Incidental Gallbladder Carcinoma Research Articles

Oncologic Extended Resection of T3-Stage Incidental Gallbladder Carcinoma

Oncologic Extended Resection of T3-Stage Incidental Gallbladder Carcinoma

Incidental Gallbladder Carcinoma: An Eastern Indian Experience and Necessity of Routine Histopathological Examination after All Cholecystectomy

Introduction: The carcinoma of gallbladder is the most common malignancy of the biliary tract. The incidence of this carcinoma varies geographically. Incidental gallbladder carcinoma is diagnosed during histopathological examination after cholecystectomy due to other reasons. Histopathological examination of all cholecystectomy specimens are very essential to rule out these incidental gallbladder carcinomas. Aim: To this study to estimate the frequency of incidental gallbladder carcinoma in patients undergoing routine cholecystectomy and also to evaluate the necessity of routine histopathological examination after all cholecystectomy. Materials and Methods: A retrospective observational study was conducted in Department of Pathology, Midnapore Medical College and Hospital, West Bengal, India between January 2014 to December 2019 (six years) covering 650 patients who underwent laparoscopic and open cholecystectomy. Patients' demographic data, pathologic results, macroscopic appearance of the specimen, cancer staging were recorded and frequency of incidental gallbladder carcinoma were calculated. Result: Total 650 cholecystectomy specimens due to benign gallbladder disease were received in pathology department. Histopathological examination revealed 18 cases of incidental gallbladder carcinoma which comprised 2.8% of all the cholecystectomies. Among them 13 were female and five were in male with male: female ratio of 1:2.6 and the age ranges from 35 to 68 years. Among 18 cases 10 cases showed invasion upto lamina propria (stage T1a), five) cases had invasion in muscular layer (stage T1b) and three cases showed perimuscular connective tissue invasion (stage T2a). Conclution: The present study observed that the incidence of incidental gallbladder carcinoma in cholecystectomy specimen was little higher range in East Indian population and so routine histopathological examination of all cholecystectomy specimens are recommended.

Node Positivity in T1b Gallbladder Cancer: A High Volume Centre Experience

Introduction: Identification of early stage gallbladder cancer is difficult which is why about half of the patients are diagnosed post simple cholecystectomy . Simple cholecystectomy is considered adequate for T1a gall bladder cancer, however T1b requires radical cholecystectomy due to chances of lymph node metastasis. Methods: A retrospective review of a prospectively maintained database of gall bladder cancer patients operated at our institute from March 2010 to March 2021 was conducted. Only patients with proven gallbladder adenocarcinoma on final histopathology report were included. Results: There were a total of 1,245 patients of upfront and revision surgery for gall bladder cancer in this period. There were 76 patients of T1b stage of which 11 patients underwent upfront surgery and 65 patients were diagnosed as incidental gall bladder carcinoma. Neoadjuvant treatment was given to 9 patients due to uptake in periportal nodes and they were excluded from final analysis. The median age was 50 years (28-72 years). The median nodal harvest was 8 nodes (2-24 nodes). Positive nodes were found in 7 (10.44%) out of 67 patients with pT1b in final histopathology report. After a median follow up of 47.5 months (range 2-120 months), 7 (10.4%) patients had succumbed due to disease, 2 were alive with disease and 3 were lost to follow up with an OS of 89% and DFS of 86%. Conclusion: Nodal positivity for T1b gall bladder cancer ranges around 10% and radical surgery with complete peri –portal lymphadenectomy should be considered as standard of care.

Incidental gallbladder carcinoma in patient’s undergone elective cholecystectomy for lithiatic cholecystitis

Incidental gallbladder carcinoma in patient’s undergone elective cholecystectomy for lithiatic cholecystitis

Incidental Gallbladder Carcinoma Diagnosed After Laparoscopic Cholecystectomy

Incidental Gallbladder Carcinoma Diagnosed After Laparoscopic Cholecystectomy

Determinants of curative resection in incidental gallbladder carcinoma with special reference to timing of referral.

