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Ueda Y, Yanagimoto H, Ajiki T, Tsugawa D, Asakura R, Urade T, Nanno Y, Fukushima K, Gon H, Komatsu S, Kuramitsu K, Goto T, Asari S, Toyama H, Kido M, Fukumoto T. Potential Role of Surgical Resection for Gallbladder Cancer in Elderly Patients. Am Surg 2023; 89:5118-5123. [PMID: 36341533 DOI: 10.1177/00031348221136570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
INTRODUCTION With the aging of the population in Japan, gallbladder cancer (GBC) in the elderly is increasing. However, the available clinical data are limited, and the optimal treatment is still controversial. The aim of this study was to evaluate the benefit of surgical resection in GBC patients ≥75 years of age. METHODS A retrospective single center analysis of patients who had undergone surgical resection for GBC between 2000 and 2019 was carried out. Patients aged ≥75 years (elderly group, n = 24) or <75 years (younger group, n = 50) were compared. RESULTS Both younger and elderly patients exhibited similar clinicopathological characteristics, but comorbidity in the latter was significantly greater, as was the frequency of less invasive surgery. Nonetheless, the incidence of postoperative complications was similar in elderly and younger patients. The proportion of patients receiving adjuvant chemotherapy was lower in the elderly. Overall survival of elderly and younger patients was not significantly different (65.0 vs 62.4% at 5 years, P = .600). In multivariate analysis, residual tumor status but not age was an independent prognostic factor. DISCUSSION This study demonstrated that appropriate surgical treatment of elderly GBC patients was safe and effective, despite their having more comorbidities and lower rates of adjuvant chemotherapy than younger patients.
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Affiliation(s)
- Yasuhiro Ueda
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Yanagimoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tetsuo Ajiki
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Tsugawa
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Riki Asakura
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Urade
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihide Nanno
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Fukushima
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidetoshi Gon
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shohei Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kaori Kuramitsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tadahiro Goto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sadaki Asari
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirochika Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masahiro Kido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Agarwal A, Malhotra KP. Gallbladder Cancer in Simple Cholecystectomy Specimens-an Analysis of 8227 Gallbladders from an Endemic Region. Indian J Surg Oncol 2023; 14:859-863. [PMID: 38187849 PMCID: PMC10767054 DOI: 10.1007/s13193-023-01792-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/24/2023] [Indexed: 01/09/2024] Open
Abstract
Gallbladder cancers (GBCs) detected at pathological examination for suspected benign gallbladder disease are known as incidental GBCs. These post-cholecystectomy GBCs (PCGBCs) constitute a small fraction of all cholecystectomies. The proportion of these PCGBCs is unknown in endemic regions like North India. We planned to study the proportion and epidemiology of these PCGBCs in a high-volume center in North India. We reviewed the histopathology reports of gallbladder specimens for a 5-year period between 1 January 2014 and 31 December 2018, from a prospectively maintained pathology database. Patient demographics, place of referral (academic/non-academic center), and tumor characteristics were recorded. Descriptive statistics are used to demonstrate the distribution of various factors. Of the 8227 gallbladder specimens examined, cancer was found in 162 specimens. Thus, the proportions of GBC in these cases were 1.96%. The T stage of the tumor was T1a in 6 (3.8%), T1b in 35 (22.2%), T2 in 61 (38.8%), and T3 in 55 (35%). Liver bed margins were positive in 32/103 (31%). Of the evaluable 108 cystic duct margins, 16 (14.8%) were positive. Both margins were positive in 7/77 (9%) specimens and at least one margin was positive in 26/77 (33.7%) patients. This is the first study to demonstrate the high proportion of PCGBCs in high incidence area. This study provides a compelling reason to investigate this high PCGBC numbers. Routine histopathological evaluation of gallbladder should be done with diligence as this could alter the prognosis of a patient, especially in areas of high GBC incidence.
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Affiliation(s)
- Akash Agarwal
- Department of Surgical Oncology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP India
| | - Kiran Preet Malhotra
- Department of Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, UP India
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Yuan Z, Shui Y, Liu L, Guo Y, Wei Q. Postoperative recurrent patterns of gallbladder cancer: possible implications for adjuvant therapy. Radiat Oncol 2022; 17:118. [PMID: 35799270 PMCID: PMC9264693 DOI: 10.1186/s13014-022-02091-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gallbladder cancer (GBC) is an uncommon malignancy with high recurrent rate and poor prognosis. This study investigates the recurrent patterns of postoperative GBC, with the aim to guide the adjuvant treatments, including the radiotherapy. METHODS Retrospectively analyzed the 109 GBC patients who underwent surgery in our institution from January 2013 to 2018. Clinical follow-up revealed 54 recurrent cases, of which 40 had detailed locations of recurrence. The sites of recurrence were recorded and divided into the tumor bed, corresponding lymphatic drainage area, intrahepatic recurrence, and the other distant metastasis. RESULTS The median follow-up time is 34 months (IQR: 11-64). The median disease-free survival (DFS) and overall survival (OS) were 48.8 months and 53.7 months, respectively. Through univariate analysis, risk factors for DFS and OS include tumor markers (CA199 and CEA), hepatic invasion, perineural invasion, lymphovascular invasion, TNM staging and tumor differentiation. Through multivariate analysis, risk factors for DFS include hepatic invasion and TNM staging, and for OS is TNM staging only. Of the 40 cases with specific recurrent sites, 29 patients (29/40, 72.5%) had recurrence in the potential target volume of postoperative radiotherapy (PORT), which include tumor bed and corresponding lymphatic drainage area. The common recurrent lymph node groups included abdominal para-aortic lymph node (No.16, 15/29), hepatoduodenal ligament lymph node (No.12, 8/29), retro-pancreatic head lymph node (No.13, 7/29) and celiac axis lymph node (No.9, 4/29). Twenty cases with recurrences inside the potential PORT target volume were accompanied by distant metastasis. Another 11 cases had distant metastasis alone, so totally 31 cases developed distant metastasis (31/40, 77.5%), including 18 cases with hepatic metastasis. CONCLUSION The recurrence and metastasis rates are high in GBC and adjuvant therapy is needed. Up to 75% of the recurrent cases occurred in the potential target volume of postoperative radiotherapy, suggesting that postoperative radiotherapy has the possible value of improving local-regional control. The potential target volume of radiotherapy should include the tumor bed, No.8, No.9, No.11, No.12, No.13, No.14, No. 16a2, No. 16b1 lymph node groups.
