Incidental Gallbladder Cancer Research Articles

Treatment Outcomes of Incidental Gallbladder Cancer – Results from a High-Volume Tertiary Care Centre in North India

Treatment Outcomes of Incidental Gallbladder Cancer – Results from a High-Volume Tertiary Care Centre in North India

Referral rate of patients with incidental gallbladder cancer and survival: outcomes of a multicentre retrospective study.

Treatment outcomes of incidental gallbladder cancer generally stem from tertiary referral centres, while many patients are initially diagnosed and managed in secondary care centres. Referral patterns of patients with incidental gallbladder cancer are poorly reported. This study aimed to evaluate incidental gallbladder cancer treatment in secondary centres, rates of referral to tertiary centres and its impact on survival. Medical records of patients with incidental gallbladder cancer diagnosed between 2000 and 2019 in 27 Dutch secondary centres were retrospectively reviewed. Patient characteristics, surgical treatment, tumour characteristics, referral pattern and survival were assessed. Predictors for overall survival were determined using multivariable Cox regression. In total, 382 patients with incidental gallbladder cancer were included. Of 243 patients eligible for re-resection (pT1b-pT3, M0), 131 (53.9%) were referred to a tertiary centre. The reason not to refer, despite indication for re-resection, was not documented for 52 of 112 non-referred patients (46.4%). In total, 98 patients underwent additional surgery with curative intent (40.3%), 12 of these in the secondary centre. Median overall survival was 33 months (95% c.i. 24 to 42 months) in referred patients versus 17 months (95% c.i. 3 to 31 months) in the non-referred group (P = 0.019). Referral to a tertiary centre was independently associated with improved survival after correction for age, ASA classification, tumour stage and resection margin (HR 0.60, 95% c.i. 0.38 to 0.97; P = 0.037). Poor incidental gallbladder cancer referral rates were associated with worse survival. Age, performance status, resection margin or tumour stage should not preclude referral of a patient with incidental gallbladder cancer to a tertiary centre.

Incidental gall bladder carcinoma after cholecystectomy for benign disease: An institutional experience

Cholecystectomy is the most common routinely performed procedure for benign gallbladder disease worldwide and incidental gall bladder cancer is mostly detected in post-cholecystectomy specimens.This retrospective study emphasizes on the need for routine surveillance of post-cholecystectomy specimens by evaluating the incidence of incidental findings of carcinoma in cholecystectomy specimens done for benign gallbladder disease.A total of 2443 patients were evaluated over a period of 7 years, out of which, 18 patients were diagnosed with incidental gall bladder carcinoma with an incidence of 0.73 %. The mean age of affected patients was 59 years. Among the 18 patients, 8 patients (44 %) had an intra-operative suspicion of malignancy. Once incidental cancer is detected the treatment decision should be decided according to tumor spread and depth as well as the patient's age, additional health problems, and life expectancy.

Incidental Finding of Gall Bladder Carcinoma in Post-Menopausal Females in Cholecystectomy Specimen

Objective: To highlight the significance of histopathological examination of gallbladder and to evaluate incidental gallbladder cancer in post-menopausal females. Study Design: Cross-sectional Study. Place and Duration of Study: Department of Pathology, Diagnostic and Research Laboratory, Liaquat University of Medical and Health Sciences, Hyderabad Pakistan, from Jan 2020 to Dec 2021. Methodology: Two thousand nine hundred fifty-nine (n=2959) gallbladder specimens with a clinical diagnosis of cholelithiasis and cholecystitis were analyzed. The clinical history of patients was taken from computer storage data. Results: Out of the total 2959 cases, on histopathological examination, chronic cholecystitis was the commonest finding (1990, 67.25%), followed by acute cholecystitis 410(13.85%) cholesterolosis (396,13.38%) and gallbladder carcinoma 42(1.42%). Out of 42 cases of gallbladder carcinoma, 34(80.95%) were female and 8(19%) were male. Most cases were post-menopausal age group 21(61.76%) compared to premenopausal 13(38.23%).Conclusion: In our study, Incidental gallbladder carcinoma in post-menopausal women was higher than expected.