Backgrounds/AimsRe-resection of incidental gallbladder carcinoma (IGBC) is possible in a select group of patients. However, the optimal timing for re-intervention lacks consensus.MethodsA retrospective analysis was performed for a prospective database of 91 patients with IGBC managed from 2009 to 2018. Patients were divided into three groups based on the duration between the index cholecystectomy and re-operation or final staging: Early (E), < 4 weeks; Intermediate (I), > 4 weeks and < 12 weeks; and Late (L), > 12 weeks. Demographic data, tumor characteristics, and operative details of patients were analyzed to determine factors affecting the re-resectability of IGBC.ResultsTwenty-two patients in ‘E’, 48 in ‘I’, and 21 in ‘L’ groups were evenly matched. Nearly two thirds were asymptomatic. Curative resection was possible in 48 (52.7%) patients. Metastasis was detected during staging laparoscopy (SL)/laparotomy in 26 (28.6%) patients. The yield of SL was more in the ‘L’ group (30.8%) than in the ‘I’ (11.1%) or ‘E’ (nil) group, avoiding unnecessary laparotomy in 13.6%. Only 28.5% of patients in the ‘L’ group could undergo curative resection (R0/R1 resection), significantly less than that in the ‘E’ (50.0%) or ‘I’ group (64.6%) (both p < 0.001). On multivariate analysis, presentation in intermediate period and tumor differentiation increased the chance of curative resection (p < 0.05).ConclusionsAsymptomatic patients in the ‘I’ group with well differentiated IGBC have the best chance of obtaining a curative resection.

TP6.2.7 Routine examination of gallbladder specimens after cholecystectomy: a single-centre analysis of the incidence, clinical and histopathological aspects of incidental gallbladder carcinoma

Abstract Aims Gallbladder carcinoma is often found incidentally on histopathologic examination after cholecystectomy – this is referred as incidental gallbladder carcinoma (IGC). Routine vs selective histopathological assessment of gallbladders is under debate, this study evaluates the role of regular specimens’ examination, based on a single-centre analysis of incidence, clinical and histopathological aspects of IGC. Methods Patients who underwent cholecystectomy, between July 2010 and January 2020, were considered. Exclusion criteria were age under 18 and preoperative diagnosis of GB carcinoma. Demographic, clinical and histopathological data were retrospectively collected, continuous variables with a normal distribution were evaluated with Student’s t-Test and ANOVA. Results Some 5779 patients were included. The female/male ratio was 2.5:1. Chronic cholecystitis (CC) was the most common finding on specimens (99.3%), IGC was found in 6 cases (0.1%). In the latter group, there were 5 women and patients were older than those with benign disease – 73.7 ± 5.38 years vs 55.8 ± 0.79 years (p &amp;lt; 0.05). In all the cases, the GB was abnormal on intraoperative inspection and beside cancer, histopathology showed associated CC and/or dysplasia. Upon diagnosis, disease was at advanced stage – one stage II, one stage IIIA, one stage IIIB, three stage IVA. Two patients are alive, three died of disease progression – median survival was 7 months (range 2-14). Conclusions In this series, ICG was rare, occurred most commonly in old adult women and was diagnosed at an advanced stage. In all the cases, the GB was abnormal intraoperatively, therefore macroscopic GB anomalies demand histopathological assessment of the specimen.

INCIDENTAL GALL BLADDER CARCINOMA (IGBC) IN CHOLECYSTECTOMY SPECIMENS REMOVED FOR CHOLELITHIASIS

Background: The present study highlights the occurrence of Incidental gallbladder carcinoma (IGBC) detected during histopathological examination in cholecystectomy specimens removed for cholelithiasis. Methods- This is a tertiary hospital based cross-sectional study of 500 cholecystectomy specimens removed during cholelithiasis. Relevant hospital records, histopathology slides and reports were reviewed, re-evaluated and studied.&#x0D; Results: 4(0.80%) cases of incidental gall bladder carcinoma (IGBC) were diagnosed from the histopathological evaluation (HPE) of 500 cholecystectomy specimens, constituting 0.80% of gall bladder specimens received during the study period. The age of the patients with IGBC ranged from 51-80 years. More females were affected than males with a M:F ratio of 1:3.&#x0D; Conclusion: Early detection of IGBC by histopathological examination would have a favourable impact on prognosis and management thereby increasing the survival outcome.&#x0D; Keywords: Cholelithiasis, Incidental Gall Bladder Carcinoma

Age, operation time and surgical approach can be used to detect incidental gallbladder carcinoma in cholecystectomy specimens from low-incidence settings.