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Affiliation(s)
- Zhijun Yuan
- Department of Radiation Oncology, Ministry of Education Key Laboratory of Cancer Prevention and Intervention, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yongjie Shui
- Department of Radiation Oncology, Ministry of Education Key Laboratory of Cancer Prevention and Intervention, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lihong Liu
- Department of Radiation Oncology, Ministry of Education Key Laboratory of Cancer Prevention and Intervention, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yinglu Guo
- Department of Radiation Oncology, Ministry of Education Key Laboratory of Cancer Prevention and Intervention, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qichun Wei
- Department of Radiation Oncology, Ministry of Education Key Laboratory of Cancer Prevention and Intervention, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Echelard P, Roy SF, Trinh VQH, Garant MP, Collin Y, Nguyen BN, Geha S. Age, operation time and surgical approach can be used to detect incidental gallbladder carcinoma in cholecystectomy specimens from low-incidence settings. Histopathology 2021; 79:667-673. [PMID: 34061406 DOI: 10.1111/his.14423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/17/2021] [Accepted: 05/30/2021] [Indexed: 11/27/2022]
Abstract
AIMS 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. METHODS AND RESULTS 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 <18 years, 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). CONCLUSION Readily available clinical parameters and postoperative data can be used to detect incidental gallbladder carcinoma. High-grade dysplasia mostly requires grossing and microscopic examination.
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Affiliation(s)
- Philippe Echelard
- Department of Pathology, University of Sherbrooke, Sherbrooke, Canada
| | - Simon F Roy
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Vincent Q-H Trinh
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Yves Collin
- Department of Surgery, University of Sherbrooke, Sherbrooke, Canada
| | - Bich N Nguyen
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Sameh Geha
- Department of Pathology, University of Sherbrooke, Sherbrooke, Canada
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5
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Bastiaenen VP, Tuijp JE, van Dieren S, Besselink MG, van Gulik TM, Koens L, Tanis PJ, Bemelman WA. Safe, selective histopathological examination of gallbladder specimens: a systematic review. Br J Surg 2020; 107:1414-1428. [PMID: 32639049 PMCID: PMC7540681 DOI: 10.1002/bjs.11759] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022]
Abstract
Background Routine histopathological examination after cholecystectomy is costly, but the prevalence of unsuspected gallbladder cancer (incidental GBC) is low. This study determined whether selective histopathological examination is safe. Methods A comprehensive search of PubMed, Embase, Web of Science and the Cochrane Library was performed. Pooled incidences of incidental and truly incidental GBC (GBC detected during histopathological examination without preoperative or intraoperative suspicion) were estimated using a random‐effects model. The clinical consequences of truly incidental GBC were assessed. Results Seventy‐three studies (232 155 patients) were included. In low‐incidence countries, the pooled incidence was 0·32 (95 per cent c.i. 0·25 to 0·42) per cent for incidental GBC and 0·18 (0·10 to 0·35) per cent for truly incidental GBC. Subgroup analysis of studies in which surgeons systematically examined the gallbladder revealed a pooled incidence of 0·04 (0·01 to 0·14) per cent. In high‐incidence countries, corresponding pooled incidences were 0·83 (0·58 to 1·18), 0·44 (0·21 to 0·91) and 0·08 (0·02 to 0·39) per cent respectively. Clinical consequences were reported for 176 (39·3 per cent) of 448 patients with truly incidental GBC. Thirty‐three patients (18·8 per cent) underwent secondary surgery. Subgroup analysis showed that at least half of GBC not detected during the surgeon's systematic examination of the gallbladder was early stage (T1a status or below) and of no clinical consequence. Conclusion Selective histopathological examination of the gallbladder after initial macroscopic assessment by the surgeon seems safe and could reduce costs.
