Are all incidental gallbladder cancers truly incidental? Or, are some missed cancers?

Abstract

Incidental gallbladder carcinoma (IGBC) is an incidental finding of cancer on histopathological examination (HPE) of gall bladder specimen removed for benign gall bladder diseases. The incidence of IGBC ranges from 0.19–3.3%. However, many such tumours are of advanced T stage on HPE. Some of these tumors are possibly missed on either pre-operative evaluation and/or during cholecystectomy. This study was done to find the proportion of patients of IGBC who had preoperative and/or intra-operative suspicious of GBC but underwent simple cholecystectomy. Materials and methods: Data from 56 consecutive IGBC patients presented to our centre between April 2016–May 2017 was analysed. A review of preoperative imaging and operative notes was done to ascertain any suspicion of malignancy-in-retrospect. Results: Preoperative USG was suspicious in 39% (22/56) of patients. CECT scan done in 13 of these patients confirmed gallbladder wall abnormalities in 10 cases. Majority of procedures were open cholecystectomy (39/56), suspicious intraoperative findings were documented in 15 (26.7%) patients. Time to referral after primary surgery was within one month in 30.3% (17/56), between one to two months in 35.7% (20/56), between 2 and six months in 23.3% (13/56) and after six months in 10.7% (6/56). Seventeen patients (30.3%) were advised completion surgery. Seven patients (13%) underwent completion surgery. Rest of the patients were found to be inoperable. Conclusion: Radiologists and surgeons should keep a high index of suspicion of GBC, especially in high incidence areas. Whenever, there is any suspicion, patients should be promptly referred appropriately. Even when detected incidentally, prompt referral maximises chances of curative resection.