A Retrospective Analysis of Incidental Gallbladder Cancer on Post-cholecystectomy Pathological Review.

Background Gallbladder cancer is a rare cancer with a poor prognosis despite all the advances in treatment options and is mostly detected incidentally. In the current literature, re-excision is performed on patients with stage T1b and above, but high mortality rates are still observed. In this study, we aimed to investigate the reasons affecting the prognosis of incidental gallbladder cancer. Methodology Data from 33 patients were retrospectively analyzed. Patient age, sex, preoperative radiologic findings, surgical procedures, margin status, postoperative results with histologic diagnosis, T stage, complications, and mortality were evaluated. Results Of the 33 patients included in the study, 24 (72.7%) were female, nine (27.3%) were male, and the mean age was 66.4 ± 13.4 years. Seventeen (51.5%) patients in our study were aged over 65 years. Age over 65 years was found to have a significant effect on mortality (p = 0.018). In the preoperative ultrasound imaging, 27 (81.8%) patients had gallstones, two (6.1%) patients had gallbladder polyps, 31 (93.9%) had focal or diffuse thickness increases in the gallbladder wall, and nine (27.3%) patients had pericholecystic fluid. The presence of pericholecystic fluid (p = 0.039) and wall thickness (p = 0.006) were found to be associated with mortality. There was perineural invasion and lymphovascular in 17 patients each. Both perineural invasion (p = 0.016) and lymphovascular invasion (p = 0.007) were associated with mortality. Tumor grade was also associated with mortality (p = 0.001). When the prognosis of the patients was evaluated according to the T stage, the increase in the T stage negatively affected the prognosis (p < 0.001). Overall survival was a median of 17 months (95% confidence interval = 10.6-23.3). Conclusions Incidental gallbladder cancer is detected on routine histologic examination of gallbladder specimens after cholecystectomy. Most patients may require re-excision, but the prognosis is still poor in patients who have undergone re-excision. Age >65 years, pericholecystic fluid, T stage, grade, lymphovascular invasion, and perineural invasion had a significant effect on mortality, the presence of which should trigger the option of re-excision to be examined more carefully.

Acute cholecystitis in old adults: the impact of advanced age on the clinical characteristics of the disease and on the surgical outcomes of laparoscopic cholecystectomy

BackgroundImpact of advanced age on disease characteristics of acute cholecystitis (AC), and surgical outcomes after laparoscopic cholecystectomy (LC) has not been established.MethodsThis single-center retrospective study included patients who underwent LC for AC between April 2010 and December 2020. We analyzed the disease characteristics and surgical outcomes according to age: Group 1 (age < 60 years), Group 2 (60 ≤ age < 80 years), and Group 3 (age ≥ 80 years). Risk factors for complications were assessed using logistic regression analysis.ResultsOf the 1,876 patients (809 [43.1%] women), 723 were in Group 1, 867 in Group 2, and 286 in Group 3. With increasing age, the severity of AC and combined common bile duct stones increased. Group 3 demonstrated significantly worse surgical outcomes when compared to Group 1 and 2 for overall (4.0 vs. 9.1 vs. 18.9%, p < 0.001) and serious complications (1.2 vs. 4.2 vs. 8.0%, p < 0.001), length of hospital stay (2.78 vs. 3.72 vs. 5.87 days, p < 0.001), and open conversion (0.1 vs. 1.0 vs. 2.1%, p = 0.007). Incidental gallbladder cancer was also the most common in Group 3 (0.3 vs. 1.5 vs. 3.1%, p = 0.001). In the multivariate analysis, body mass index < 18.5, moderate/severe AC, and albumin < 2.5 g/dL were significant risk factors for serious complications in Group 3.ConclusionAdvanced age was associated with severe AC, worse surgical outcomes, and a higher rate of incidental gallbladder cancer following LC. Therefore, in patients over 80 years of age with AC, especially those with poor nutritional status and high severity grading, urgent surgery should be avoided, and surgery should be performed after sufficient supportive care to restore nutritional status before LC.

252 Incidental Gall Bladder Cancer in Patients Underwent Cholecystectomy: Do We Need Selective Histological Examination of the Gallbladder Following Cholecystectomy?