Gallbladders resected for non-neoplastic diseases are systemically examined microscopically to rule out incidental dysplasia and carcinoma. The main aim of this study was to test whether a pre-grossing algorithm can detect incidental gallbladder carcinoma. The secondary aim was to test whether the algorithm can detect high-grade dysplasia. A retrospective study of clinical, pathological and radiological findings in cholecystectomy recipients was performed on a test set to develop a classification and regression tree algorithm. Cholecystectomy cases were included; exclusion criteria were age <18years, missing pathology reports, preoperative suspicion of neoplastic disease, and cholecystectomy for non-gallbladder oncological disease. Five thousand nine hundred and eighty-two cholecystectomies from 2006 to 2018 were included in the study, with 18 cases of incidental gallbladder carcinoma and 11 cases of high-grade dysplasia. Three hundred and ninety controls were randomly selected for the testing set. Patient age, surgical approach, operation duration, dilatation of the biliary tract and gallbladder gross anomalies were statistically significant distinguishing factors in multivariate analysis (P<0.00-0.026). Unsupervised testing with a conditional inference tree suggested that age, procedure type and operation duration can be used to identify incidental gallbladder carcinoma from controls, whereas high-grade dysplasia also requires grossing parameters to identify half of the cases (5/11). Readily available clinical parameters and postoperative data can be used to detect incidental gallbladder carcinoma. High-grade dysplasia mostly requires grossing and microscopic examination.

Incidental Gallbladder Carcinoma in North Indian Population: Importance of Routine Histopathological Examination of All Benign Gallbladder Specimens.

Aim: To evaluate the incidence of incidental gallbladder carcinoma in specimens of cholecystectomy performed for benign gallbladder diseases and to establish the utility of routine histopathological examination of all gallbladder specimens obtained following cholecystectomy done for benign diseases.Material and Methods: This was a hospital-based three years prospective and retrospective study done at a tertiary care centre in North India. Gallbladder specimens from laparoscopic and open cholecystectomies done for benign gallbladder diseases without any clinico-radiological evidence of malignancy were included in the study. Routine histopathological evaluation of 1,268 such gallbladder specimens was carried out to get the incidence of incidental gallbladder carcinoma and pathological staging of carcinoma was done according to American Joint Committee recommendations for cancer staging (AJCC). All the diagnosed cases of Incidental gallbladder carcinoma (IGBC) were analysed in terms of demographics, radiology findings, and gross and microscopic pathology findings.Results: Out of 1,268 gallbladder specimens of clinically benign diseases, 16 cases (1.26%) were diagnosed as cases of IGBC with female predominance with a male to female ratio of 1:7. Mean gallbladder thickness in these cases was 0.77±0.20 cm, and 98.30% cases of IGBC were associated with gall stone disease. However, no correlation was observed between the age, gallbladder thickness and pathological stages of these IGBC.Conclusion: IGBC is an occult disastrous malignancy of the gallbladder, which can be missed in the pre and intraoperative periods despite careful clinical and radiological evaluation and comes as a surprise for pathologists the first time. We recommend that all specimens of gallbladder obtained from its surgical resection for benign diseases should be subjected to histopathological examination.

