re-resection. Ann Surg Oncol 2007;14:833–840.PubMedCrossRefGoogle Scholar
  13. 13.
    Benoist S, Panis Y, Fagniez PL. Long-term results after curative resection for carcinoma of the gallbladder. French University Association for Surgical Research. Am J Surg 1998;175:118–122.PubMedCrossRefGoogle Scholar
  14. 14.
    Donohue JH, Nagorney DM, Grant CS, Tsushima K, Ilstrup DM, Adson MA. Carcinoma of the gallbladder. Does radical resection improve outcome? Arch Surg 1990;125:237–241.PubMedGoogle Scholar
  15. 15.
    Yamaguchi K, Tsuneyoshi M. Subclinical gallbladder carcinoma. Am J Surg 1992;163:382–386.PubMedCrossRefGoogle Scholar
  16. 16.
    Gallbladder. In Greene FL, Page DL, Fleming ID, et al., eds. American Joint Committee on Cancer Staging manual. New York, NY: Springer, 2002. pp 139–142.Google Scholar
  17. 17.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. Am Stat Assoc J 1958;53:457–480.CrossRefGoogle Scholar
  18. 18.
    Fong Y, Jarnagin W, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg 2000;232:557–569.PubMedCrossRefGoogle Scholar
  19. 19.
    Wakai T, Shirai Y, Yokoyama N, Ajioka Y, Watanabe H, Hatakeyama K. Depth of subserosal invasion predicts long-term survival after resection in patients with T2 gallbladder carcinoma. Ann Surg Oncol 2003;10:447–454.PubMedCrossRefGoogle Scholar
  20. 20.
    Yasui K, Shimizu Y. Surgical treatment for metastatic malignancies. Anatomical resection of liver metastasis: indications and outcomes. Int J Clin Oncol 2005;10:86–96.PubMedCrossRefGoogle Scholar
  21. 21.
    Yamamoto J, Saiura A, Koga R, Seki M, Ueno M, Oya M, et al. Surgical treatment for metastatic malignancies. Nonanatomical resection of liver metastasis: indications and outcomes. Int J Clin Oncol 2005;10:97–102.PubMedCrossRefGoogle Scholar
  22. 22.
    Zorzi D, Mullen JT, Abdalla EK, Pawlik TM, Andres A, Muratore A, et al. Comparison between hepatic wedge resection and anatomic resection for colorectal liver metastases. J Gastrointest Surg 2006;10:86–94.PubMedCrossRefGoogle Scholar
  23. 23.
    Chijiiwa K, Nakano K, Ueda J, Noshiro H, Nagai E, Yamaguchi K, et al. Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg 2001;192:600–607.PubMedCrossRefGoogle Scholar
  24. 24.
    Shimada H, Endo I, Togo S, Nakano A, Izumi T, Nakagawara G. The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer 1997;79:892–899.PubMedCrossRefGoogle Scholar
  25. 25.
    Nakamura S, Sakaguchi S, Suzuki S, Muro H. Aggressive surgery for carcinoma of the gallbladder. Surgery 1989;106:467–473.PubMedGoogle Scholar
  26. 26.
    Shimizu Y, Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, et al. Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer? Surgery 2004;136:1012–1017; discussion 1018.PubMedCrossRefGoogle Scholar
  27. 27.
    Kosuge T, Sano K, Shimada K, Yamamoto J, Yamasaki S, Makuuchi M. Should the bile duct be preserved or removed in radical surgery for gallbladder cancer? Hepatogastroenterology 1999;46:2133–2137.PubMedGoogle Scholar
  28. 28.
    Chijiiwa K, Tanaka M. Indications for and limitations of extended cholecystectomy in the treatment of carcinoma of the gall bladder. Eur J Surg 1996;162:211–216.PubMedGoogle Scholar
  29. 29.
    Wanebo HJ, Castle WN, Fechner RE. Is carcinoma of the gallbladder a curable lesion? Ann Surg 1982;195:624–631.PubMedCrossRefGoogle Scholar
  30. 30.
    Ouchi K, Owada Y, Matsuno S, Sato T. Prognostic factors in the surgical treatment of gallbladder carcinoma. Surgery 1987;101:731–737.PubMedGoogle Scholar
  31. 31.
    Chijiiwa K, Noshiro H, Nakano K, Okido M, Sugitani A, Yamaguchi K, et al. Role of surgery for gallbladder carcinoma with special reference to lymph node metastasis and stage using western and Japanese classification systems. World J Surg 2000;24:1271–1276; discussion 1277.PubMedCrossRefGoogle Scholar

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

Personalised recommendations