1
|
Yong Z, Ang L, Wen-Zhang Z, Xu-Dong W, Ren-Gen F. Incidental gall bladder cancer in the laparoscopic treatment and magnetic resonance imaging era: A single institution experience. J Minim Access Surg 2024; 20:148-153. [PMID: 36695237 PMCID: PMC11095808 DOI: 10.4103/jmas.jmas_117_22] [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: 04/12/2022] [Revised: 09/22/2022] [Accepted: 11/15/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Incidental gall bladder cancer (IGBC) is often discovered unexpectedly in patients after cholecystectomy. Currently, magnetic resonance imaging (MRI) has been widely applied in the pre-operative diagnosis of gall bladder diseases as laparoscopic cholecystectomy developed into the preferred method. AIMS AND OBJECTIVES This study aimed to evaluate the pre-operative MRI application and laparoscopic management in the IGBCs. MATERIALS AND METHODS Between January 2011 and January 2020, a total of 7917 patients with gall bladder diseases treated by laparoscopy were enrolled in this study. RESULTS Amongst 49 patients diagnosed with IGBCs, the incidence of IGBCs in polypoid lesions, biliary pancreatitis, cholecystitis, cholecystocholedocholithiasis and gall bladder stones was 0.42%, 1.19%, 0.62%, 1.20% and 0.49%, respectively. MRI evaluation showed more remarkable pre-operative imaging as compared to ultrasonographic evaluation (40.8 vs. 26.5, P < 0.05). Furthermore, 14 patients were diagnosed with gall bladder cancer through intraoperative histological examination and 11 received laparoscopic extensive resection after cholecystectomy. MRI findings with diffuse thickening of the gall bladder detected IGBCs with 6.1% sensitivity, 96.02 specificity, 0.95% positive predictive values and 99.4% negative predictive values; diffuse thickening of the gall bladder with suspicion of malignancy detected IGBCs with 12.2% sensitivity, 99.1% specificity, 7.6% positive predictive values and 99.5% negative predictive values; focal thickening of the gall bladder detected IGBCs with 16% sensitivity, 99.8% specificity, 32% positive predictive values and 99.5% negative predictive values; moreover, suspicious lesion detected IGBCs with 6.1% sensitivity, 99.6% specificity, 8.8% positive predictive values and 99.4% negative predictive values. CONCLUSIONS Patients with biliary pancreatitis and cholecystocholedocholithiasis have a higher incidence of IGBC. MRI evaluation could provide more accurate information for the IGBCs, which should be recommended for patients accepting cholecystectomy. MRI findings exhibited an unsatisfactory sensitivity when detecting IGBCs, but they represented high specificity. Pre-operative MRI evaluation and intraoperative histological examination may help some IGBCs to achieve one-stage laparoscopic extensive resection.
Collapse
Affiliation(s)
- Zhou Yong
- Department of General Surgery, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, Jiangsu Province, China
| | - Li Ang
- Department of General Surgery, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, Jiangsu Province, China
| | - Zha Wen-Zhang
- Department of General Surgery, The Yancheng Clinical College of Xuzhou Medical University, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, Yancheng, Jiangsu Province, China
| | - Wu Xu-Dong
- Department of Gastroenterology, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, Jiangsu Province, China
| | - Fan Ren-Gen
- Department of General Surgery, Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, The Yancheng Clinical College of Xuzhou Medical University, Yancheng, Jiangsu Province, China
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Dutta A, Mungle T, Chowdhury N, Banerjee P, Gehani A, Sen S, Mallath M, Roy P, Krishnan S, Ganguly S, Banerjee S, Roy M, Saha V. Characteristics and outcomes of gallbladder cancer patients at the Tata Medical Center, Kolkata 2017-2019. Cancer Med 2023; 12:9293-9302. [PMID: 36779618 PMCID: PMC10166897 DOI: 10.1002/cam4.5677] [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: 09/15/2022] [Revised: 01/18/2023] [Accepted: 01/28/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND The north and north-eastern regions of India have among the highest incidence of gallbladder cancer (GBC) in the world. We report the clinicopathological charateristics and outcome of GBC patients in India. METHODS Electronic medical records of patients diagnosed with GBC at Tata Medical Center, Kolkata between 2017 and 2019 were analyzed. RESULTS 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). CONCLUSION 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 9.1 months. Our data suggests that the tumor is chemoresponsive and multi-center collaborative clinical trials to identify alternative therapies are urgently required.