Does timing of completion radical cholecystectomy determine the survival outcome in incidental carcinoma gallbladder: A single center retrospective analysis

Incidental discovery of gallbladder cancer (GBC) on postoperative histopathology or intra-operative suspicion is becoming increasingly frequent, since laparoscopic cholecystectomy became the standard of care for gall stone disease. Incidental GBC (IGBC) portends a better survival than primarily detected GBC. Various factors affect the outcome of re-resection with timing of re-intervention an important determinant of survival. All patients of IGBC who underwent curative resection from January 2009 to December 2018 were considered for analysis. Details of demographic profile, index surgery, primary histopathology, operative findings on re-resection, final histopathology and follow-up data were retrieved from the prospectively maintained database. Patients were evaluated in three groups based on the interval between index cholecystectomy and re-intervention (early [< 4weeks], intermediate [4-12 weeks], and late [> 12 weeks]) using appropriate statistical tests. Forty eight patients underwent re-resection with curative intent. Median age of presentation was 55 years. Mean and median follow-up was 51.6 and 40.6 months respectively (range, 1.2-130.6 months). The overall survival and disease free survival among the three groups was the best in 'early' group (104 & 102 months) as compared to the 'Intermediate' (84 & 83 months) and 'late' groups (75 & 73 months), though the difference was not statistically significant (p = 0.588 and p = 0.581). On Multivariate analysis, poor differentiation was the only independent factor affecting survival. Other attributes which were associated with poor outcome, but could not reach statistical significance were node metastasis, delay in re-resection, residual tumor, need for CBD excision and lymphovascular invasion. Grade of tumor is the most important determinant of survival in IGBC. Early surgery, preferably within 4 weeks possibly entails better survival.

527 Selective Approach to Gallbladder Histopathological Examination Following Cholecystectomy. Would Incidental Gallbladder Cancers Be Missed?

Abstract Background The incidental finding of gallbladder carcinoma on histopathological examination following cholecystectomy is rare and thus, a selective approach should be evaluated as it could be more cost-efficient. The primary aim of this retrospective study was to assess the incidence of gallbladder cancer in a single hospital trust. The secondary aim was to evaluate the predictive value of macroscopic changes. Method A retrospective analysis of all cholecystectomies performed at a hospital trust between November 2017-November 2019. Discharge notes, operation notes, histopathology reports were evaluated. Results In total, 966 patients were included. All gallbladder specimens had been sent for histopathological examination. The histology was normal in 21 patients (2.1%) and inflammatory changes reported in 930 cases (96.3%). Gallbladder dysplasia was found in 14 specimens (1.5%) and macroscopic abnormalities were seen in 11 of those. One case (0.1%) was reported as incidental gallbladder carcinoma and macroscopic abnormalities were observed intra-operatively. Conclusions Gallbladder carcinoma detected incidentally after cholecystectomy is rare. Gallbladder dysplasia and cancer are associated with macroscopic abnormalities and thus selective approach could potentially replace routine histopathological examination - provided all gallbladders are dissected and inspected at the time of surgery.

Incidental Finding of Gall Bladder Carcinoma–A Retrospective Study in a Tertiary Care Hospital of Eastern India, West Bengal

Introduction: Gall bladder carcinoma is the most common biliary tract malignancy worldwide.1Aggressivebiological nature of the tumor results in rapid spread of the tumor to adjoining vital structures since theGB is located in an anatomically busy area.1The tumor is thus, often unresectable at presentation.In thisretrospective study we aimed to establish the overall rate of unsuspected gallbladder carcinoma in allcholecystectomy specimens in a tertiary care hospital in the eastern part of India.Material and Method: In our study we have reviewed the clinical records of consecutive 731Cholecystectomyspecimens during the last 5 Years (2014May-2019April) .A uniform procedure of history taking,physicalexamination, investigation and treatment adopted for all the patients.Diagnosis of Incidental gall bladdercarcinoma was confirmed on microscopic examination.Results: During the last 5 years, 731 cholecystectomies were performed in this tertiary care hospital. Outof them 65.43% was from female population whereas 34.57% were from male. Median age of the patientpopulation is around 55± 9.34 years.Most of the approaches were laparotomy.Evaluation of the all pathologicspecimen revealed 74 cases of gall bladder carcinoma which comprises 10.12% of all the cholecystectomiesdone in that aforesaid period.Conclusions: The findings of Incidental gall bladder carcinoma is a clinical problematic scenario whichoften misses the eye of a radiologist and comes as a histopathological surprise. Microscopical examinationof all cholecystectomy specimen should be done because it is not only the gold standard diagnostic methodbut also reveals the occult malignancy at the earliest.

