P-0155 Incidental Carcinoma of Gallbladder: Audit of Experience From a Tertiary Care Cancer Centre in North India

Abstract

ABSTRACT Introduction Laparoscopic cholecystectomy is the most common surgery performed for symptomatic benign gall bladder disease. Carcinoma may be detected after histological examination of simple cholecystectomy (laparoscopic / open) (called incidental carcinoma of gall bladder, ICGB). The incidence of ICGB ranges from 0.3 to 2.9%. According to literature, the incidence of carcinoma gall bladder is high in northern India and laparoscopic or open cholecystectomy is done widely in patients with benign gall bladder disease. There is limited literature regarding management and outcomes of ICGB. We performed an audit of patients undergoing exploration for radical cholecystectomy in patients with ICGB. Methods A retrospective review was performed of the data from the prospective maintained computerized database of all patients who have undergone simple cholecystectomy elsewhere and presented to the department of Surgical Oncology with ICGB from November 1995 to January 2009 for completion radical cholecystectomy. Statistical analysis was done using SPSS software. Descriptive analyses of the data were done. Chi-square test was used to compare proportions of categorical covariates. A p-value of 0.05 was considered significant. Kaplan-Meier analysis was done for survival analysis. Results Forty-two patients with incidental CGB were re-explored with plan for completion radical cholecystectomy. Eighteen (43%) and 24 (57%) patients had undergone laparoscopic or open simple cholecystectomy for benign gallbladder disease respectively. The median age was 46 years (range 25 to 69 years). M:F ratio was 1:6. The median time of re-exploration after initial surgery was 65 days (range of 19 to 145 days). Twenty-four (57%) patients were operable and underwent radical cholecystectomy. Eighteen (43%) patients were found inoperable due to locally advanced unresectable or metastatic disease. Thirteen patients with high-risk histopathological features received adjuvant concurrent chemoradiotherapy. Among the 24 patients who could undergo a completion radical cholecystectomy, 11 developed recurrence over a median period of 11 months. Finally 13 (31%) patients were alive and disease free at median follow-up time of 14 months (range 8-86 months).Those patients explored before 3 months had a decreased chance of having inoperable disease than those explored after 3 months (33% vs 67%, p Conclusion Incidental carcinoma of gall bladder is supposed to be associated with good prognosis group in-view-of early stage at detection. However, our experience has shown that approximately half of ICGB were operable at definitive surgical exploration and 1/3rd of those undergo exploration benefit in the long-term. The reason for this high recurrence may be due to spillage of bile and tumor during laparoscopic simple cholecystectomy, increased chances of locally advanced disease after a delayed re-exploration and highly aggressive disease. Re-exploration before 3 months have a better operability and recurrence free survival rate than after 3 months.