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Management of Incidentally Detected Gallbladder Cancer After Cholecystectomy

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Abstract

Gallbladder cancer (GBC) is rare, but cancers incidentally detected are increasing. Between 0.25% and 0.89% of all cholecystectomy specimens have an incidental GBC on pathological examination. Most patients are staged with pT2 (50%) or pT1 (33%) of GBC. Patients with GBC confined to the mucosa (T1a or less) had 5-year survival rates of up to 100% after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent, and timing of reresection remain controversial. Observation time may be used for new cross-sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of disease dissemination. GBC is PET-avid, and PET may detect residual disease and thus prevent unnecessary surgery, but data are still scarce on the use in GBC. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. Port-site metastases may occur in up to 10% and has decreased over the last decades. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. Management of incidental GBC continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.

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References

  1. Valle JW, Kelley RK, Nervi B, Oh DY, Zhu AX. Biliary tract cancer. Lancet. 2021;397(10272):428–44. https://doi.org/10.1016/s0140-6736(21)00153-7.

    Article  CAS  Google Scholar 

  2. Lau CSM, Zywot A, Mahendraraj K, Chamberlain RS. Gallbladder carcinoma in the United States: a population based clinical outcomes study involving 22,343 patients from the surveillance, epidemiology, and End Result Database (1973-2013). HPB Surg. 2017;2017:1532835. https://doi.org/10.1155/2017/1532835.

    Article  Google Scholar 

  3. Smith GC, Parks RW, Madhavan KK, Garden OJ. A 10-year experience in the management of gallbladder cancer. HPB (Oxford). 2003;5(3):159–66. https://doi.org/10.1080/13651820310000037.

    Article  CAS  Google Scholar 

  4. Shukla SK, Singh G, Shahi KS, Bhuvan, Pant P. Staging, treatment, and future approaches of gallbladder carcinoma. J Gastrointest Cancer. 2018;49(1):9–15. https://doi.org/10.1007/s12029-017-0036-5.

    Article  CAS  Google Scholar 

  5. Khan S, Rashikh MA, Rehman KU, Berjis H. Selective or routine histology of cholecystectomy specimens for diagnosing incidental carcinoma of gallbladder and correlation with careful intraoperative macroscopic examination? A systematic review. Asian Pac J Cancer Prev. 2021;22(3):651–9. https://doi.org/10.31557/apjcp.2021.22.3.651.

    Article  Google Scholar 

  6. Lundgren L, Henriksson M, Andersson B, Sandström P. Cost-effectiveness of gallbladder histopathology after cholecystectomy for benign disease. BJS Open. 2020;4(6):1125–36. https://doi.org/10.1002/bjs5.50325.

    Article  CAS  Google Scholar 

  7. Bastiaenen VP, Tuijp JE, van Dieren S, Besselink MG, van Gulik TM, Koens L, et al. Safe, selective histopathological examination of gallbladder specimens: a systematic review. Br J Surg. 2020;107(11):1414–28. https://doi.org/10.1002/bjs.11759.

    Article  CAS  Google Scholar 

  8. Corten B, Leclercq WKG, Roumen RMH, van Zwam PH, Dejong CH, Slooter GD. Histological examination of the gallbladder following routine cholecystectomy? A selective analysis is justified. Eur J Surg Oncol. 2020;46(4 Pt A):572–6. https://doi.org/10.1016/j.ejso.2019.11.497.

    Article  CAS  Google Scholar 

  9. Dincel O, Goksu M, Hatipoglu HS. Importance of routine histopathological examination of a gallbladder surgical specimen: unexpected gallbladder cancer. J Cancer Res Ther. 2018;14(6):1325–9. https://doi.org/10.4103/0973-1482.187301.

    Article  Google Scholar 

  10. Kozan R, Özaydın S, Bayhan H, Leventoğlu S, Karamercan A, Anadol AZ, et al. Routine histopathological examination of the specimen after laparoscopic cholecystectomy: can we be brave enough to give up? Turk J Gastroenterol. 2021;32(2):218–24. https://doi.org/10.5152/tjg.2021.20334.

    Article  Google Scholar 

  11. Corten B, Leclercq WKG, Dejong CH, Roumen RMH, Slooter GD. Selective histological examination after cholecystectomy: an analysis of current daily practice in the Netherlands. World J Surg. 2019;43(10):2561–70. https://doi.org/10.1007/s00268-019-05077-w.

    Article  CAS  Google Scholar 

  12. Sundbom M, Hedberg J. Use of laparoscopy in gastrointestinal surgery in Sweden 1998-2014: a Nationwide study. Scand J Surg. 2017;106(1):34–9. https://doi.org/10.1177/1457496916630645.

    Article  CAS  Google Scholar 

  13. Tucker JJ, Grim R, Bell T, Martin J, Ahuja V. Changing demographics in laparoscopic cholecystectomy performed in the United States: hospitalizations from 1998 to 2010. Am Surg. 2014;80(7):652–8.

    Article  Google Scholar 

  14. Choi KS, Choi SB, Park P, Kim WB, Choi SY. Clinical characteristics of incidental or unsuspected gallbladder cancers diagnosed during or after cholecystectomy: a systematic review and meta-analysis. World J Gastroenterol. 2015;21(4):1315–23. https://doi.org/10.3748/wjg.v21.i4.1315.