Selective or Routine Histology of Cholecystectomy Specimens for Diagnosing Incidental Carcinoma of Gallbladder and Correlation with Careful Intraoperative Macroscopic Examination? A Systematic Review.

Background:Selective or Routine histology of cholecystectomy specimens for benign gallbladder disease has always been a matter of debate because of the low prevalence and bad prognosis associated with gall bladder carcinoma. The objective of this study is to ascertain whether selective histology can be preferred over Routine histology without any harm. Methods:This systematic review is conducted according to PRISMA’s checklist; relevant articles were searched in the database until September 1 2020 in PubMed, Scopus, Science Direct, and Web of Science databases, manually, with search queries and without date restrictions. Studies included in this systematic review involved patients who underwent cholecystectomy for benign gallbladder disease and were diagnosed with gallbladder carcinoma incidentally either after selective or routine histology of the gallbladder. Results:A total of 24 routine or selective histology recommending studies were selected for the systematic review after following the inclusion and exclusion criteria. These studies comprised 77,213 numbers of patients and 486 numbers of Malignancies. These studies correlate the number of IGBC diagnosed histologically with the number of IGBC’s that were suspected by the surgeons intraoperative by macroscopy. Routine recommending studies show a significant number of IGBC diagnosed histologically as missed by surgeons whereas the selective recommending studies show most of the histologically diagnosed IGBC already suspected by the surgeons intraoperative. When comparing the macroscopic details of the IGBC’s between routine and selective studies, we found that there was significant overlap. Most of the findings missed by the surgeons as suspicious in routine studies were suspected by the surgeons involved in selective histology recommending studies. Thereby, favouring selective histology and emphasizing the need for careful intraoperative macroscopy for suspecting IGBC. Conclusion:Selective Histological examination of cholecystectomy specimens can be preferred if a careful intraoperative macroscopic examination is done and patient risk factors are taken into consideration.

Routine examination of gallbladder specimens after cholecystectomy: a single-centre analysis of the incidence, clinical and histopathological aspects of incidental gallbladder carcinoma

BackgroundGallbladder carcinoma is often found incidentally on histopathologic examination after cholecystectomy—this is referred as incidental gallbladder carcinoma (IGC). Routine vs selective histopathological assessment of gallbladders is under debate and this study evaluates the role of regular specimens’ examination, based on a single-centre analysis of incidence, clinical and histopathological aspects of IGC.MethodsPatients who underwent cholecystectomy, between July 2010 and January 2020, were considered. Exclusion criteria were age under 18 and preoperative diagnosis of GB carcinoma. Demographic, clinical and histopathological data were retrospectively collected, continuous variables with a normal distribution were evaluated with Student’s t-test and ANOVA.ResultsSome 5779 patients were included. The female/male ratio was 2.5:1. Chronic cholecystitis (CC) was the most common finding on specimens (99.3%), IGC was found in six cases (0.1%). In the latter group, there were 5 women and patients were older than those with benign disease—73.7 pm 5.38 years vs 55.8 pm 0.79 years (p < 0.05). In all the cases, the GB was abnormal on intraoperative inspection and beside cancer, histopathology showed associated CC and/or dysplasia. Upon diagnosis, disease was at advanced stage—one stage II, one stage IIIA, one stage IIIB, three stage IVA. Two patients are alive, three died of disease progression—median survival was 7 months (range 2–14).ConclusionsIn this series, ICG was rare, occurred most commonly in old adult women and was diagnosed at an advanced stage. In all the cases, the GB was abnormal intraoperatively, therefore macroscopic GB anomalies demand histopathological assessment of the specimen.

Incidental Gallbladder Carcinoma in Gallbladder Polyps: Challenges of Gallbladder Malignancy for an Endemic Population.

