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Port-Site Metastases in Incidentally Detected Carcinoma Gall Bladder: Role of 18F-FDG PET/CT and Patient Outcome

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Abstract

Background

Incidentally detected gall bladder carcinoma (IGBC) is occasionally encountered after cholecystectomy for benign gall bladder disease. Rarely these patients may present with port-site metastases (PSM) in follow-up. We retrospectively assessed the role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) in them. We aimed to determine the clinical outcome and correlate the survival based on FDG PET/CT findings.

Material and Method

We did a single-center retrospective study in IGBC patients presented with histopathologically proven PSM. FDG PET/CT was done for restaging. The metastatic burden was evaluated. Survival after PSM and overall survival (OS) were assessed in different disease groups.

Results

A total of 22 patients (51.86 ± 12.04 years) were included in the study. The mean interval between LC and PSM was 336.7 ± 501.9 days. On FDG PET/CT, isolated single PSM was noted in 21 (95.5%) patients. Apart from PSM, abdominal lymph nodes, GB fossa lesion, and liver metastases were noted in the 10 (45.5%), 6 ( 27.3%), and 7 (31.8%) patients, respectively. FDG PET/CT revealed intra-abdominal disease and visceral metastasis in 11 (50%) and 10 (45.5%) patients. Nineteen (86.4%) patients died in follow-up with a median survival of 328.50 (225.25–804.0) day after PSM. Median OS after LC was 687.00 (362.50–1047.0) days. Patients with PSM plus disease (432.0 days, 255.9–608.1), extra-abdominal metastases (400.0 days, 316.9–483.1), and visceral metastases (400.0 days, 296.2–503.8) had significantly lower OS compared to isolated PSM (1763 days, p = 0.013), the intra-abdominal disease (996.0 days, 753.2–1238.8, p = 0.0340), and non visceral metastasis (807.0 days, 467.5–1146.4, p = 0.037).

Summary

IGBC presenting as PSM is a distinct clinical entity. FDG PET/CT as functional imaging evaluates the local and metastatic disease burden. There is significantly lower survival in patients with PSM plus disease, extra-abdominal metastases, or visceral metastases. FDG PET/CT was an important prognostic marker in these patients and could help in management.

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Abbreviations

FDG-PET/CT:

18F-fluorodeoxyglucose positron emission tomography-computed tomography

HPE:

Histopathology

CaGB:

Carcinoma gall bladder

OS:

Overall survival

References

  1. Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol. 2014;6:99–109.

    PubMed  PubMed Central  Google Scholar 

  2. Misra S, Chaturvedi A, Misra NC, Sharma ID. Carcinoma of the gallbladder. Lancet Oncol. 2003;4(3):167–76.

    Article  Google Scholar 

  3. Gonzalez-Escobedo G, Marshall JM, Gunn JS. Chronic and acute infection of the gall bladder by Salmonella Typhi: understanding the carrier state. Nat Rev Microbiol. 2011;9(1):9–14.

    Article  CAS  Google Scholar 

  4. Kumar S, Kumar S, Kumar S. Infection as a risk factor for gallbladder cancer. J Surg Oncol. 2006;93(8):633–9.

    Article  Google Scholar 

  5. Cavallaro A, Piccolo G, Di Vita M, Zanghì A, Cardì F, Di Mattia P, et al. Managing the incidentally detected gallbladder cancer: algorithms and controversies. Int J Surg. 2014;12(Suppl 2):S108–19.

    Article  Google Scholar 

  6. Duffy A, Capanu M, Abou-Alfa GK, Huitzil D, Jarnagin W, Fong Y, et al. Gallbladder cancer (GBC): 10-year experience at Memorial Sloan-Kettering Cancer Centre (MSKCC). J Surg Oncol. 2008;98(7):485–9.

    Article  CAS  Google Scholar 

  7. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30.