    Article  Google Scholar 

  15. Dorobisz T, Dorobisz K, Chabowski M, Pawlowski W, Janczak D, Patrzalek D, et al. Incidental gallbladder cancer after cholecystectomy: 1990 to 2014. Onco Targets Ther. 2016;9:4913–6. https://doi.org/10.2147/ott.s106580.

    Article  Google Scholar 

  16. Emmett CD, Barrett P, Gilliam AD, Mitchell AI. Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma. Ann R Coll Surg Engl. 2015;97(7):526–9. https://doi.org/10.1308/rcsann.2015.0013.

    Article  CAS  Google Scholar 

  17. Koppatz H, Nordin A, Scheinin T, Sallinen V. The risk of incidental gallbladder cancer is negligible in macroscopically normal cholecystectomy specimens. HPB (Oxford). 2018;5(20):456–61. https://doi.org/10.1016/j.hpb.2017.11.006.

    Article  Google Scholar 

  18. Lundgren L, Muszynska C, Ros A, Persson G, Gimm O, Valter L, et al. Are incidental gallbladder cancers missed with a selective approach of gallbladder histology at cholecystectomy? World J Surg. 2018;42(4):1092–9. https://doi.org/10.1007/s00268-017-4215-0.

    Article  Google Scholar 

  19. Are C, Ahmad H, Ravipati A, Croo D, Clarey D, Smith L, et al. Global epidemiological trends and variations in the burden of gallbladder cancer. J Surg Oncol. 2017;115(5):580–90. https://doi.org/10.1002/jso.24546.

    Article  Google Scholar 

  20. Misra S, Chaturvedi A, Misra NC, Sharma ID. Carcinoma of the gallbladder. Lancet Oncol. 2003;4(3):167–76. https://doi.org/10.1016/s1470-2045(03)01021-0.

    Article  Google Scholar 

  21. Butte JM, Matsuo K, Gonen M, D'Angelica MI, Waugh E, Allen PJ, et al. Gallbladder cancer: differences in presentation, surgical treatment, and survival in patients treated at centers in three countries. J Am Coll Surg. 2011;212(1):50–61. https://doi.org/10.1016/j.jamcollsurg.2010.09.009.

    Article  Google Scholar 

  22. Ethun CG, Le N, Lopez-Aguiar AG, Pawlik TM, Poultsides G, Tran T, et al. Pathologic and prognostic implications of incidental versus nonincidental gallbladder cancer: a 10-institution study from the United States extrahepatic biliary malignancy consortium. Am Surg. 2017;83(7):679–86.

    Article  Google Scholar 

  23. Søreide K, Harrison EM, Wigmore SJ. Research gaps and unanswered questions in gallbladder cancer. HPB (Oxford). 2018;20(8):685–6. https://doi.org/10.1016/j.hpb.2018.03.006.

    Article  Google Scholar 

  24. 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. https://doi.org/10.1002/bjs.11035.

    Article  Google Scholar 

  25. Torén W, Ansari D, Søreide K, Andersson R. Re-resection for incidentally detected gallbladder cancer: weighing in on the options. Eur J Surg Oncol. 2020;46(4 Pt A):495–7. https://doi.org/10.1016/j.ejso.2019.10.001.

    Article  Google Scholar 

  26. Shroff RT, Kennedy EB, Bachini M, Bekaii-Saab T, Crane C, Edeline J, et al. Adjuvant therapy for resected biliary tract cancer: ASCO clinical practice guideline. J Clin Oncol. 2019;37(12):1015–27. https://doi.org/10.1200/jco.18.02178.

    Article  Google Scholar 

  27. Benson AB, D'Angelica MI, Abbott DE, Anaya DA, Anders R, Are C, et al. Hepatobiliary cancers, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2021;19(5):541–65. https://doi.org/10.6004/jnccn.2021.0022.

    Article  Google Scholar 

  28. Keilson JM, Maithel SK. The undertreatment of gallbladder cancer: gaps in seeking, reaching, and receiving care. Ann Surg Oncol. 2021;28(6):2925–7. https://doi.org/10.1245/s10434-021-09761-x.

    Article  Google Scholar 

  29. Papageorge MV, de Geus SWL, Woods AP, Ng SC, Drake FT, Cassidy MR, et al. Undertreatment of gallbladder cancer: a Nationwide analysis. Ann Surg Oncol. 2021;28(6):2949–57. https://doi.org/10.1245/s10434-021-09607-6.

    Article  Google Scholar 

  30. Vo E, Curley SA, Chai CY, Massarweh NN, Tran Cao HS. National failure of surgical staging for T1b gallbladder cancer. Ann Surg Oncol. 2019;26(2):604–10. https://doi.org/10.1245/s10434-018-7064-7.

    Article  Google Scholar 

  31. Chun YS, Pawlik TM, Vauthey JN. 8th edition of the AJCC cancer staging manual: pancreas and hepatobiliary cancers. Ann Surg Oncol. 2018;25(4):845–7. https://doi.org/10.1245/s10434-017-6025-x.

    Article  Google Scholar 

  32. Zhu AX, Pawlik T, Kooby DA, Schefter T, Vauthey JN. Gallbladder. In: Amin MB, editor. AJCC cancer staging manual. 8th ed. Chicago, IL: Springer; 2017. p. 303–9.

    Chapter  Google Scholar 

  33. Chatelain D, Fuks D, Farges O, Attencourt C, Pruvot FR, Regimbeau JM. Pathology report assessment of incidental gallbladder carcinoma diagnosed from cholecystectomy specimens: results of a French multicentre survey. Dig Liver Dis. 2013;45(12):1056–60. https://doi.org/10.1016/j.dld.2013.07.004.