BackgroundGallbladder polyps are considered pre-malignant lesions of gallbladder carcinoma. This study aims to highlight the role of early cholecystectomy in the management of gallbladder polyps in an endemic population.MethodsA retrospective analysis of 2,076 lap cholecystectomy procedures performed at the Department of Surgical Gastroenterology at a tertiary referral centre in Northern India was conducted and incidental malignancy in gallbladder polyps analysed. The 8th edition of the American Joint Committee on Cancer for tumour-node-metastasis (TNM) staging of gallbladder carcinoma was used.ResultsOf 54 patients with gallbladder polyps, 53 had benign histology and one had malignant cells in the lamina propria suggestive of T1a adenocarcinoma. The patient with the malignant polyp was older (57 years old) than the patients in the non-cancer group, which had a mean age of 45 (P = 0.039). The size of the malignant polyp was approximately 4 mm, significantly smaller than the average 7.9 mm size of the benign polys (P = 0.031).ConclusionCholecystectomy needs to be considered early in the management of small-sized gallbladder polyps, particularly in areas endemic for gallbladder carcinoma.

EVALUATION OF RADICAL CHOLECYSTECTOMY FOR INCIDENTAL GALLBLADDER CARCINOMA DIAGNOSED AFTER CHOLECYSTECTOMY, SINGLE CENTER EXPERIENCE

Objective: To evaluate the procedure of radical cholecystectomy for incidental gallbladder carcinoma diagnosed after cholecystectomy at a tertiary care teaching hospital of Pakistan.&#x0D; Study Design: Observational study (case series).&#x0D; Place and Duration of Study: Army Liver Transplant Unit, Pak Emirates Military Hospital, Rawalpindi, from Jun2018 to Apr 2019.&#x0D; Methodology: A prospective study was conducted on 11 patients who underwent routine cholecystectomy either open or laparoscopic for a possibly benign condition but were found with a malignancy on histopathology, were included in the study. Detailed assessment regarding all the side effects was done immediately after the procedure, at 48 hours, at time of discharge and two weeks after the procedure was done on all the participants.&#x0D; Results: Out of 11patients included in the final analysis, 06 were male and 05 were female. Mean age of patients put who underwent cholecystectomy and had incidental finding of cancer was 44.23 ± 3.621. Mean duration of hospital stay after the surgery was 5.13 ± 2.175. Most of the patients had well differentiated tumor. Post-operative pain was the commonest complication among the target population followed by biliary complication.&#x0D; Cholecystectomy,Conclusion: Gallbladder carcinoma may be missed on routine clinical screening and radiological modalities.Surgeon should be careful enough and suspect unusual finding of malignancy in routine surgeries. Radicalsurgery of the incidental gallbladder cancer emerged as an effective management modality among the patientsmanaged in our set up during this study period.

Identification of patients who may benefit the most from adjuvant chemotherapy following resection of incidental gallbladder carcinoma.

To develop a scoring system to identify the subset of patients who may benefit the most from adjuvant chemotherapy following curative-intent resection for incidental gallbladder cancer (IGBC). A novel scoring system was utilized to stratify patients relative to overall survival (OS), as well as potential benefit from adjuvant chemotherapy following curative resection for IGBC. Among 266 patients with IGBC, a total of 99 (37.2%) patients received adjuvant chemotherapy. Five risk factors were used to develop an integer-based score to predict OS. Risk of death at 5-years incrementally increased among patients in the low (n = 42, 69.0%), medium (n = 64, 56.3%) and high-risk groups (n = 40, 30.0%) (median OS, 99.4 vs. 33.5 vs. 15.6 months, all p < .001). Use of adjuvant chemotherapy did not provide a survival benefit among patients in the low-risk group (median survival, 99.4 vs. 60.7 months, p = .56). In contrast, utilization of adjuvant chemotherapy was associated with an improvement in survival among medium- (median survival, 21.7 vs. 59.5 months, p = .04) and high-risk patients (median survival, 11.6 vs. 20.1 months, p = .01). While low-risk patients did not benefit from adjuvant chemotherapy, individuals with medium or high-risk scores had an improved survival with the utilization of adjuvant chemotherapy.

Perioperative chemotherapy with gemcitabine plus cisplatin followed by radical liver resection versus immediate radical liver resection alone in gallbladder carcinoma or in front of radical resection in BTC: The phase III GAIN trial.