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Affiliation(s)
- V P Bastiaenen
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - J E Tuijp
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - T M van Gulik
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - L Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - P J Tanis
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - W A Bemelman
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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6
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Incidental Carcinoma after Cholecystectomy for Benign Disease of the Gallbladder: A Meta-Analysis. J Clin Med 2020; 9:jcm9051484. [PMID: 32423156 PMCID: PMC7290945 DOI: 10.3390/jcm9051484] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
This study aimed to determine the incidence and the prognosis of incidental carcinoma of the gallbladder (IGBC) after cholecystectomy through a meta-analysis. This meta-analysis included 51 studies and 436,636 patients with cholecystectomy. The incidence rate of IGBC after cholecystectomy was 0.6% (95% confidence interval (CI) 0.5%-0.8%). The incidence rate of recent studies was not significantly different from those of past studies. The mean age and female ratio of the IGBC subgroup were not significantly different from those of the overall patient group. The estimated rates of IGBC were 13.0%, 34.1%, 39.7%, 22.7%, and 12.5% in the pTis, pT1, pT2, pT3, and pT4 stages, respectively. Patients with IGBC had a favorable overall survival rate compared to patients with non-IGBC (hazard ratio (HR) 0.574, 95% CI 0.445-0.739). However, there was no significant difference of disease-free survival between the IGBC and non-IGBC subgroups (HR 0.931, 95% CI 0.618-1.402). IGBC was found in 0.6% of patients with cholecystectomy. The prognosis of patients with IGBC was favorable compared to those with non-IGBC. In the pathologic examination after cholecystectomy for benign diseases, a sufficient examination for histology should be guaranteed to detect IGBC.
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Geramizadeh B, Kashkooe A. Incidental Gall Bladder Adenocarcinoma in Cholecystectomy Specimens; A Single Center Experience and Review of the Literature. Middle East J Dig Dis 2018; 10:249-253. [PMID: 31049173 PMCID: PMC6488505 DOI: 10.15171/mejdd.2018.118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 09/12/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND
Gallbladder adenocarcinoma is the most common malignant tumor of the biliary tract. Most of
gall bladder cancers are detected incidentally only after pathological examination of the surgical
specimens. In this study we investigated the characteristics of incidental gallbladder cancers in
our center and also reviewed the current literature regarding the diagnosis and treatment of such
incidentally detected tumors in the gall bladder.
METHODS
We retrospectively reviewed all of the cholecystectomy specimens in the archives of Pathology
Department in the hospitals affiliated to Shiraz University of Medical Sciences in the study period
(2010-2016). Clinicopathological characteristics were extracted from the patients’ clinical charts, which
included symptoms, radiological findings, laboratory data, and surgical procedures as well as outcome.
RESULTS
During these 7 years we identified 18 cases of incidental gall bladder cancer, consisted of 13
women and 5 men with the age range of 32 to 85 (62.5 ± 14.2) years detected after pathological study
of the resected gall bladders among more than 4800 resected gall bladders. During the period, only
two patients were operated on with the impression of gall bladder adenocarcinoma, which was
not included in the study. Ten cases were T1 and eight were T2 at the time of surgery. They have
been followed up for 1-7 years, during which, six cases of T2 died. All of the T1 cases are alive
and symptom free.
CONCLUSION
By increasing laparoscopic cholecystectomies in our center we observed 0.37% incidental
cases of gall bladder adenocarcinoma. Preoperative diagnosis of this cancer in early stages is very
difficult and needs high degree of suspicion. The most important predictor of prognosis is the
stage of the cancer at the time of surgery. To the best of our knowledge, this is the first report of
incidental gall bladder cancer from Iran.
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Medical School of Shiraz University, Shiraz University of Medical Sciences, Shiraz, Iran.,Transplant Research Center, Shiraz University of medical Sciences, Shiraz, Iran
| | - Ali Kashkooe
- Student Research Committee, Shiraz University of medical Sciences, Shiraz, Iran
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Lee H, Kwon W, Han Y, Kim JR, Kim SW, Jang JY. Optimal extent of surgery for early gallbladder cancer with regard to long-term survival: a meta-analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2017; 25:131-141. [DOI: 10.1002/jhbp.521] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Hongeun Lee
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
| | - Jae Ri Kim
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute; Seoul National University Hospital; Seoul National University College of Medicine; 101 Daehak-ro Chongno-gu, Seoul 03080 Korea
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Watson H, Dasari B, Wyatt J, Hidalgo E, Prasad R, Lodge P, Toogood G. Does a second resection provide a survival benefit in patients diagnosed with incidental T1b/T2 gallbladder cancer following cholecystectomy? HPB (Oxford) 2017; 19:104-107. [PMID: 27986417 DOI: 10.1016/j.hpb.2016.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/07/2016] [Accepted: 11/13/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Incidental T1b/T2 gallbladder cancers are often managed with a second resection. However it is unclear whether the additional surgical risk is associated with any survival advantage. The aim of this study was to examine the outcomes of patients who underwent a second resection following a diagnosis of incidental T1b/T2 gallbladder cancer. METHODS A retrospective analysis of patients undergoing surgical management following a diagnosis of incidental T1b/T2 gallbladder cancer between 1994 and 2014. Survival outcomes were analysed using the Kaplan-Meier method. RESULTS Twenty two patients underwent completion surgery following diagnosis of T1b/T2 gallbladder cancer at initial cholecystectomy, 11 of which were found to have residual disease. The presence of residual disease at second surgery in T1b/T2 disease was associated with worse overall survival (residual disease: median survival 12 months, absence of residual disease: median survival not reached, p = 0.025). CONCLUSION A significant percentage of patients with T1b/T2 disease have identifiable residual disease following second surgery. Residual disease is associated with poor survival. It is therefore important to inform patients that completion cholecystectomy is primarily performed to inform staging rather than to improve prognosis.