    Article  Google Scholar 

  34. Fuks D, Regimbeau JM, Le Treut YP, Bachellier P, Raventos A, Pruvot FR, et al. Incidental gallbladder cancer by the AFC-GBC-2009 study group. World J Surg. 2011;35(8):1887–97. https://doi.org/10.1007/s00268-011-1134-3.

    Article  Google Scholar 

  35. Kemp Bohan PM, O'Shea AE, Ellis OV, Chick RC, Clem AM, Kirby DT, et al. Rates, predictors, and outcomes of portal lymphadenectomy for Resectable gallbladder cancer. Ann Surg Oncol. 2021;28(6):2960–72. https://doi.org/10.1245/s10434-021-09667-8.

    Article  Google Scholar 

  36. González-Domingo M, Lafuente BO, Luca ÁR, Zamorano PK, Mella PG. Impact of lymph nodal stage on gallbladder cancer survival after extended cholecystectomy and adjuvant radiochemotherapy: long-term results from an oncology institute, Chile. Ecancermedicalscience. 2021;15:1222. https://doi.org/10.3332/ecancer.2021.1222.

    Article  Google Scholar 

  37. Dominguez DA, Aversa JG, Hagerty BL, Diggs LP, Raoof M, Davis JL, et al. Prognostic impact of lymphovascular invasion in pT1-T3 gallbladder adenocarcinoma. J Surg Oncol. 2020;122(7):1401–8. https://doi.org/10.1002/jso.26160.

    Article  Google Scholar 

  38. Ethun CG, Postlewait LM, Le N, Pawlik TM, Buettner S, Poultsides G, 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(5):1343–50. https://doi.org/10.1245/s10434-016-5637-x.

    Article  Google Scholar 

  39. Shindoh J, de Aretxabala X, Aloia TA, Roa JC, Roa I, Zimmitti G, et al. Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study. Ann Surg. 2015;261(4):733–9. https://doi.org/10.1097/sla.0000000000000728.

    Article  Google Scholar 

  40. Lee H, Choi DW, Park JY, Youn S, Kwon W, Heo JS, et al. Surgical strategy for T2 gallbladder cancer according to tumor location. Ann Surg Oncol. 2015;22(8):2779–86. https://doi.org/10.1245/s10434-014-4300-7.

    Article  Google Scholar 

  41. Burasakarn P, Thienhiran A, Hongjinda S, Fuengfoo P. The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: a meta-analysis. Asian J Surg. 2021;45:33. https://doi.org/10.1016/j.asjsur.2021.05.005.

    Article  Google Scholar 

  42. Kwon W, Kim H, Han Y, Hwang YJ, Kim SG, Kwon HJ, et al. Role of tumour location and surgical extent on prognosis in T2 gallbladder cancer: an international multicentre study. Br J Surg. 2020;107(10):1334–43. https://doi.org/10.1002/bjs.11618.

    Article  CAS  Google Scholar 

  43. Lee SE, Choi YS, Kim YH, Heo JS, Jeong CY, Lee WJ, et al. Prognostic significance of tumor location in T2 gallbladder cancer: a Korea tumor registry system biliary pancreas (KOTUS-BP) database analysis. J Clin Med. 2020;9(10):3268. https://doi.org/10.3390/jcm9103268.

    Article  CAS  Google Scholar 

  44. Goetze TO, Paolucci V. Use of retrieval bags in incidental gallbladder cancer cases. World J Surg. 2009;33(10):2161–5. https://doi.org/10.1007/s00268-009-0163-7.

    Article  Google Scholar 

  45. Goussous N, Maqsood H, Patel K, Ferdosi H, Muhammad N, Sill AM, et al. Clues to predict incidental gallbladder cancer. Hepatobiliary Pancreat Dis Int. 2018;17(2):149–54. https://doi.org/10.1016/j.hbpd.2018.02.001.

    Article  Google Scholar 

  46. Tian YH, Ji X, Liu B, Yang GY, Meng XF, Xia HT, et al. Surgical treatment of incidental gallbladder cancer discovered during or following laparoscopic cholecystectomy. World J Surg. 2015;39(3):746–52. https://doi.org/10.1007/s00268-014-2864-9.

    Article  Google Scholar 

  47. Isambert M, Leux C, Metairie S, Paineau J. Incidentally-discovered gallbladder cancer: when, why and which reoperation? J Visc Surg. 2011;148(2):e77–84. https://doi.org/10.1016/j.jviscsurg.2011.02.005.

    Article  CAS  Google Scholar 

  48. Yip VS, Gomez D, Brown S, Byrne C, White D, Fenwick SW, et al. Management of incidental and suspicious gallbladder cancer: focus on early referral to a tertiary centre. HPB (Oxford). 2014;16(7):641–7. https://doi.org/10.1111/hpb.12189.

    Article  Google Scholar 

  49. O'Connor SC, Mogal H, Russell G, Ethun C, Fields RC, Jin L, et al. The effects of travel burden on outcomes after resection of extrahepatic biliary malignancies: results from the US extrahepatic biliary consortium. J Gastrointest Surg. 2017;21(12):2016–24. https://doi.org/10.1007/s11605-017-3537-4.

    Article  Google Scholar 

  50. Shukla PJ, Barreto G, Kakade A, Shrikhande SV. Revision surgery for incidental gallbladder cancer: factors influencing operability and further evidence for T1b tumours. HPB (Oxford). 2008;10(1):43–7. https://doi.org/10.1080/13651820701867794.