TPS353 Background: Radical surgical resection represents the only potentially curative treatment option for Biliary Tract Cancer (BTC) and Gallbladder Carcinoma (GBC). Nevertheless, 5-year OS is only 20–40% after curatively intended resection. GBC is the fifth most common neoplasm of the digestive tract and even the most frequent cancer of the biliary system. The majority of gallbladder carcinoma cases are discovered incidentally by the pathologist after cholecystectomy for a benign indication, so called incidental gallbladder carcinomas. For improving curative rates in BTC and GBC, early systemic therapy combined with radical resection seems to be a promising approach. The earliest moment to apply chemotherapy would be in front of radical surgery. Encouraging results of neoadjuvant/perioperative concepts in other malignancies provide an additional rationale to use this treatment in the early phase management of GBC and intrahepatic as well extrahepatic cholangiocarcinoma, especially because data regarding pure adjuvant chemotherapy in BTC`s are currently conflicting. Methods: GAIN is a multicenter, randomized, controlled, open-label phase III trial, including pts with GBCs in front of radical liver resection and pts with resectable/borderline resectable intra- and extrahepatic cholangiocarcinomas (ICC/ECC). Pts. are randomized to either neoadjuvant systemic chemotherapy (Gemcitabine + Cisplatin 3 cycles pre- and post-surgery) followed by radical surgery or to direct surgery without neoadjuvant treatment. Primary endpoint is OS; secondary endpoints are PFS, R0-resection rate, toxicity, perioperative morbidity, mortality and QoL. A total of N = 333 patients with GBC or BTC will be included. Recruitment has just started; first patient in was on December 6th, 2019. Clinical trial information: NCT03673072.

Routine Examination of Gallbladder Specimens after Cholecystectomy: Analysis of the Incidence, Clinical and Histopathological aspects of incidental gallbladder carcinoma

Purpose: Gallbladder carcinoma is often found incidentally on histopathologic examination after cholecystectomy – this is referred as incidental gallbladder carcinoma (IGC). Routine vs selective histopathological assessment of gallbladders is under debate and this study evaluates the role of regular specimens’ examination, based on a single-centre analysis of incidence, clinical and histopathological aspects of IGC. Method: Patients who underwent cholecystectomy, between July 2010 and January 2020, were considered. Exclusion criteria were age under 18 and preoperative diagnosis of GB carcinoma. Demographic, clinical and histopathological data were retrospectively collected, continuous variables with a normal distribution were evaluated with Student’s t-Test and ANOVA. Results: Some 5779 patients were included. The female/male ratio was 2.5:1. Chronic cholecystitis (CC) was the most common finding on specimens (99.3%), IGC was found in 6 cases (0.1%). In the latter group, there were 5 women and patients were older than those with benign disease – 73.7 ± 5.38 years vs 55.8 ± 0.79 years (p<0.05). In all the cases, the GB was abnormal on intraoperative inspection and beside cancer, histopathology showed associated CC and/or dysplasia. Upon diagnosis, disease was at advanced stage – one stage II, one stage IIIA, one stage IIIB, three stage IVA. Two patients are alive, three died of disease progression – median survival was 7 months (range 2-14). Conclusion: In this series, ICG was rare, occurred most commonly in old adult women and was diagnosed at an advanced stage. In all the cases, the GB was abnormal intraoperatively, therefore macroscopic GB anomalies demand histopathological assessment of the specimen.TP01.04_Table. Characteristics of patients with Incidental Gallbladder CancerPatientGenderAgeIndication of surgeryGBaGallbladder on preoperative imagingHistopathologyAJCCcAmerican Joint Committee on Cancer StageTreatmentAliveSurvival (months)1M53Biliary colicThick-walledCCbChronic CholecystitisIISurgeryY172F80PancreatitisThick-walledCCbChronic CholecystitisIVAChemotherapyN23F80CholangitisNormalCCbChronic Cholecystitis + DysplasiaIVAN74F72Biliary colicNormalCCbChronic CholecystitisIIIBChemotherapyN75F66CholangitisNormalDysplasiaIVAChemotherapyN146F91Biliary colicAdenomyomatosisCCbChronic Cholecystitis + DysplasiaIIIAY23a Gallbladderb Chronic Cholecystitisc American Joint Committee on Cancer Open table in a new tab