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Affiliation(s)
- Henry Watson
- Department of HPB & Transplant Surgery, St James University Hospital, Beckett Street, Leeds, LS97TF, UK
| | - Bobby Dasari
- Department of HPB & Transplant Surgery, St James University Hospital, Beckett Street, Leeds, LS97TF, UK
| | - Judy Wyatt
- Department of Histopathology, St James University Hospital, Beckett Street, Leeds, LS97TF, UK
| | - Ernest Hidalgo
- Department of HPB & Transplant Surgery, St James University Hospital, Beckett Street, Leeds, LS97TF, UK
| | - Raj Prasad
- Department of HPB & Transplant Surgery, St James University Hospital, Beckett Street, Leeds, LS97TF, UK
| | - Peter Lodge
- Department of HPB & Transplant Surgery, St James University Hospital, Beckett Street, Leeds, LS97TF, UK
| | - Giles Toogood
- Department of HPB & Transplant Surgery, St James University Hospital, Beckett Street, Leeds, LS97TF, UK.
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Utsumi M, Aoki H, Kunitomo T, Mushiake Y, Yasuhara I, Arata T, Katsuda K, Tanakaya K, Takeuchi H. Evaluation of surgical treatment for incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy: single center results. BMC Res Notes 2017; 10:56. [PMID: 28109315 PMCID: PMC5251282 DOI: 10.1186/s13104-017-2387-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/13/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the accepted standard management for benign gallbladder disease. LC rarely results in a diagnosis of incidental gallbladder carcinoma (IGBC). The aim of our study was to report our experience with IGBC diagnosed during or following LC. METHODS Between January 2008 and January 2015, 352 patients underwent LC at Iwakuni Clinical Center. Among these patients, 8 (2.3%) were diagnosed with IGBC. We evaluated their characteristics, surgical related variables, histopathological findings and surgical outcomes. RESULTS Patient median age was 71 (range 49-88) years, and 3 out of 8 were female. All patients with IGBC were Japanese. The grade of cancer was as follows: pT1a (3 cases), pT2 (4 cases) and pT3 (1 case). Two patients with pT2 disease underwent radical surgery. The median follow-up time of these patients was 24 (range 11-80) months. All patients are still alive and two of three patients who refused radical surgery have developed recurrence (liver metastases and recurrence in the peritoneum). CONCLUSIONS Although the number of cases was small, the results of this study further support the suggestion that gallbladder carcinoma may be curable if diagnosed as IGBC at an early stage. If the cancer has reached an advanced stage, radical surgery should be performed.
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Affiliation(s)
- Masashi Utsumi
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni, Yamaguchi, 740-8510, Japan.
| | - Hideki Aoki
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni, Yamaguchi, 740-8510, Japan
| | - Tomoyoshi Kunitomo
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni, Yamaguchi, 740-8510, Japan
| | - Yutaka Mushiake
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni, Yamaguchi, 740-8510, Japan
| | - Isao Yasuhara
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni, Yamaguchi, 740-8510, Japan
| | - Takashi Arata
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni, Yamaguchi, 740-8510, Japan
| | - Koh Katsuda
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni, Yamaguchi, 740-8510, Japan
| | - Kohji Tanakaya
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni, Yamaguchi, 740-8510, Japan
| | - Hitoshi Takeuchi
- Department of Surgery, National Hospital Organization, Iwakuni Clinical Center, 1-1-1 Atago-machi, Iwakuni, Yamaguchi, 740-8510, Japan
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Ferrarese A, Buccelli C, Addeo G, Capasso E, Conti A, Amato M, Compagna R, Niola M, Martino V. Excellence and safety in surgery require excellent and safe tutoring. Open Med (Wars) 2016; 11:518-522. [PMID: 28352844 PMCID: PMC5329876 DOI: 10.1515/med-2016-0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 11/15/2022] Open
Abstract
The surgical education in Italy has always been a very important issue. The aim of this article is to bring together the feedback of the definitions of the various components of the learning scheme and to evaluate the importance of the legal point. In March 2016 we performed a literature review. We have also examinated the internet pages of the Italian Department of Education, Health and Medical Order. In Italy the tutor had an unclear role from a legal point of view. He is the person who must be able to perform a specific procedure with expert technical and who must know how to stop the student if this is about to perform a dangerous maneuver. In Italy the ability to work for the trainee is limited in all reality, it depends on several factors including the increase of numbers of medical-legal disputes, the timing, the commitment it requires mentoring and a lack of mentors. Conclusion: In surgery, the problem is greater because of the increasingly of medico-legal implications that we are after surgical procedure. It would be necessary to define a role of the tutor in a regular protocol and a proper assessment of his performance.