    Article  CAS  Google Scholar 

  51. Barreto SG, Pawar S, Shah S, Talole S, Goel M, Shrikhande SV. Patterns of failure and determinants of outcomes following radical re-resection for incidental gallbladder cancer. World J Surg. 2014;38(2):484–9. https://doi.org/10.1007/s00268-013-2266-4.

    Article  Google Scholar 

  52. Rahul HK, Singh A, Mishra P, Singh RK, Behari A, et al. Does timing of completion radical cholecystectomy determine the survival outcome in incidental carcinoma gallbladder: a single center retrospective analysis. Ann Hepatobiliary Pancreat Surg. 2021;25(Suppl 1):S165. https://doi.org/10.14701/ahbps.BP-PP-3-4.

    Article  Google Scholar 

  53. Agopian VG, Hiatt JR. The timing of reoperation for incidental gallbladder cancer: sooner or later? JAMA Surg. 2017;152(2):149. https://doi.org/10.1001/jamasurg.2016.3643.

    Article  Google Scholar 

  54. Tsirlis T, Ausania F, White SA, French JJ, Jaques BC, Charnley RM, et al. Implications of the index cholecystectomy and timing of referral for radical resection of advanced incidental gallbladder cancer. Ann R Coll Surg Engl. 2015;97(2):131–6. https://doi.org/10.1308/003588414x14055925060073.

    Article  CAS  Google Scholar 

  55. Ethun CG, Postlewait LM, Le N, Pawlik TM, Buettner S, Poultsides G, 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(2):143–9. https://doi.org/10.1001/jamasurg.2016.3642.

    Article  Google Scholar 

  56. Ausania F, Tsirlis T, White SA, French JJ, Jaques BC, Charnley RM, et al. Incidental pT2-T3 gallbladder cancer after a cholecystectomy: outcome of staging at 3 months prior to a radical resection. HPB (Oxford). 2013;15(8):633–7. https://doi.org/10.1111/hpb.12032.

    Article  Google Scholar 

  57. Watson H, Dasari B, Wyatt J, Hidalgo E, Prasad R, Lodge P, et al. Does a second resection provide a survival benefit in patients diagnosed with incidental T1b/T2 gallbladder cancer following cholecystectomy? HPB (Oxford). 2017;19(2):104–7. https://doi.org/10.1016/j.hpb.2016.11.006.

    Article  Google Scholar 

  58. Parida GK, Panda RA, Agrawal K. Impact of fluorine-18-fluorodeoxyglucose PET/computed tomography in staging of patients with gallbladder cancer: a systematic review and meta-analysis. Nucl Med Commun. 2021;42:846. https://doi.org/10.1097/mnm.0000000000001405.

    Article  CAS  Google Scholar 

  59. Moradi F, Iagaru A. The role of positron emission tomography in pancreatic cancer and gallbladder cancer. Semin Nucl Med. 2020;50(5):434–46. https://doi.org/10.1053/j.semnuclmed.2020.04.002.

    Article  Google Scholar 

  60. Petrowsky H, Wildbrett P, Husarik DB, Hany TF, Tam S, Jochum W, et al. Impact of integrated positron emission tomography and computed tomography on staging and management of gallbladder cancer and cholangiocarcinoma. J Hepatol. 2006;45(1):43–50. https://doi.org/10.1016/j.jhep.2006.03.009.

    Article  Google Scholar 

  61. Garcea G, Ong SL, Maddern GJ. The current role of PET-CT in the characterization of hepatobiliary malignancies. HPB (Oxford). 2009;11(1):4–17. https://doi.org/10.1111/j.1477-2574.2008.00009.x.

    Article  Google Scholar 

  62. Parikh U, Marcus C, Sarangi R, Taghipour M, Subramaniam RM. FDG PET/CT in pancreatic and hepatobiliary carcinomas: value to patient management and patient outcomes. PET Clin. 2015;10(3):327–43. https://doi.org/10.1016/j.cpet.2015.03.001.

    Article  Google Scholar 

  63. Annunziata S, Pizzuto DA, Caldarella C, Galiandro F, Sadeghi R, Treglia G. Diagnostic accuracy of fluorine-18-fluorodeoxyglucose positron emission tomography in gallbladder cancer: a meta-analysis. World J Gastroenterol. 2015;21(40):11481–8. https://doi.org/10.3748/wjg.v21.i40.11481.

    Article  CAS  Google Scholar 

  64. Goel M, Tamhankar A, Rangarajan V, Patkar S, Ramadwar M, Shrikhande SV. Role of PET CT scan in redefining treatment of incidental gall bladder carcinoma. J Surg Oncol. 2016;113(6):652–8. https://doi.org/10.1002/jso.24198.

    Article  Google Scholar 

  65. Butte JM, Redondo F, Waugh E, Meneses M, Pruzzo R, Parada H, et al. The role of PET-CT in patients with incidental gallbladder cancer. HPB (Oxford). 2009;11(7):585–91. https://doi.org/10.1111/j.1477-2574.2009.00104.x.

    Article  Google Scholar 

  66. Shukla PJ, Barreto SG, Arya S, Shrikhande SV, Hawaldar R, Purandare N, et al. Does PET-CT scan have a role prior to radical re-resection for incidental gallbladder cancer? HPB (Oxford). 2008;10(6):439–45. https://doi.org/10.1080/13651820802286910.

