The treatment strategy for incidental gallbladder carcinoma without excess and insufficiency

Abstract

Objective: Radical surgery is essential for the favorable result in patients with gallbladder cancer. From this point of view, the treatment strategy for incidental gallbladder carcinoma (IGBC) is a significant issue, however, it is still controversial. The present study retrospectively analyzed the clinicopathological features upon the additional radical surgery without excess and insufficiency for IGBC. Methods: From April 2000 to July 2016, 2,145 patients underwent cholecystectomy. In these, 19 cases were accidentally diagnosed as gallbladder cancer (0.88%). Operative and clinicopathological factors associated with prognosis were evaluated. Results: The additional radical surgery was performed in 8 cases. In two T1 patients, T1a (m) patient received cystic duct resection, and T1b (mp) patient did liver bed resection with lymphadenectomy. In six T2 (ss) patients, cystic duct resection, cystic duct resection with lymphadenectomy, and cystic duct resection with liver bed resection and lymphadenectomy performed in each 2 cases. Three T2 patients without additional surgery and one T3a patient died of recurrence. In the other cases, there is no evidence of recurrence so far. In the cases that received additional liver bed resection, the margin of gall bladder resection was negative for cancer cells. These patients survived without recurrence. T1 or T2 with additional surgery cases showed a significant better survival rate compared with the other cases (P = 0.0181). Conclusion: In T2 stage IGBC, the additional radical surgery is strongly recommended. However, additional liver bed resection should not be necessary, if the margin of gall bladder resection is negative for cancer cells.