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Affiliation(s)
- Alessia Ferrarese
- Department of Oncology, University of Turin, Section of General Surgery, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy . Tel: +39 0119026224
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples, Naples, Italy
| | - Giuseppe Addeo
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples, Naples, Italy
| | - Emanuele Capasso
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples, Naples, Italy
| | - Adelaide Conti
- Department of Surgery, Radiology and Public Health, Public Health and Humanities Section, University of Brescia, Centre of Bioethics Research (with the contribution of IRCCS "S.Giovanni di Dio - Fatebenefratelli"), 25123 Brescia, Italy
| | - Maurizio Amato
- Department of Neuroscience, Naples, Italy. Fellow in General Surgery at University of Naples, Italy
| | - Rita Compagna
- Department of Public Health, Naples, Italy. Fellow in Vascular Surgery at University of Naples, Italy
| | - Massimo Niola
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples, Naples, Italy
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
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12
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Borello A, Ferrarese A, Passera R, Surace A, Marola S, Buccelli C, Niola M, Di Lorenzo P, Amato M, Di Domenico L, Solej M, Martino V. Use of a simplified consent form to facilitate patient understanding of informed consent for laparoscopic cholecystectomy. Open Med (Wars) 2016; 11:564-573. [PMID: 28352847 PMCID: PMC5329879 DOI: 10.1515/med-2016-0092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 12/26/2022] Open
Abstract
Background Surgical informed consent forms can be complicated for patients to read and understand. We created a consent form with key information presented in bulleted texts and diagrams combined in a graphical format to facilitate the understanding of information during the verbal consent discussion. Methods This prospective, randomized study involved 70 adult patients awaiting cholecystectomy for gallstones. Consent was obtained after standard verbal explanation using either a graphically formatted (study group, n=33) or a standard text document (control group, n=37). Comprehension was evaluated with a 9-item multiple-choice questionnaire administered before surgery and factors affecting comprehension were analyzed. Results Comparison of questionnaire scores showed no effect of age, sex, time between consent and surgery, or document format on understanding of informed consent. Educational level was the only predictor of comprehension. Conclusions Simplified surgical consent documents meet the goals of health literacy and informed consent. Educational level appears to be a strong predictor of understanding.
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Affiliation(s)
- Alessandro Borello
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
| | - Alessia Ferrarese
- Department of Oncology, University of Turin, Section of General Surgery, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy ,
| | - Roberto Passera
- Città della Salute e della Scienza Hospital, Section of Nuclear Medicine, Turin, Italy
| | - Alessandra Surace
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
| | - Silvia Marola
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples. Via Sergio Pansini 5, 80131, Naples, Italy
| | - Massimo Niola
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples. Via Sergio Pansini 5, 80131, Naples, Italy
| | - Pierpaolo Di Lorenzo
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples. Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maurizio Amato
- Department of Neuroscience, Naples, Italy. Fellow in General Surgery at University of Naples, Naples, Italy
| | - Lorenza Di Domenico
- Department of Neuroscience, Naples, Italy. Fellow in Anestesiology at University of Naples, Naples, Italy
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
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13
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Ferrarese A, Gentile V, Bindi M, Rivelli M, Cumbo J, Solej M, Enrico S, Martino V. The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor? Open Med (Wars) 2016; 11:489-496. [PMID: 28352841 PMCID: PMC5329873 DOI: 10.1515/med-2016-0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/11/2016] [Indexed: 01/27/2023] Open
Abstract
A well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient. Electronic databases were interrogated to better define the terms “surgeon”, “specialized surgeon”, and “specialist surgeon”; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy. Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee’s progress. Conclusions. The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor’s ability, the trainee’s own skills, and the safety of the surgical environment. There were no patient characteristics that can derail the methods. With this training scheme, resident trainees may be provided the opportunity to develop their intrinsic capabilities without the loss of basic technical skills.
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Affiliation(s)
- Alessia Ferrarese
- Department of Oncology, University of Turin, Section of General Surgery, San Luigi Gonzaga Teaching Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Valentina Gentile
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Marco Bindi
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Matteo Rivelli
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Jacopo Cumbo
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
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14
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Ferrarese A, Bindi M, Rivelli M, Solej M, Enrico S, Martino V. Self-gripping mesh versus fibrin glue fixation in laparoscopic inguinal hernia repair: a randomized prospective clinical trial in young and elderly patients. Open Med (Wars) 2016; 11:497-508. [PMID: 28352842 PMCID: PMC5329874 DOI: 10.1515/med-2016-0087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/19/2016] [Indexed: 12/29/2022] Open
Abstract
Laparoscopic transabdominal preperitoneal inguinal hernia repair is a safe and effective technique. In this study we tested the hypothesis that self-gripping mesh used with the laparoscopic approach is comparable to polypropylene mesh in terms of perioperative complications, against a lower overall cost of the procedure. We carried out a prospective randomized trial comparing a group of 30 patients who underwent laparoscopic inguinal hernia repair with self-gripping mesh versus a group of 30 patients who received polypropylene mesh with fibrin glue fixation. There were no statistically significant differences between the two groups with regard to intraoperative variables, early or late intraoperative complications, chronic pain or recurrence. Self-gripping mesh in transabdominal hernia repair was found to be a valid alternative to polypropylene mesh in terms of complications, recurrence and postoperative pain. The cost analysis and comparability of outcomes support the preferential use of self-gripping mesh.