    Article  Google Scholar 

  67. Agarwal AK, Kalayarasan R, Javed A, Gupta N, Nag HH. The role of staging laparoscopy in primary gall bladder cancer--an analysis of 409 patients: a prospective study to evaluate the role of staging laparoscopy in the management of gallbladder cancer. Ann Surg. 2013;258(2):318–23. https://doi.org/10.1097/SLA.0b013e318271497e.

    Article  Google Scholar 

  68. Butte JM, Gonen M, Allen PJ, D'Angelica MI, Kingham TP, Fong Y, et al. The role of laparoscopic staging in patients with incidental gallbladder cancer. HPB (Oxford). 2011;13(7):463–72. https://doi.org/10.1111/j.1477-2574.2011.00325.x.

    Article  Google Scholar 

  69. Lv TR, Yang C, Regmi P, Ma WJ, Hu HJ, Liu F, et al. The role of laparoscopic surgery in the surgical management of gallbladder carcinoma: a systematic review and meta-analysis. Asian J Surg. 2021;44:1493. https://doi.org/10.1016/j.asjsur.2021.03.015.

    Article  Google Scholar 

  70. Zhang W, Che X. Feasibility and safety of laparoscopic treatment for early and T3 stage gallbladder cancer: a systematic review. Surg Laparosc Endosc Percutan Tech. 2020;31(1):113–23. https://doi.org/10.1097/sle.0000000000000852.

    Article  Google Scholar 

  71. Wang Z, Xu Y, Hu D, Wu X, Chen Y, Ye Q, et al. Laparoscopy versus open reoperation for incidental gallbladder carcinoma after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2020;30(7):764–8. https://doi.org/10.1089/lap.2019.0802.

    Article  Google Scholar 

  72. Nag HH, Sachan A, Nekarakanti PK. Laparoscopic versus open extended cholecystectomy with bi-segmentectomy (s4b and s5) in patients with gallbladder cancer. J Minim Access Surg. 2021;17(1):21–7. https://doi.org/10.4103/jmas.JMAS_98_19.

    Article  Google Scholar 

  73. Yoon YS, Han HS, Agarwal A, Belli G, Itano O, Gumbs AA, et al. Survey results of the expert meeting on laparoscopic surgery for gallbladder cancer and a review of relevant literature. Dig Surg. 2019;36(1):7–12. https://doi.org/10.1159/000486208.

    Article  Google Scholar 

  74. Han HS, Yoon YS, Agarwal AK, Belli G, Itano O, Gumbs AA, et al. Laparoscopic surgery for gallbladder cancer: an expert consensus statement. Dig Surg. 2019;36(1):1–6. https://doi.org/10.1159/000486207.

    Article  CAS  Google Scholar 

  75. Pitt HA. Gallbladder cancer: what is an aggressive approach? Ann Surg. 2005;241(3):395–6.

    Article  Google Scholar 

  76. Sternby Eilard M, Lundgren L, Cahlin C, Strandell A, Svanberg T, Sandstrom P. Surgical treatment for gallbladder cancer - a systematic literature review. Scand J Gastroenterol. 2017;52(5):505–14. https://doi.org/10.1080/00365521.2017.1284895.

    Article  Google Scholar 

  77. Qadan M, Kingham TP. Technical aspects of gallbladder cancer surgery. Surg Clin North Am. 2016;96(2):229–45. https://doi.org/10.1016/j.suc.2015.12.007.

    Article  Google Scholar 

  78. de Savornin Lohman EAJ, van der Geest LG, de Bitter TJJ, Nagtegaal ID, van Laarhoven C, van den Boezem P, et al. Re-resection in incidental gallbladder cancer: survival and the incidence of residual disease. Ann Surg Oncol. 2020;27(4):1132–42. https://doi.org/10.1245/s10434-019-08074-4.

    Article  Google Scholar 

  79. Erdem S, White RR. Incidental gallbladder cancer: permission to operate. Ann Surg Oncol. 2020;27(4):980–2. https://doi.org/10.1245/s10434-019-08080-6.

    Article  Google Scholar 

  80. Lundgren L, Muszynska C, Ros A, Persson G, Gimm O, Andersson B, et al. Management of incidental gallbladder cancer in a national cohort. Br J Surg. 2019;106(9):1216–27. https://doi.org/10.1002/bjs.11205.

    Article  CAS  Google Scholar 

  81. Zaidi MY, Abou-Alfa GK, Ethun CG, Shrikhande SV, Goel M, Nervi B, et al. Evaluation and management of incidental gallbladder cancer. Chin Clin Oncol. 2019;8(4):37. https://doi.org/10.21037/cco.2019.07.01.

    Article  Google Scholar 

  82. Cherkassky L, D'Angelica M. Gallbladder cancer: managing the incidental diagnosis. Surg Oncol Clin N Am. 2019;28(4):619–30. https://doi.org/10.1016/j.soc.2019.06.005.

    Article  Google Scholar 

  83. Lee SE, Jang JY, Lim CS, Kang MJ, Kim SW. Systematic review on the surgical treatment for T1 gallbladder cancer. World J Gastroenterol. 2011;17(2):174–80. https://doi.org/10.3748/wjg.v17.i2.174.

    Article  Google Scholar 

  84. Lee H, Kwon W, Han Y, Kim JR, Kim SW, Jang JY. Optimal extent of surgery for early gallbladder cancer with regard to long-term survival: a meta-analysis. J Hepatobiliary Pancreat Sci. 2018;25(2):131–41. https://doi.org/10.1002/jhbp.521.

