Incidental Gallbladder Carcinoma Discovered after Laparoscopic Cholecystectomy: Identifying Patients Who will Benefit from Reoperation
- 265 Downloads
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.
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.
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).
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.
KeywordsGallbladder carcinoma Laparoscopic cholecystectomy Survival Reoperation Outcomes
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.
- 5.Ethun CG, Postlewait LM, Le N, et al.Association of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall Survival: A Multi-Institution Analysis From the US Extrahepatic Biliary Malignancy Consortium. JAMA Surg. 2017;152:143–149.CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Ethun CG, Postlewait LM, Le N, et al. A Novel Pathology-Based Preoperative Risk Score to Predict Locoregional Residual and Distant Disease and Survival for Incidental Gallbladder Cancer: A 10-Institution Study from the U.S. Extrahepatic Biliary Malignancy Consortium. Ann Surg Oncol. 2017;24:1343–1350.CrossRefPubMedGoogle Scholar
- 7.Creasy JM, Goldman DA, Gonen M et al. Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratificatioor Modified Treatment Strategies. J Gastrointest Surg. 2017 May 8.Google Scholar
- 18.Vega EA, Vinuela E, Yamashita S et al. Extended Lymphadenectomy Is Required for Incidental Gallbladder Cancer Independent of Cystic Duct Lymph Node Status. J Gastrointest Surg. 2017 Jul 27.Google Scholar