Management of incidental and suspicious gallbladder cancer: focus on early referral to a tertiary centre.

Abstract

OBJECTIVES:

This study was conducted to assess the management of incidental gallbladder cancer and indeterminate gallbladder lesions. Its secondary aim referred to the devising of a management pathway for these patients.

METHODS:

Patients referred with incidental gallbladder cancer and indeterminate gallbladder lesions during 2002-2011 were identified from a prospectively maintained database. Collated data included operative findings, histopathological data and survival outcomes.

RESULTS:

The study included a total of 104 patients, 40 of whom had incidental gallbladder cancer following cholecystectomy. In this group, the index cholecystectomy was considered curative (T-is/T1a stage) in three patients; 11 patients underwent further resection, and 26 patients were inoperable. One-, 3- and 5-year overall survival rates were 91.1%, 91.0% and 60.7%, respectively, in patients who underwent re-resection. Of the 64 patients with indeterminate gallbladder lesions, 54 patients underwent modified radical cholecystectomy. Seven patients were found to have gallbladder cancer. One-, 3- and 5-year overall survival rates were 85.9%, 43.1% and 42.8%, respectively. Five-year overall survival in patients treated with surgery for gallbladder cancer was 59.9%.

CONCLUSIONS:

The majority of patients with incidental gallbladder cancer were not amenable to further potentially curative resection. The radiological suspicion of gallbladder cancer should lead to prompt referral to a tertiary hepatobiliary unit for further management.

• Authors: Vincent S Yip, Dhanwant Gomez, Sean Brown, Clare Byrne, David White, Stephen W Fenwick, Graeme J Poston, Hassan Z Malik
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 16 Issue 7 Pg. 641-7 (Jul 2014) ISSN: 1477-2574 [Electronic] England
• PMID: 24279377 (Publication Type: Journal Article)
• Copyright: © 2013 International Hepato-Pancreato-Biliary Association.

Topics

• Aged
• Cholecystectomy (adverse effects, mortality)
• Female
• Gallbladder (pathology, surgery)
• Gallbladder Neoplasms (mortality, pathology, surgery)
• Humans
• Incidental Findings
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Proportional Hazards Models
• Referral and Consultation
• Reoperation
• Risk Factors
• Tertiary Care Centers
• Time Factors
• Treatment Outcome