    Article  Google Scholar 

  85. Lee SE, Jang JY, Kim SW, Han HS, Kim HJ, Yun SS, et al. Surgical strategy for T1 gallbladder cancer: a nationwide multicenter survey in South Korea. Ann Surg Oncol. 2014;21(11):3654–60. https://doi.org/10.1245/s10434-014-3527-7.

    Article  Google Scholar 

  86. Aloia TA, Járufe N, Javle M, Maithel SK, Roa JC, Adsay V, et al. Gallbladder cancer: expert consensus statement. HPB (Oxford). 2015;17(8):681–90. https://doi.org/10.1111/hpb.12444.

    Article  Google Scholar 

  87. Lee SE, Kim KS, Kim WB, Kim IG, Nah YW, Ryu DH, et al. Practical guidelines for the surgical treatment of gallbladder cancer. J Korean Med Sci. 2014;29(10):1333–40. https://doi.org/10.3346/jkms.2014.29.10.1333.

    Article  Google Scholar 

  88. Valle JW, Borbath I, Khan SA, Huguet F, Gruenberger T, Arnold D. Biliary cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v28–37. https://doi.org/10.1093/annonc/mdw324.

    Article  CAS  Google Scholar 

  89. Lee SE, Kim SW, Han HS, Lee WJ, Yoon DS, Cho BH, et al. Surgical strategy for T2 gallbladder cancer: Nationwide multicenter survey in Korea. J Korean Med Sci. 2018;33(28):e186. https://doi.org/10.3346/jkms.2018.33.e186.

    Article  Google Scholar 

  90. Coimbra FJF, Torres OJM, Alikhanov R, Agarwal A, Pessaux P, Fernandes ESM, et al. Brazilian consensus on incidental gallbladder carcinoma. Arq Bras Cir Dig. 2020;33(1):e1496. https://doi.org/10.1590/0102-672020190001e1496.

    Article  Google Scholar 

  91. Gwark SC, Hwang S, Kim KH, Lee YJ, Park KM, Ahn CS, et al. Extent of resection for T2N0 gallbladder carcinoma regarding concurrent extrahepatic bile duct resection. Korean J Hepatobiliary Pancreat Surg. 2012;16(4):142–6. https://doi.org/10.14701/kjhbps.2012.16.4.142.

    Article  Google Scholar 

  92. Toge K, Sakata J, Hirose Y, Yuza K, Ando T, Soma D, et al. Lymphatic spread of T2 gallbladder carcinoma: regional lymphadenectomy is required independent of tumor location. Eur J Surg Oncol. 2019;45(8):1446–52. https://doi.org/10.1016/j.ejso.2019.03.038.

    Article  Google Scholar 

  93. DeSimone MS, Goodman M, Pehlivanoglu B, Memis B, Balci S, Roa JC, et al. T2 gallbladder cancer shows substantial survival variation between continents and this is not due to histopathologic criteria or pathologic sampling differences. Virchows Arch. 2021;478(5):875–84. https://doi.org/10.1007/s00428-020-02968-5.

    Article  CAS  Google Scholar 

  94. Goetze TO, Paolucci V. Benefits of reoperation of T2 and more advanced incidental gallbladder carcinoma: analysis of the German registry. Ann Surg. 2008;247(1):104–8. https://doi.org/10.1097/SLA.0b013e318154bf5d.

    Article  Google Scholar 

  95. Ito H, Ito K, D'Angelica M, Gonen M, Klimstra D, Allen P, et al. Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg. 2011;254(2):320–5. https://doi.org/10.1097/SLA.0b013e31822238d8.

    Article  Google Scholar 

  96. Nigri G, Berardi G, Mattana C, Mangogna L, Petrucciani N, Sagnotta A, et al. Routine extra-hepatic bile duct resection in gallbladder cancer patients without bile duct infiltration: a systematic review. Surgeon. 2016;14(6):337–44. https://doi.org/10.1016/j.surge.2016.06.004.

    Article  Google Scholar 

  97. D'Angelica M, Dalal KM, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR. Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncol. 2009;16(4):806–16. https://doi.org/10.1245/s10434-008-0189-3.

    Article  Google Scholar 

  98. Maplanka C. Gallbladder cancer, treatment failure and relapses: the peritoneum in gallbladder cancer. J Gastrointest Cancer. 2014;45(3):245–55. https://doi.org/10.1007/s12029-014-9597-8.

    Article  Google Scholar 

  99. 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. https://doi.org/10.1016/j.surg.2016.08.007.

    Article  Google Scholar 

  100. 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. https://doi.org/10.1002/jso.24591.

    Article  Google Scholar 

  101. Fuks D, Regimbeau JM, Pessaux P, Bachellier P, Raventos A, Mantion G, et al. Is port-site resection necessary in the surgical management of gallbladder cancer? J Visc Surg. 2013;150(4):277–84. https://doi.org/10.1016/j.jviscsurg.2013.03.006.

    Article  CAS  Google Scholar 

  102. Maker AV, Butte JM, Oxenberg J, Kuk D, Gonen M, Fong Y, et al. Is port site resection necessary in the surgical management of gallbladder cancer? Ann Surg Oncol. 2012;19(2):409–17. https://doi.org/10.1245/s10434-011-1850-9.

    Article  Google Scholar 

  103. Lim JH, Chong JU, Kim SH, Park SW, Choi JS, Lee WJ, et al. Role of common bile duct resection in T2 and T3 gallbladder cancer patients. Ann Hepatobiliary Pancreat Surg. 2018;22(1):42–51. https://doi.org/10.14701/ahbps.2018.22.1.42.