Abstract Background This study evaluated the incidence of incidental gall bladder cancer in patients undergoing cholecystectomy using the selective histological examination of the gallbladder following cholecystectomy operation (S-GALLOP). In return, the study assessed the value of S-GALLOP in patients undergoing cholecystectomy and the factors that can prompt histological examination. Method The present retrospective chart review retrieved the records of 3710 consecutive patients who underwent elective or emergency cholecystectomy due to benign pathologies at through 10-year period. Results 80.7% of the patients were chronic cholecystitis,6.3% were acute cholecystitis, 1.9% were gallbladder and 1% were gallbladder cholesterolosis. Six cases had incidental GBC (incidence rate = 0.0016%). All patients were females, except two patients, who underwent elective cholecystectomy. The median age 60.5 (range 55 to 70) . The preoperative ultrasound showed multiple gallbladder stones and thickened gallbladder wall in most of these six patients. Four patients had moderately differentiated adenocarcinoma, one had well-differentiated adenocarcinoma, and one had poorly differentiated adenocarcinoma with metastasis. On the other hand, 23 cases had gallbladder dysplasia (incidence rate = 0.006%). The median age was 61 (35 – 73), and 82.3% of the patients were females. Only three cases underwent an emergency procedure. Only one patient had high-grade dysplasia, aged 71 years old. Conclusions Incidence GBC is rare in patients undergoing elective or emergency cholecystectomy. Thus, histological examination for all cases is not recommended and S-GALLOP can represent a cost-effective alternative. S-GALLOP is recommended for any gallbladder specimen that seems abnormal on macroscopic examination, especially in old age and patients with suspicious preoperative imaging findings.

Practices in the Management of Incidental Gallbladder Cancer

Background Histopathology of gallbladder removed for stones may reveal incidental gallbladder cancer (iGBC). We conducted this online e-survey to document the knowledge and practices of management of iGBC among surgeons in India. Methods A 38-question online e-survey Results Two-hundred thirty responses were recorded. Ninety-eight out of two-hundred (49%) responses were general surgeons. Two-hundred ten out of two-hundred twenty-one (95%) saw at least one iGBC per year, but only 74/225 (32%) correctly defined true iGBC. One-hundred seventy-eight out of two hundred twenty-two (80%) did computed tomography/magnetic resonance imaging for thick-walled gallbladder (GB) detected on ultrasound, while 25/222 (11%) did laparoscopic cholecystectomy and 14/222 (6%) did open cholecystectomy. For GB mass on laparoscopy, 16/222 (7%) responses went ahead with simple cholecystectomy. Seventy-four out of two-hundred twenty-five (32%) responses routinely used bag while extracting GB. One-hundred ninety-one out of two-hundred twenty-five (86%) mentioned about stone/bile spill, 121/220 (55%) mentioned about use of bag for extraction while 137/220 62% mentioned port used for extraction of GB in operation notes. One-hundred sixty-six out of two-hundred twenty-seven (73%) always cut open GB after cholecystectomy. On encountering a mass/lesion on cut open GB, 111/225 (49%) sent it for frozen section, 89/225 (40%) sent for routine histopathology while 10% (22/225) directly proceeded for extended cholecystectomy. Ten out of two-hundred twenty-seven (4.4%) did not consider it important to send GB for histopathology. T stage on histopathology is most important factor for deciding reoperation by 205/223 (91%). Conclusion There are lacunae in understanding and deficiencies in management of iGBC in India—a high GBC incidence country. The situation is likely to be worse in low GBC incidence areas. There is need for more awareness and knowledge for proper management of iGBC among surgeons.

