Study of Scar Recurrence in Incidental Gallbladder Cancer

Abstract

Incidental gallbladder cancer (IGBC) is defined as GBC diagnosed intra-operatively or after cholecystectomy done for benign gallbladder disease. Laparoscopic cholecystectomy (LC) in patients with GBC has been associated with an increased incidence of peritoneal metastasis and port site recurrences. Similar high incidence of scar site recurrence after open cholecystectomy in IGBC is not a commonly reported phenomenon with only a few anecdotal case reports. Records of all GBC patients registered between 2008 and 2012 were analyzed retrospectively. GBC patients with scar site/port site metastasis were reviewed for their clinical presentation, time elapsed between initial cholecystectomy and presentation with scar site recurrence, radiological imaging, treatment received and disease outcome. Of 337 patients of GBC, 30.56% (n = 103) presented with diagnosis of IGBC. 15/103 cases of IGBC had radiologically and cytologically proven scar site/port site metastasis ([open and laparoscopic cholycystectomy] [n = 11 and 4 respectively]). The most common presenting symptom was gradually increasing subcutaneous swelling at previous operative site and accompanying constant upper abdominal pain. Duration of symptoms varied from 2 to 24 months before medical attention was sought. Of 12 patients with available intra-operative details of previous procedure undertaken, intra-operative gallbladder perforation and spillage was reported in 5 (41%) while partial cholecystectomy was documented in 4 (33%). Patients with disease confined to scar site did marginally better on palliative chemotherapy (median follow-up duration 11 months). The results from this study suggest that scar metastasis after open cholecystectomy in IGBC is not an uncommon phenomenon. Both the radiologists and surgeons should have a high index of suspicion for GBC while reporting or operating benign gallbladder disease especially atypical clinical and ultrasound findings.