    Article  Google Scholar 

  104. Gani F, Buettner S, Margonis GA, Ethun CG, Poultsides G, Tran T, et al. Assessing the impact of common bile duct resection in the surgical management of gallbladder cancer. J Surg Oncol. 2016;114(2):176–80. https://doi.org/10.1002/jso.24283.

    Article  Google Scholar 

  105. Gavriilidis P, Askari A, Azoulay D. To resect or not to resect extrahepatic bile duct in gallbladder cancer? J Clin Med Res. 2017;9(2):81–91. https://doi.org/10.14740/jocmr2804w.

    Article  Google Scholar 

  106. Araida T, Higuchi R, Hamano M, Kodera Y, Takeshita N, Ota T, et al. 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. 2009;39(9):770–9. https://doi.org/10.1007/s00595-009-3960-6.

    Article  Google Scholar 

  107. Saqib R, Pathak S, Smart N, Nunes Q, Rees J, Finch Jones M, et al. Prognostic significance of pre-operative inflammatory markers in resected gallbladder cancer: a systematic review. ANZ J Surg. 2018;88(6):554–9. https://doi.org/10.1111/ans.14300.

    Article  Google Scholar 

  108. Amini N, Spolverato G, Kim Y, Gupta R, Margonis GA, Ejaz A, et al. Lymph node status after resection for gallbladder adenocarcinoma: prognostic implications of different nodal staging/scoring systems. J Surg Oncol. 2015;111(3):299–305. https://doi.org/10.1002/jso.23813.

    Article  Google Scholar 

  109. Zhang W, Hong HJ, Chen YL. Establishment of a gallbladder cancer-specific survival model to predict prognosis in non-metastatic gallbladder cancer patients after surgical resection. Dig Dis Sci. 2018;63(9):2251–8. https://doi.org/10.1007/s10620-018-5103-7.

    Article  Google Scholar 

  110. Amini N, Kim Y, Wilson A, Margonis GA, Ethun CG, Poultsides G, et al. Prognostic implications of lymph node status for patients with gallbladder cancer: a multi-institutional study. Ann Surg Oncol. 2016;23(9):3016–23. https://doi.org/10.1245/s10434-016-5243-y.

    Article  Google Scholar 

  111. Mochizuki T, Abe T, Amano H, Hanada K, Hattori M, Kobayashi T, et al. Efficacy of the gallbladder cancer predictive risk score based on pathological findings: a propensity score-matched analysis. Ann Surg Oncol. 2018;25(6):1699–708. https://doi.org/10.1245/s10434-018-6444-3.

    Article  Google Scholar 

  112. Zhu GQ, Shi KQ, You J, Zou H, Lin YQ, Wang LR, et al. Systematic review with network meta-analysis: adjuvant therapy for resected biliary tract cancer. Aliment Pharmacol Ther. 2014;40(7):759–70. https://doi.org/10.1111/apt.12900.

    Article  CAS  Google Scholar 

  113. Kasumova GG, Tabatabaie O, Najarian RM, Callery MP, Ng SC, Bullock AJ, et al. Surgical management of gallbladder cancer: simple versus extended cholecystectomy and the role of adjuvant therapy. Ann Surg. 2017;266(4):625–31. https://doi.org/10.1097/sla.0000000000002385.

    Article  Google Scholar 

  114. Bonet Beltran M, Allal AS, Gich I, Sole JM, Carrio I. Is adjuvant radiotherapy needed after curative resection of extrahepatic biliary tract cancers? A systematic review with a meta-analysis of observational studies. Cancer Treat Rev. 2012;38(2):111–9. https://doi.org/10.1016/j.ctrv.2011.05.003.

    Article  Google Scholar 

  115. Ghidini M, Tomasello G, Botticelli A, Barni S, Zabbialini G, Seghezzi S, et al. Adjuvant chemotherapy for resected biliary tract cancers: a systematic review and meta-analysis. HPB (Oxford). 2017;19(9):741–8. https://doi.org/10.1016/j.hpb.2017.05.010.

    Article  Google Scholar 

  116. Bergquist JR, Shah HN, Habermann EB, Hernandez MC, Ivanics T, Kendrick ML, et al. Adjuvant systemic therapy after resection of node positive gallbladder cancer: time for a well-designed trial? (results of a US-national retrospective cohort study). Int J Surg. 2018;52:171–9. https://doi.org/10.1016/j.ijsu.2018.02.052.

    Article  Google Scholar 

  117. Horgan AM, Amir E, Walter T, Knox JJ. Adjuvant therapy in the treatment of biliary tract cancer: a systematic review and meta-analysis. J Clin Oncol. 2012;30(16):1934–40. https://doi.org/10.1200/jco.2011.40.5381.

    Article  Google Scholar 

  118. Williams TM, Majithia L, Wang SJ, Thomas CR Jr. Defining the role of adjuvant therapy: cholangiocarcinoma and gall bladder cancer. Semin Radiat Oncol. 2014;24(2):94–104. https://doi.org/10.1016/j.semradonc.2014.01.001.

    Article  Google Scholar 

  119. Hyder O, Dodson RM, Sachs T, Weiss M, Mayo SC, Choti MA, et al. Impact of adjuvant external beam radiotherapy on survival in surgically resected gallbladder adenocarcinoma: a propensity score-matched surveillance, epidemiology, and end results analysis. Surgery. 2014;155(1):85–93. https://doi.org/10.1016/j.surg.2013.06.001.