Can the sampling method affect the detection of incidental gallbladder carcinoma? Comparative analysis of two sampling methods

Gallbladder cancer (GBC) is the most common biliary tract carcinoma and is commonly diagnosed incidentally in cholecystectomies performed for gallstones. GBC are mostly unrecognizable macroscopically, and sampling is therefore import. This single center study aimed to find out the effect of sampling method on the identification rate of incidental GBC by comparing random sampling and longitudinal full-thickness slice sampling, which was developed in high-incidence areas. A hospital electronic database was searched for cholecystectomy specimens submitted to the pathology department between 01/2000 and 03/2016. Cases with a preoperative clinical and/or radiological suspicion of neoplasia and cases with a macroscopically identified mass were excluded from the study. Two groups were formed according to the sampling method: “random sampling” group (Group 1, n = 10,954) and “full-thickness slice sampling” group (Group 2, n = 5254). In the first group, random samples from the fundus, body and neck were submitted in gallbladders without grossly visible pathology. In the second group, a full-thickness slice sampling protocol was performed, wherein a longitudinal full-thickness slice, including fundus, corpus-neck and the cystic duct margin was submitted for each gallbladder. Statistical comparisons of GBC incidence and clinicopathologic features was performed. In group 1, GBC prevalence was 0.6 % and low grade dysplasia (LGD) was detected in 199 cases (1.8 %). In group 2, GBC prevalence was 1.5 %, LGD was detected in 166 cases (3.2 %). The GBC rate in Group 2 was significantly (p < 0.05) higher than Group 1. The two groups did not show any statistically significant differences in age, sex and presence of gallstones (p > 0.05). In conclusion, this is the largest study comparing two grossing methods in gallbladders without preoperative clinical and/or radiological suspicion of malignancy and macroscopically identified mass. This study demonstrates the importance of systematic and algorithmic sampling in the detection of GBC.

ASO Visual Abstract: Analysis of the Extent of Liver Oncologic Extended Resection for Incidental Gallbladder Cancer: How Much is too Much?

ASO Visual Abstract: Analysis of the Extent of Liver Oncologic Extended Resection for Incidental Gallbladder Cancer: How Much is too Much?

Analysis of the Extent of Liver Oncological Extended Resection for Incidental Gallbladder Cancer: How Much Is Too Much?

Liver resection is pivotal in treating incidental gallbladder cancer (IGBC). However, the adequate volume of liver resection remains controversial. A cross-sectional retrospective analysis was performed on resected IGBC patients between 1999 and 2018. Morbidity was evaluated according to the Clavien-Dindo classification. The theoretical volume of a 2-cm and 1.5-cm wedge liver resection was calculated (105 cm3 and 77.5 cm3, respectively) and used as reference. Overall survival (OS) was estimated using Kaplan-Meier and Cox regression analyses. Among 111 patients re-resected for IGBC, 84 provided sufficient data to calculate liver resection volume. Patients with a resection volume ≥ 105 cm3 had a higher rate of overall morbidity (P = 0.001) and length of stay (P = 0.012), with no difference in mortality. There was no significant difference in OS according to residual cancer or T-category. A resection volume ≥ 77.5 cm3 was more frequent in T ≥ 3 than in T1-2 patients (P = 0.026), and residual cancer was higher (P = 0.041) among patients with ≥ 77.5 cm3 resected. Cox multivariate regression showed that residual cancer (HR = 11.47, P < 0.001), perineural/lymphovascular invasion (HR = 2.48, P = 0.021), and Clavien-Dindo ≥ IIIa morbidity (HR = 5.03, P = 0.003) predict worse OS, but not liver volume resection. There are no significant differences in OS based on resected liver volume of IGBC, when R0 is achieved. There is a significant difference in morbidity and length of stay when liver wedges are ≥ 105 cm3, which is lost when analyzed by Clavien-Dindo ≥ IIIa. A 77.5-105 cm3 resection is indicated in ≥ T3 patients, minimizing morbidity risk, while addressing concerns of overall survival.

Pattern of Care and Outcomes of Gallbladder Cancer Patients: Retrospective Study from a High Incidence Region in India.