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Affiliation(s)
- Alessia Ferrarese
- University of Turin, Section of General Surgery, San Luigi Gonzaga Teaching Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Marco Bindi
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Matteo Rivelli
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
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15
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Surace A, Ferrarese A, Gentile V, Bindi M, Cumbo J, Solej M, Enrico S, Martino V. Learning curve for endorectal ultrasound in young and elderly: lights and shades. Open Med (Wars) 2016; 11:418-425. [PMID: 28352830 PMCID: PMC5329861 DOI: 10.1515/med-2016-0074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/20/2016] [Indexed: 01/04/2023] Open
Abstract
Aim of the study is to highlight difficulties faced by an inexperienced surgeon in approaching endorectal-ultrasound, trying to define when learning curve can be considered complete. A prospective analysis was conducted on endorectal-ultrasound performed for subperitoneal rectal adenocarcinoma staging in the period from January 2008 to July 2013, reported by a single surgeon of Department of Oncology, Section of General Surgery, "San Luigi Gonzaga" Teaching Hospital, Orbassano (Turin, Italy); the surgeon had no previous experience in endorectal-ultrasound. Fourty-six endorectal-ultrasounds were divided into two groups: early group (composed by 23 endorectal-ultrasounds, made from January 2008 to May 2009) and late group (composed by 23 endorectal-ultrasound, carried out from June 2009 to July 2013). In our experience, the importance of a learning curve is evident for T staging, but no statystical significance is reached for results deal with N stage. We can conclude that ultrasound evaluation of anorectal and perirectal tissues is technically challenging and requires a long learning curve. Our learning curve can not be closed down, at least for N parameter.
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Affiliation(s)
- Alessandra Surace
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Alessia Ferrarese
- Department of Oncology, University of Turin, Section of General Surgery, San Luigi Gonzaga Teaching Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Valentina Gentile
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Marco Bindi
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Jacopo Cumbo
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
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16
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Margonis GA, Gani F, Buettner S, Amini N, Sasaki K, Andreatos N, Ethun CG, Poultsides G, Tran T, Idrees K, Isom CA, Fields RC, Krasnick B, Weber SM, Salem A, Martin RC, Scoggins C, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Shenoy R, Maithel SK, Pawlik TM. Rates and patterns of recurrence after curative intent resection for gallbladder cancer: a multi-institution analysis from the US Extra-hepatic Biliary Malignancy Consortium. HPB (Oxford) 2016; 18:872-878. [PMID: 27527802 PMCID: PMC5094487 DOI: 10.1016/j.hpb.2016.05.016] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/18/2016] [Accepted: 05/30/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer is a relatively rare malignancy. The current study aimed to define the incidence and patterns of recurrence following gallbladder cancer resection. METHODS Using a multi-institutional cohort we identified 217 patient undergoing curative intent surgery for gallbladder cancer. Patterns of recurrence were classified as locoregional and distant recurrence. RESULTS At last follow-up, 76 patients (35.0%) had experienced a recurrence (locoregional only, n = 12, 15.8%; distant only, n = 50, 65.8%; locoregional and distant, n = 14, 18.4%). Median time to recurrence was 9.5 months (IQR 4.7-17.6) and was not associated with recurrence site (all p > 0.05). On multivariable analysis, T3 disease (HR = 8.44, p = 0.014), lymphovascular invasion (HR = 4.24, p < 0.001) and residual disease (HR = 2.04, p = 0.042) were associated with an increased risk of recurrence. Patients who recurred demonstrated a worse 1-, 3- and 5-year OS (1-year OS: 91.3% vs. 68.6%, p = 0.001, 3-year OS: 79.3% vs. 28.7%, p < 0.001, and 5-year OS: 75.9% vs. 16.0%, p < 0.001). After adjusting for other risk factors, recurrence was independently associated with a decreased OS (HR = 3.71, p = 0.006). Of note, receipt of adjuvant therapy was associated with improved OS (HR = 0.56, p = 0.027) among those patients who developed a tumor recurrence. DISCUSSION Over one-third of patients experienced a recurrence after gallbladder cancer surgery. While chemotherapy did not decrease the rate of recurrence, patients who experienced recurrence after administration of adjuvant treatment faired better than patients who did not receive adjuvant therapy.