    Article  Google Scholar 

  120. Gamboa AC, Maithel SK. The landmark series: gallbladder cancer. Ann Surg Oncol. 2020;27(8):2846–58. https://doi.org/10.1245/s10434-020-08654-9.

    Article  Google Scholar 

  121. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362(14):1273–81. https://doi.org/10.1056/NEJMoa0908721.

    Article  CAS  Google Scholar 

  122. Mantripragada KC, Hamid F, Shafqat H, Olszewski AJ. Adjuvant therapy for resected gallbladder cancer: analysis of the National Cancer Data Base. J Natl Cancer Inst. 2016;109(2):djw202. https://doi.org/10.1093/jnci/djw202.

    Article  Google Scholar 

  123. Deng YL, Li J. Adjuvant chemotherapy in resectable gallbladder cancer is underutilized despite benefits in node-positive patients. Ann Surg Oncol. 2020;27(Suppl 3):940–1. https://doi.org/10.1245/s10434-020-09167-1.

    Article  Google Scholar 

  124. Mitin T, Enestvedt CK, Jemal A, Sineshaw HM. Limited use of adjuvant therapy in patients with resected gallbladder cancer despite a strong association with survival. J Natl Cancer Inst. 2017;109(7). https://doi.org/10.1093/jnci/djw324.

  125. Tran Cao HS, Zhang Q, Sada YH, Chai C, Curley SA, Massarweh NN. The role of surgery and adjuvant therapy in lymph node-positive cancers of the gallbladder and intrahepatic bile ducts. Cancer. 2018;124(1):74–83. https://doi.org/10.1002/cncr.30968.

    Article  Google Scholar 

  126. Hari DM, Howard JH, Leung AM, Chui CG, Sim MS, Bilchik AJ. A 21-year analysis of stage I gallbladder carcinoma: is cholecystectomy alone adequate? HPB (Oxford). 2013;15(1):40–8. https://doi.org/10.1111/j.1477-2574.2012.00559.x.

    Article  Google Scholar 

  127. Chaudhari VA, Ostwal V, Patkar S, Sahu A, Toshniwal A, Ramaswamy A, et al. Outcome of neoadjuvant chemotherapy in “locally advanced/borderline resectable” gallbladder cancer: the need to define indications. HPB (Oxford). 2018;20(9):841–7. https://doi.org/10.1016/j.hpb.2018.03.008.

    Article  Google Scholar 

  128. Engineer R, Goel M, Chopra S, Patil P, Purandare N, Rangarajan V, et al. Neoadjuvant chemoradiation followed by surgery for locally advanced gallbladder cancers: a new paradigm. Ann Surg Oncol. 2016;23(9):3009–15. https://doi.org/10.1245/s10434-016-5197-0.

    Article  Google Scholar 

  129. Edeline J, Bonnetain F, Phelip JM, Watelet J, Hammel P, Joly J-P, et al. Gemox versus surveillance following surgery of localized biliary tract cancer: results of the PRODIGE 12-ACCORD 18 (UNICANCER GI) phase III trial. J Clin Oncol. 2017;35(4_suppl):225. https://doi.org/10.1200/JCO.2017.35.4_suppl.225.

    Article  Google Scholar 

  130. Primrose JN, Fox RP, Palmer DH, Malik HZ, Prasad R, Mirza D, et al. Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol. 2019;20(5):663–73. https://doi.org/10.1016/s1470-2045(18)30915-x.

    Article  CAS  Google Scholar 

  131. Stein A, Arnold D, Bridgewater J, Goldstein D, Jensen LH, Klumpen HJ, et al. Adjuvant chemotherapy with gemcitabine and cisplatin compared to observation after curative intent resection of cholangiocarcinoma and muscle invasive gallbladder carcinoma (ACTICCA-1 trial) - a randomized, multidisciplinary, multinational phase III trial. BMC Cancer. 2015;15:564. https://doi.org/10.1186/s12885-015-1498-0.

    Article  CAS  Google Scholar 

  132. Khan TM, Verbus EA, Hong H, Ethun CG, Maithel SK, Hernandez JM. Perioperative versus adjuvant chemotherapy in the management of incidentally found gallbladder cancer (OPT-IN). Ann Surg Oncol. 2021;29:37. https://doi.org/10.1245/s10434-021-10277-7.

    Article  Google Scholar 

  133. Lamarca A, Edeline J, McNamara MG, Hubner RA, Nagino M, Bridgewater J, et al. Current standards and future perspectives in adjuvant treatment for biliary tract cancers. Cancer Treat Rev. 2020;84:101936. https://doi.org/10.1016/j.ctrv.2019.101936.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway

    K. Søreide

  2. Department of Clinical Medicine, University of Bergen, Bergen, Norway

    K. Søreide

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  1. Department of General Surgery, Banaras Hindu University, Varanasi, Uttar Pradesh, India

    Vijay Kumar Shukla

  2. Department of Surgical Oncology, Banaras Hindu University, Varanasi, Uttar Pradesh, India

    Manoj Pandey

  3. Department of General Surgery, Banaras Hindu University, Varanasi, Uttar Pradesh, India

    Ruhi Dixit

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Søreide, K. (2023). Management of Incidentally Detected Gallbladder Cancer After Cholecystectomy. In: Kumar Shukla, V., Pandey, M., Dixit, R. (eds) Gallbladder Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-19-6442-8_8

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