Lakhan KasyapIntroduction  Gallbladder cancer (GBC) is the 20th most common cancer in India with a crude incidence rate of 2.3 per 100,000 persons. Of note, it is relatively common in states which fall in the Gangetic plains. Patients often present in the advanced stage and have an unfavorable prognosis. Materials and Methods  From January to June 2021, 170 treatment-naive GBC (adenocarcinoma) patients who were registered at a tertiary care cancer center in North India, were included. Data were extracted from electronic medical records and was analyzed with SPSS. Results  Median age was 56 years (range 32-77 years) and 65.5% ( n  = 112) were female. Incidental GBC was found in 20% patient ( n  = 34). Majority of patients (79.4%, n  = 135) had preserved performance status. Advanced GBC was present in 85.8% ( n  = 146) patients (locally advanced = 37.0% and metastatic = 48.8%). Biliary drainage procedure was performed in 24% of patients (68% of patients with obstructive jaundice). More than half of patients (53.5%) were lost to follow-up without any treatment. There were 33 patients (19.4%) who underwent surgery and 20 of them received neoadjuvant chemotherapy. Adjuvant chemotherapy and adjuvant radiotherapy were received by 13 and 2 patients, respectively. Palliative chemotherapy was administered to 46 patients. The most common chemotherapy regimen was gemcitabine-cisplatin. At a median follow-up of 1.7 months (95% confidence interval, 1-2.4 months), 42 patients (24%) progressed and 24 patients (14%) died, with 6 months estimated progression-free survival and overall survival being 60.2 and 79%, respectively. Conclusion  GBC is an aggressive and lethal malignancy predominantly affecting females in the fifth decade with dismal outcomes. Improved access to health care, an aggressive approach in operable cases, and optimization of systemic and adjuvant therapy are the need of the hour.

Estimating the influencing factors for T1b/T2 gallbladder cancer on survival and surgical approaches selection.

The influencing factors, especially time to treatment (TTT), for T1b/T2 gallbladder cancer (GBC) patients remain unknown. We aimed to identify the influencing factors on survival and surgical approaches selection for T1b/T2 GBC. We retrospectively screened GBC patients between January 2011 and August 2018 from our hospital. Clinical variables, including patient characteristics, TTT, overall survival (OS), disease-free survival (DFS), surgery-related outcomes, and surgical approaches were collected. A total of 114 T1b/T2 GBC patients who underwent radical resection were included. Based on the median TTT of 7.5 days, the study cohort was divided into short TTT group (TTT ≤7 days, n = 57) and long TTT group (TTT >7 days, n = 57). Referrals were identified as the primary factor prolonging TTT (p < 0.001). There was no significance in OS (p = 0.790), DFS (p = 0.580), and surgery-related outcomes (all p > 0.05) between both groups. Decreased referrals (p = 0.005), fewer positive lymph nodes (LNs; p = 0.004), and well tumor differentiation (p = 0.004) were all associated with better OS, while fewer positive LNs (p = 0.049) were associated with better DFS. Subgroup analyses revealed no significant difference in survival between patients undergoing laparoscopic or open approach in different TTT groups (all p > 0.05). And secondary subgroup analyses found no significance in survival and surgery-related outcomes between different TTT groups of incidental GBC patients (all p > 0.05). Positive LNs and tumor differentiation were prognostic factors for T1b/T2 GBC survival. Referrals associating with poor OS would delay TTT, while the prolonged TTT would not impact survival, surgery-related outcomes, and surgical approaches decisions in T1b/T2 GBC patients.

Curative re-resection after incidental gallbladder cancer: When and how?

Curative re-resection after incidental gallbladder cancer: When and how?

Laparoscopic surgery of incidental gallbladder cancer after cholecystectomy for acute cholecystitis

Laparoscopic surgery of incidental gallbladder cancer after cholecystectomy for acute cholecystitis

Current status and progress in laparoscopic surgery for gallbladder carcinoma.