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Affiliation(s)
| | - Faiz Gani
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stefan Buettner
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Neda Amini
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kazunari Sasaki
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Cecilia G. Ethun
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Kamran Idrees
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea A. Isom
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan C. Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Bradley Krasnick
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Charles Scoggins
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Harveshp D. Mogal
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Carl Schmidt
- Department of Surgery, Ohio State University, Columbus, OH, USA
| | - Eliza Beal
- Department of Surgery, Ohio State University, Columbus, OH, USA
| | | | - Rivfka Shenoy
- Department of Surgery, New York University, New York, NY, USA
| | - Shishir K. Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy M. Pawlik
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA,Department of Surgery, Ohio State University, Columbus, OH, USA,Correspondence Timothy M. Pawlik, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center at the Ohio State University, 395 W. 12th Avenue, Suite 670, Columbus, OH 43210, USA. Tel: +1 (614) 293 8701. Fax: +1 (614) 293 4063.Department of SurgeryDepartment of SurgeryThe Urban Meyer III and Shelley Meyer Chair for Cancer ResearchWexner Medical Center at the Ohio State University600 N. Wolfe Street395 W. 12th Avenue, Suite 670ColumbusOH43210USA
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17
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Dorobisz T, Dorobisz K, Chabowski M, Pawłowski W, Janczak D, Patrzałek D, Janczak D. Incidental gallbladder cancer after cholecystectomy: 1990 to 2014. Onco Targets Ther 2016; 9:4913-6. [PMID: 27540304 PMCID: PMC4982486 DOI: 10.2147/ott.s106580] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Cancer of the gallbladder is a serious diagnostic and therapeutic problem. According to the literature, 30% of cases are not confirmed before surgery. Other cases are detected incidentally by histopathology. Clinical trials and meta-analyses show that incidental gallbladder cancer (iGBC) occurs in 0.19%-2.8% of patients after cholecystectomy. The aim of this study was to analyze the incidence and severity of iGBC in cholecystectomy procedures performed in the surgical department at the 4th Military Teaching Hospital in Wroclaw during the years 1990-2014. PATIENTS AND METHODS In the years 1990-2014, a total of 7,314 cholecystectomies were performed in the surgical department because of cholecystolithiasis: 6,145 were performed using the laparoscopic approach (84.02%), 867 were performed as open surgery (11.8%), and 302 cases required conversion (5.1%). In this group, 5,214 of the patients were females (71.3%) and 2,100 were males (28.7%), with an average age of 54.7 years. RESULTS We found 64 iGBC cases which were confirmed by histopathology. This represented 0.87% of all cases. In this group, 50 patients were females (78.1%) and 14 were males (21.8%), with an average age of 67.1 years. Of this group, 40 patients underwent a classic cholecystectomy, while 24 underwent laparoscopic procedures, out of which 13 cases ultimately required traditional surgery. The histopathology showed 15 carcinomas that were classified as G1 (23.4%), 28 were G2 (43.75%), and 21 were G3 (32.8%). CONCLUSION iGBC detected after a cholecystectomy due to cholecystolithiasis is a rare disease. We found iGBC in 0.87% of cases, which is on a comparable scale to the world literature. In the case of cancer, we frequently found it necessary to convert to an open surgical procedure. This cancer is more common in females and in people over 60 years of age.
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Affiliation(s)
- Tadeusz Dorobisz
- Department of Surgery, 4th Military Teaching Hospital; Department of Clinical Basics of Physiotherapy, Faculty of Health Science
| | | | - Mariusz Chabowski
- Department of Surgery, 4th Military Teaching Hospital; Department of Surgical Specialties
| | | | - Dawid Janczak
- Department of Palliative Care Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
| | - Dariusz Patrzałek
- Department of Surgery, 4th Military Teaching Hospital; Department of Clinical Basics of Physiotherapy, Faculty of Health Science
| | - Dariusz Janczak
- Department of Surgery, 4th Military Teaching Hospital; Department of Surgical Specialties
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18
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Lu D, Radin R, Yung E, Tchelepi H. Malignant transformation of a 5-mm gallbladder polyp over 2 years: a case report and review of current literature. Ultrasound Q 2015; 31:66-8. [PMID: 25054905 DOI: 10.1097/ruq.0000000000000094] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Gallbladder polyps (GBPs) are incidentally seen in 4% to 7% of adults on abdominal ultrasounds. Most GBPs are benign cholesterol polyps, adenomyomatosis, or inflammatory polyps. Currently, cholecystectomy is widely accepted as appropriate care for polyps 10 mm or larger as they present a higher risk for malignancy. However, the management of small polyps smaller than 10 mm has continued to be a dilemma to clinicians and radiologists. Many authors support a nonoperative approach with imaging follow-up for polyps smaller than 10 mm, as most have been shown to be benign. However, small polyps do have the potential to be neoplastic adenomas and become malignant. In this report, we will describe a case of a tiny GBP that subsequently developed into a 20-mm carcinoma over a period of 2 years.
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Affiliation(s)
- Darren Lu
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA
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19
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Surgical treatment of incidental gallbladder cancer discovered during or following laparoscopic cholecystectomy. World J Surg 2015; 39:746-52. [PMID: 25403888 DOI: 10.1007/s00268-014-2864-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal surgical management of patients with incidental gallbladder cancer (IGBC) and their long-term survival remains unclear. OBJECTIVE The purpose of this study was to examine the long-term prognosis of patients with IGBC diagnosed during or after LC. METHODS Between January 2002 and January 2012, a total of 7,582 consecutive patients underwent LC for presumed gallbladder benign disease in the Chinese PLA General Hospital, China. Among them, 69 patients (0.91%) were diagnosed to have IGBC. Their medical records, imaging data, surgery records, pathological findings, and survival data were retrospectively reviewed. RESULTS Median age was 61 years (range: 34-83). After a median follow-up period of 61 months, the 1-, 3-, and 5-year survival rates of patients were 89.9, 78.3, and 76.8%, respectively. The 5-year survival rates of patients with T1a, T1b, T2, and T3 stages were 95.5, 93.8, 69.2, and 44.4%, respectively. The 5-year survival rates in simple LC (n = 45), converted to open extended cholecystectomy (n = 16), and radical second resection (n = 8) groups were 91.1, 37.5, and 75.0%, respectively. Local port-site tumor recurrence was identified in one patient. Prognostic factors including depth of invasion, lymph node status, vascular or neural invasion, tumor differentiation, extent of resection, bile spillage, and type of surgery were statistically significant (p < 0.05). CONCLUSIONS Simple LC is appropriate for T1a patients with clear margin and unbroken gallbladder, whereas extended radical resection is recommended for patients with T1b or more advanced IGBC. An intact surgical specimen and the use of plastic retrieval bags are important to reduce the risk of port-site recurrences and disease relapse. Early diagnosis, meticulous perioperative assessment, and precise surgery are essential factors to obtain good results in IGBC treatment.