    Article  Google Scholar 

  8. Skalický T, Třeška V, Liška V, Molacek J, Fichtl J, Skalický A, al. Treatment of accidentally diagnosed gallbladder cancer after laparoscopic cholecystectomy. Clinics In Surgery [Internet]. 2018 Nov 1 [cited 2021 Jul 15];3(1). Available from: https://www.remedypublications.com/clinics-in-surgery-abstract.php?aid=3604

  9. Cavallaro A, Piccolo G, Panebianco V, Lo Menzo E, Berretta M, Zanghì A, et al. Incidental gallbladder cancer during laparoscopic cholecystectomy: managing an unexpected finding. World J Gastroenterol. 2012;18(30):4019–27.

    Article  Google Scholar 

  10. Z’graggen K, Birrer S, Maurer CA, Wehrli H, Klaiber C, Baer HU. Incidence of port site recurrence after laparoscopic cholecystectomy for preoperatively unsuspected gallbladder carcinoma. Surgery. 1998 Nov;124(5):831–8.

  11. Berger-Richardson D, Chesney TR, Englesakis M, Govindarajan A, Cleary SP, Swallow CJ. Trends in port-site metastasis after laparoscopic resection of incidental gallbladder cancer: a systematic review. Surgery. 2017;161(3):618–27.

    Article  Google Scholar 

  12. Agarwala V, Ramaswamy A, Dsouza S, Pande N, Goel M, Patkar S, et al. Resection of isolated port site metastasis in gall bladder cancers-careful selection and perioperative systemic therapy may improve outcomes. Indian J Surg Oncol. 2018;9(3):427–31.

    Article  Google Scholar 

  13. Hu J-B, Sun X-N, Xu J, He C. Port site and distant metastases of gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography. World J Gastroenterol. 2008;14(41):6428–31.

    Article  Google Scholar 

  14. Sharma P, Chatterjee P. Late port site metastasis from occult gall bladder carcinoma after laparoscopic cholecystectomy for cholelithiasis: the role of (18)F-FDG PET/CT. Nucl Med Mol Imaging. 2014;48(4):317–20.

    Article  CAS  Google Scholar 

  15. Delbeke D, Coleman RE, Guiberteau MJ, Brown ML, Royal HD, Siegel BA, et al. Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0. J Nucl Med. 2006 May;47(5):885–95.

  16. Søreide K, Guest RV, Harrison EM, Kendall TJ, Garden OJ, Wigmore SJ. Systematic review of management of incidental gallbladder cancer after cholecystectomy. Br J Surg. 2019;106(1):32–45.

    Article  Google Scholar 

  17. Lundberg O, Kristoffersson A. Port site metastases from gallbladder cancer after laparoscopic cholecystectomy. Results of a Swedish survey and review of published reports. Eur J Surg. 1999 Mar;165(3):215–22.

  18. Ethun CG, Postlewait LM, Le N, Pawlik TM, Poultsides G, Tran T, et al. Routine port-site excision in incidentally discovered gallbladder cancer is not associated with improved survival: a multi-institution analysis from the US Extrahepatic Biliary Malignancy Consortium. J Surg Oncol. 2017;115(7):805–11.

    Article  Google Scholar 

  19. Chauhan A, Ganguly M, Sharma AK. Isolated port site metastases in carcinoma gallbladder: does it represent better prognosis? Indian J Surg Oncol. 2017;8(3):258–62.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Nuclear Medicine, SGPGIMS, Lucknow, India

    Vivek Kumar Saini, AftabNazar Hassan, Manish Ora & Sanjay Gambhir

  2. Department of Surgical Gastroenterology, SGPGIMS, Lucknow, India

    Ashish Kumar Singh

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  1. Vivek Kumar Saini
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  2. AftabNazar Hassan
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  3. Ashish Kumar Singh
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Correspondence to Manish Ora.

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Saini, V.K., Hassan, A., Singh, A.K. et al. Port-Site Metastases in Incidentally Detected Carcinoma Gall Bladder: Role of 18F-FDG PET/CT and Patient Outcome. J Gastrointest Canc 53, 16–21 (2022). https://doi.org/10.1007/s12029-021-00746-3

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