Gallbladder carcinoma (GBC) is the most common biliary tract malignancy associated with a concealed onset, high invasiveness and poor prognosis. Radical surgery remains the only curative treatment for GBC, and the optimal extent of surgery depends on the tumor stage. Radical resection can be achieved by simple cholecystectomy for Tis and T1a GBC. However, whether simple cholecystectomy or extended cholecystectomy, including regional lymph node dissection and hepatectomy, is the standard surgical extent for T1b GBC remains controversial. Extended cholecystectomy should be performed for T2 and some T3 GBC without distant metastasis. Secondary radical surgery is essential for incidental gall-bladder cancer diagnosed after cholecystectomy. For locally advanced GBC, hepatopancreatoduodenectomy may achieve R0 resection and improve long-term survival outcomes, but the extremely high risk of the surgery limits its implementation. Laparoscopic surgery has been widely used in the treatment of gastrointestinal malignancies. GBC was once regarded as a contraindication of laparoscopic surgery. However, with improvements in surgical instruments and skills, studies have shown that laparoscopic surgery will not result in a poorer prognosis for selected patients with GBC compared with open surgery. Moreover, laparoscopic surgery is associated with enhanced recovery after surgery since it is minimally invasive.

ASO Author Reflections: Robotic Radical Surgery for Incidental Gallbladder Cancer is on the Rise.

ASO Author Reflections: Robotic Radical Surgery for Incidental Gallbladder Cancer is on the Rise.

ASO Visual Abstract: Robotic Hepatic Bisegmentectomy (s4b+s5) and Hilar Lymphadenectomy for Incidental Gallbladder Cancer Using Glissonian Approach.

ASO Visual Abstract: Robotic Hepatic Bisegmentectomy (s4b+s5) and Hilar Lymphadenectomy for Incidental Gallbladder Cancer Using Glissonian Approach.

Incidental gallbladder cancer and its contemporary management: From evaluation to targeted therapy

Gall bladder cancer (GBC) is the commonest malignancy of biliary tract. It is locally aggressive and potentially fatal in most of the patients. With the rise in the number of laparoscopic cholecystectomies being performed worldwide, incidental presentation of GBC is becoming common. The revelation of cancer for benign cholecystectomy presents a challenge. Incidental GBC needs detailed evaluation that includes review of preoperative imaging, histopathology report of cholecystectomy and high quality imaging to look for residual or metastatic disease. It is imperative to correctly stage the disease to formulate the best treatment strategy. For assessment of disease, triple-phase Contrast Enhanced Computed Tomography (CECT) scan and staging laparoscopy have definite roles; with Positron Emission Tomography and Computed Tomography (PET/CT) useful in confirming suspicious lesions. The factors associated with poor prognosis is presence of residual disease, lymphovascular invasion, grade of tumor and presence of metastatic lymph nodes. Neoadjuvant chemotherapy can be employed for the patients who are not candidate for upfront re-resection. Surgery includes liver excision and lymphadenectomy. Adjuvant therapy is indicated for higher stage tumor for improving survival, but response rate is low. Evaluation of biomarkers can provide a target for novel therapy.

Characteristics and outcomes of gallbladder cancer patients at the Tata Medical Center, Kolkata 2017-2019.

The north and north-eastern regions of India have among the highest incidence of gallbladder cancer (GBC) in the world. WereporttheclinicopathologicalcharateristicsandoutcomeofGBCpatientsinIndia. Electronic medical records of patients diagnosed with GBC atTataMedicalCenter,Kolkatabetween 2017 and 2019 were analyzed. There were 698 cases of confirmed GBC with a median age of 58 (IQR: 50-65) years and female:male ratio of 1.96. At presentation, 91% (496/544) had stage III/IV disease and 30% (189/640) had incidental GBC. The 2-year overall survival (OS) was 100% (95% CI: 100-100); 61% (95% CI: 45-83); 30% (95% CI: 21-43); and 9% (95% CI: 6-13) for stages I-IV, respectively (p= <0.0001). For all patients, the 2-year OS in patients who had a radical cholecystectomy followed by adjuvant therapy (N= 36) was 50% (95% CI: 39-64), compared to 29% (95% CI: 22-38) for those who had a simple cholecystectomy and/or chemotherapy (N= 265) and 9% (95% CI: 6-14) in patients who were palliated (N= 107) (p= <0.0001). The combined surgical/chemotherapy approach for patients with stage II GBC showed the best outcomes. Early detection of GBC remains problematic with the majority of patients presenting with stage III-IV and who have a median survival of 9.1months. Our data suggests that the tumor is chemoresponsive and multi-center collaborative clinical trials to identify alternative therapies are urgently required.