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20
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Machado MA, Makdissi FF, Surjan RC. Totally Laparoscopic Hepatic Bisegmentectomy (s4b+s5) and Hilar Lymphadenectomy for Incidental Gallbladder Cancer. Ann Surg Oncol 2015; 22 Suppl 3:S336-9. [PMID: 26059653 DOI: 10.1245/s10434-015-4650-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Gallbladder cancer is suspected preoperatively in only 30 % of all patients, while the remaining 70 % of cases are discovered incidentally by the pathologist. The increasing rate of cholecystectomies via laparoscopy has led to the detection of more gallbladder cancers in an early stage, and extended resection with regional lymph node dissection has been suggested. We present a video of a totally laparoscopic liver resection (segments 5 and 4b) with regional lymphadenectomy in a patient with an incidental gallbladder cancer. METHODS A 50-year-old woman underwent laparoscopic cholecystectomy, and pathology revealed a T1b gallbladder carcinoma. The patient was referred for further treatment. Contact with the primary surgeon revealed that no intraoperative cholangiogram was performed, and the gallbladder was removed intact, with no perforation, and inside a plastic retrieval bag. Pathology revision confirmed T1b, and positron emission tomography/computed tomography was negative. The multidisciplinary tumor board recommended radical re-resection, and a decision was made to perform a laparoscopic extended hilar lymphadenectomy, along the resection of segments 5 and 4b. RESULTS Operative time was 5 h, with an estimated blood loss of 240 mL. Recovery was uneventful and the patient was discharged on the fourth postoperative day. Final pathology showed no residual disease and no lymph node metastasis. CONCLUSIONS Laparoscopic resection of liver segments 5 and 4b combined with a locoregional lymphadenectomy of the hepatoduodenal ligament is an oncologically appropriate technique, provided it is performed in a specialized center with experience in hepatobiliary surgery and advanced laparoscopic surgery. This video may help oncological surgeons to perform this complex procedure.
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Affiliation(s)
| | - Fabio F Makdissi
- Department of Surgery, Sirio Libanes Hospital, São Paulo, Brazil.,Department of Gastroenterology, University of Sao Paulo, São Paulo, Brazil
| | - Rodrigo C Surjan
- Department of Surgery, Sirio Libanes Hospital, São Paulo, Brazil
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21
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Lai QY, Wang DS. Surgical treatment of gallbladder cancer: Strategy and optimization. Shijie Huaren Xiaohua Zazhi 2015; 23:1865-1872. [DOI: 10.11569/wcjd.v23.i12.1865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gallbladder cancer is the most common malignant tumor of the biliary tract. It is difficult to diagnose early due to the lack of special symptoms and physical signs. Most cases are diagnosed in advanced stages and the response to traditional chemotherapy and radiotherapy is extremely limited, with modest impact on overall survival. Despite improvements in outcome associated with extended resections, selection of patients for such extensive surgery remains controversial. In this article, we analyze and discuss the key issues about the surgical management of gallbladder cancer, with the hope of a more comprehensive recognition of this malignancy.
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Gulwani HV, Gupta S, Kaur S. Incidental detection of carcinoma gall bladder in laparoscopic cholecystectomy specimens: a thirteen year study of 23 cases and literature review. Indian J Surg Oncol 2015; 6:30-5. [PMID: 25937761 DOI: 10.1007/s13193-015-0379-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 01/13/2015] [Indexed: 12/17/2022] Open
Abstract
Carcinoma of gall bladder is the most common malignancy of the biliary tract worldwide and is usually associated with poor prognosis. In this era of laparoscopic cholecystectomy, there has been increase in detection of early stage incidental gall bladder carcinoma in cholecystectomy specimens. A retrospective study was carried out in tertiary care hospital in central India. A total of 2990 patients underwent laparoscopic cholecystectomy during the year 2001-2013. Hospital records and histopathology reports of these patients were studied in detail. Twenty three cases of gall bladder carcinoma were detected incidentally accounting for an incidence of 0.76 %. It was more common in females with an M: F ratio of 1:1.9. Mean age of presentation was 57.8 years. Gall stones were present in 22 cases and one patient presented with features of acute cholecystitis. Three patients had associated xanthogranulomatous inflammation and 10 had associated intestinal metaplasia. It is not uncommon to encounter incidental malignancies of gall bladder in laparoscopic cholecystectomy specimens sent to histopathology for presumably benign disease. Histopathology reports must include comments on extent of infiltration, perineural invasion, tumor differentiation and nodal involvement for oncologist information and subsequent management of patients.
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Affiliation(s)
- Hanni V Gulwani
- Department of Pathology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Bhopal, Madhya Pradesh 462038 India
| | - Suneeta Gupta
- Department of Pathology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Bhopal, Madhya Pradesh 462038 India
| | - Sukhpreet Kaur
- Department of Pathology, Bhopal Memorial Hospital and Research Centre, Raisen Bypass Road, Bhopal, Madhya Pradesh 462038 India
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