Skip to main content

Advertisement

Log in

Incidental gallbladder cancer: what management?

  • Review
  • Published:
Oncology Reviews

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. 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

    Article  PubMed  Google Scholar 

  2. Kayahara M, Nagakawa T (2007) Recent trends of gallbladder cancer in Japan: an analysis of 4, 770 patients. Cancer. 110(3):572–580

    Article  PubMed  Google Scholar 

  3. Miller G, Jarnagin WR (2008) Gallbladder carcinoma. Eur J Surg Oncol 34(3):306–312

    Article  PubMed  CAS  Google Scholar 

  4. 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

    Article  PubMed  CAS  Google Scholar 

  5. 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  PubMed  CAS  Google Scholar 

  7. Kianmanesh R, Scaringi S, Castel B, Flamant Y, Msika S (2007) Precancerous lesions of the gallbladder. J Chir 144(4):278–286

    Article  CAS  Google Scholar 

  8. Randi G, Franceschi S, La Vecchia C (2006) Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer 118(7):1591–1602

    Article  PubMed  CAS  Google Scholar 

  9. Zou S, Zhang L (2000) Relative risk factors analysis of 3, 922 cases of gallbladder cancer. Zhonghua Wai Ke Za Zhi 38:805–808

    PubMed  CAS  Google Scholar 

  10. 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

    Article  PubMed  CAS  Google Scholar 

  11. 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

    Article  PubMed  CAS  Google Scholar 

  12. 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

    PubMed  CAS  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. 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

    PubMed  CAS  Google Scholar 

  16. 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

    Article  PubMed  Google Scholar 

  17. 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

    PubMed  CAS  Google Scholar 

  18. 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

    Article  PubMed  CAS  Google Scholar 

  19. Tsukada K, Kurosaki I, Uchida K et al (1997) Lymph node spread from carcinoma of the gallbladder. Cancer 80:661–667

    Article  PubMed  CAS  Google Scholar 

  20. Yokoyama N, Shirai Y, Hatakeyama K (1999) Immunohistochemical detection of lymph node micrometastases from gallbladder carcinoma using monoclonal anticytokeratin antibody. Cancer 85:1465–1469

    Article  PubMed  CAS  Google Scholar 

  21. Wakai T, Shirai Y, Yokoyama N et al (2001) Early gallbladder carcinoma does not warrant radical resection. Br J Surg 88(5):675–678

    Article  PubMed  CAS  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

  23. Edge SB (2010) American Joint Committee on Cancer: AJCC cancer staging manual, 7th edn. Springer, New York

    Google Scholar 

  24. 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

    Article  PubMed  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. 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

    Article  PubMed  CAS  Google Scholar 

  28. Paolucci V, Schaeff B, Schneider M, Gutt C (1999) Tumor seeding following laparoscopy: international survey. World J Surg 23:989–997

    Article  PubMed  CAS  Google Scholar 

  29. 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

    Article  PubMed  CAS  Google Scholar 

  30. Fong Y, Hefferman N, Blumgart LH (1998) Gallbladder carcinoma discovered during laparoscopic cholecystectomy. Aggressive resection is beneficial. Cancer 83:423–427

    Article  PubMed  CAS  Google Scholar 

  31. Chiche L, Metairie S (2001) Le cancer de la vésicule de découverte fortuite. J Chir (Paris). 138(6):336–341

    CAS  Google Scholar 

  32. 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

    Article  PubMed  Google Scholar 

  33. 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

    Article  PubMed  Google Scholar 

  34. 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

    PubMed  CAS  Google Scholar 

  35. 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

    Article  PubMed  Google Scholar 

  36. 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

    Article  PubMed  Google Scholar 

  37. 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

    Article  PubMed  CAS  Google Scholar 

  38. 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

    Google Scholar 

  39. Mekeel KL, Hemming AW (2007) Surgical management of gallbladder carcinoma: a review. J Gastrointest Surg 11(9):1188–1193

    Article  PubMed  Google Scholar 

  40. Misra MC, Guleria S (2006) Management of cancer gallbladder found as a surprise on a resected gallbladder specimen. J Surg Oncol 93:690–698

    Article  PubMed  Google Scholar 

  41. 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

  42. 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

    Article  Google Scholar 

  43. Principe A, Del Gaudio M, Ercolani G (2006) Radical surgery for gallbladder carcinoma: possibilities of survival. Hepatogastroenterology 53:660–664

    PubMed  Google Scholar 

  44. 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

    Article  Google Scholar 

  45. 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

    Article  PubMed  Google Scholar 

  46. Dai M, Fong Y, Lowy A (2009) Treatment of T3 Gallbladder Cancer. J Gastrointest Surg 13(11):2040–2042

    Article  PubMed  Google Scholar 

  47. 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

    Article  PubMed  CAS  Google Scholar 

  48. 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

    PubMed  Google Scholar 

  49. Yehuda Z, Patt MD (2004) Oral capecitabine for the treatment of hepatocellular carcinoma, cholangiocarcinoma, and gallbladder carcinoma. Cancer 101(3):578–586

    Article  Google Scholar 

  50. 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

    Article  PubMed  Google Scholar 

  51. 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

    Article  PubMed  Google Scholar 

  52. 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

    Article  PubMed  Google Scholar 

  53. 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

    Article  PubMed  CAS  Google Scholar 

  54. Cho SY, Kim SH, Park SJ et al (2010) Adjuvant chemoradiation therapy in gallbladder cancer. J Surg Oncol 102(1):87–93

    Article  PubMed  Google Scholar 

  55. 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

    Article  PubMed  CAS  Google Scholar 

  56. Wakai T, Shirai Y, Yokoyama N et al (2001) Early gallbladder carcinoma does not warrant radical resection. Br J Surg 88(5):675–678

    Article  PubMed  CAS  Google Scholar 

  57. Shirai Y, Yoshida K, Tsukada K et al (1992) Early carcinoma of the gallbladder. Eur J Surg 158:545–548

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sidi Mohammed Bouchentouf.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12156-011-0092-1

Keywords

Navigation