Journal of Gastrointestinal Surgery

, Volume 22, Issue 4, pp 606–614 | Cite as

Incidental Gallbladder Carcinoma Discovered after Laparoscopic Cholecystectomy: Identifying Patients Who will Benefit from Reoperation

  • Pietro Addeo
  • Leonardo Centonze
  • Andrea Locicero
  • François Faitot
  • Hissam Jedidi
  • Emanuele Felli
  • Pascal Fuchshuber
  • Philippe Bachellier
Original Article
  • 181 Downloads

Abstract

Background

Despite an early radical reoperation, recurrence and poor survival are observed in up to 40% of patients with an incidentally discovered gallbladder carcinoma (I-GBC) after undergoing a laparoscopic cholecystectomy (LC). This study seeks to identify prognostic factors after re-I-GBC resection.

Methods

A retrospective review of a prospectively maintained patient database with patients who were undergoing resection for I-GBC from January 1995 to March 2017 was performed. Prognostic factors for survival were assessed by multivariate Cox analysis.

Results

There were 50 consecutive patients (median age 64 years; range 38–82) undergoing reoperation 45 ± 30 days after LC. Re-resection entailed a major hepatectomy in five patients (10%) and lymphadenectomy in all patients. Ninety-day morbidity and mortality were 22 and 2%, respectively. Lymph node (LN) involvement was present in 24 (48%) patients with a mean of 5.79 ± 14.4 LN+. Median overall survival was 40 months with 1-, 3-, 5- and 10-year survival rates of 80, 50, 41 and 36%, respectively. Independent risk factors for overall survival were T3 tumours (HR = 7.58; 95% confidence intervals (CI), 2.41–23.83.) and LN involvement (HR = 3.66; 95% CI, 1.42–9.45). Patients presenting with zero, one and two risk factors had 3-year survival rates of 85, 31 and 0%, respectively, and median overall survival of 80, 22 and 13 months, respectively (p < 0.0001).

Conclusions

After I-GBC discovery following an LC, T3 tumours and tumours with LN+ are characterised by poor prognosis. The presence and the identification of these prognostic factors help identify patients in need of alternative perioperative treatments.

Keywords

Gallbladder carcinoma Laparoscopic cholecystectomy Survival Reoperation Outcomes 

Notes

Author Contribution

Substantial contributions to the conception or design of the work: PA, LC, HJ, FF, Al, EF, PF, PB.

Acquisition, analysis or interpretation of data for the work: PA, LC, HJ, FF, Al, EF, PF, PB.

Drafting the work or revising it critically for important intellectual content: PA, LC, HJ, FF, Al, EF, PF, PB.

Final approval of the version to be published: PA, LC, HJ, FF, Al, EF, PF, PB.

Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: PA, LC, HJ, FF, Al, EF, PF, PB.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Pietro Addeo
    • 1
  • Leonardo Centonze
    • 1
  • Andrea Locicero
    • 1
  • François Faitot
    • 1
  • Hissam Jedidi
  • Emanuele Felli
    • 1
  • Pascal Fuchshuber
    • 2
  • Philippe Bachellier
    • 1
  1. 1.Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Digestives, Hépatiques et de la TransplantationHôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de StrasbourgStrasbourgFrance
  2. 2.The Permanente Medical GroupKaiser Medical CenterWalnut CreekUSA

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