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Surgical Treatment of Incidental Gallbladder Cancer Discovered During or Following Laparoscopic Cholecystectomy

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Abstract

Background

The optimal surgical management of patients with incidental gallbladder cancer (IGBC) and their long-term survival remains unclear.

Objective

The purpose of this study was to examine the long-term prognosis of patients with IGBC diagnosed during or after LC.

Methods

Between January 2002 and January 2012, a total of 7,582 consecutive patients underwent LC for presumed gallbladder benign disease in the Chinese PLA General Hospital, China. Among them, 69 patients (0.91 %) were diagnosed to have IGBC. Their medical records, imaging data, surgery records, pathological findings, and survival data were retrospectively reviewed.

Results

Median age was 61 years (range: 34–83). After a median follow-up period of 61 months, the 1-, 3-, and 5-year survival rates of patients were 89.9, 78.3, and 76.8 %, respectively. The 5-year survival rates of patients with T1a, T1b, T2, and T3 stages were 95.5, 93.8, 69.2, and 44.4 %, respectively. The 5-year survival rates in simple LC (n = 45), converted to open extended cholecystectomy (n = 16), and radical second resection (n = 8) groups were 91.1, 37.5, and 75.0 %, respectively. Local port-site tumor recurrence was identified in one patient. Prognostic factors including depth of invasion, lymph node status, vascular or neural invasion, tumor differentiation, extent of resection, bile spillage, and type of surgery were statistically significant (p < 0.05).

Conclusions

Simple LC is appropriate for T1a patients with clear margin and unbroken gallbladder, whereas extended radical resection is recommended for patients with T1b or more advanced IGBC. An intact surgical specimen and the use of plastic retrieval bags are important to reduce the risk of port-site recurrences and disease relapse. Early diagnosis, meticulous perioperative assessment, and precise surgery are essential factors to obtain good results in IGBC treatment.

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Acknowledgement

This work was supported by the National Key Research and Development Program of China (No. 2012BAI06B01) and China Postdoctoral Science Foundation funded Project (No. 20080441310).

Conflict of interest

The authors have no conflicts of interest. There was no commercial interest.

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Authors and Affiliations

  1. Hospital & Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, 100853, China

    Yuan-Hu Tian, Xu Ji, Bo Liu, Guang-Yun Yang, Xiang-Fei Meng, Hong-Tian Xia, Jing Wang, Zhi-Qiang Huang & Jia-Hong Dong

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  1. Yuan-Hu Tian
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  2. Xu Ji
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  3. Bo Liu
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Correspondence to Jia-Hong Dong.

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Yuan-Hu Tian and Xu Ji have contributed equally to this work.

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Tian, YH., Ji, X., Liu, B. et al. Surgical Treatment of Incidental Gallbladder Cancer Discovered During or Following Laparoscopic Cholecystectomy. World J Surg 39, 746–752 (2015). https://doi.org/10.1007/s00268-014-2864-9

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  • DOI: https://doi.org/10.1007/s00268-014-2864-9

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