Collapse
Affiliation(s)
- Anindita Dutta
- Cell Biology, Tata Translational Cancer Research Centre, Kolkata, India.,Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Tushar Mungle
- Clinical Research Unit, Tata Translational Cancer Research Centre, Kolkata, India
| | - Nandita Chowdhury
- Cell Biology, Tata Translational Cancer Research Centre, Kolkata, India
| | - Pritha Banerjee
- Clinical Research Unit, Tata Translational Cancer Research Centre, Kolkata, India
| | - Anisha Gehani
- Department of Radiology, Tata Medical Center, Kolkata, India
| | - Saugata Sen
- Department of Radiology, Tata Medical Center, Kolkata, India
| | - Mohandas Mallath
- Department of Digestive Diseases, Tata Medical Center, Kolkata, India
| | - Paromita Roy
- Department of Histopathology, Tata Medical Center, Kolkata, India
| | - Shekhar Krishnan
- Division of Cancer Sciences, University of Manchester, Manchester, UK.,Clinical Research Unit, Tata Translational Cancer Research Centre, Kolkata, India.,Department of Paediatric Haematology and Oncology, Tata Medical Center, Kolkata, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, India
| | - Sudeep Banerjee
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Medical Center, Kolkata, India
| | - Manas Roy
- Department of Gastrointestinal and Hepatobiliary Surgery, Tata Medical Center, Kolkata, India
| | - Vaskar Saha
- Cell Biology, Tata Translational Cancer Research Centre, Kolkata, India.,Division of Cancer Sciences, University of Manchester, Manchester, UK.,Department of Paediatric Haematology and Oncology, Tata Medical Center, Kolkata, India
| |
Collapse
|
4
|
Gupta P, Dutta U, Rana P, Singhal M, Gulati A, Kalra N, Soundararajan R, Kalage D, Chhabra M, Sharma V, Gupta V, Yadav TD, Kaman L, Irrinki S, Singh H, Sakaray Y, Das CK, Saikia U, Nada R, Srinivasan R, Sandhu MS, Sharma R, Shetty N, Eapen A, Kaur H, Kambadakone A, de Haas R, Kapoor VK, Barreto SG, Sharma AK, Patel A, Garg P, Pal SK, Goel M, Patkar S, Behari A, Agarwal AK, Sirohi B, Javle M, Garcea G, Nervi F, Adsay V, Roa JC, Han HS. Gallbladder reporting and data system (GB-RADS) for risk stratification of gallbladder wall thickening on ultrasonography: an international expert consensus. Abdom Radiol (NY) 2022; 47:554-565. [PMID: 34851429 DOI: 10.1007/s00261-021-03360-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 02/07/2023]
Abstract
The Gallbladder Reporting and Data System (GB-RADS) ultrasound (US) risk stratification is proposed to improve consistency in US interpretations, reporting, and assessment of risk of malignancy in gallbladder wall thickening in non-acute setting. It was developed based on a systematic review of the literature and the consensus of an international multidisciplinary committee comprising expert radiologists, gastroenterologists, gastrointestinal surgeons, surgical oncologists, medical oncologists, and pathologists using modified Delphi method. For risk stratification, the GB-RADS system recommends six categories (GB-RADS 0-5) of gallbladder wall thickening with gradually increasing risk of malignancy. GB-RADS is based on gallbladder wall features on US including symmetry and extent (focal vs. circumferential) of involvement, layered appearance, intramural features (including intramural cysts and echogenic foci), and interface with the liver. GB-RADS represents the first collaborative effort at risk stratifying the gallbladder wall thickening. This concept is in line with the other US-based risk stratification systems which have been shown to increase the accuracy of detection of malignant lesions and improve management.
Collapse
Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pratyaksha Rana
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Gulati
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daneshwari Kalage
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manika Chhabra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lileshwar Kaman
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Santosh Irrinki
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Yashwant Sakaray
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chandan Krishuna Das
- Haematology and Medical Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Saikia
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhara Nada
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raju Sharma
- Department of Radiology, All India Institute of Medical Education and Research, New Delhi, India
| | - Nitin Shetty
- Department of Interventional Radiology, Tata Memorial Hospital, Mumbai, India
| | - Anu Eapen
- Department of Radiodiagnosis, Christian Medical College, Vellore, India
| | - Harmeet Kaur
- Division of Diagnostic Imaging, Department of Abdominal Imaging, MD Anderson Cancer Centre, Houston, TX, USA
| | - Avinash Kambadakone
- Abdominal Imaging, Harvard Medical School, Medical Director, Martha's Vineyard Hospital Imaging, Massachusetts General Hospital, Boston, USA
| | - Robbert de Haas
- Radiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Vinay K Kapoor
- HPB Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur, India
| | - Savio George Barreto
- Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Atul K Sharma
- Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Patel
- Indian Naval Hospital Ship, Asvini, Mumbai, India
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sujoy K Pal
- Surgical Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mahesh Goel
- Gastrointestinal and HPB Surgery, Tata Memorial Hospital, Mumbai, India
| | - Shraddha Patkar
- Gastrointestinal and HPB Surgery, Tata Memorial Hospital, Mumbai, India
| | - Anu Behari
- HPB Surgery, Mahatma Gandhi Medical College & Hospital, Jaipur, India
| | - Anil K Agarwal
- GI Surgery and Liver Transplant, GB Pant Institute of Medical Education and Research and MAM College, New Delhi, India
| | - Bhawna Sirohi
- Medical Oncology, Apollo Proton Cancer Centre, Chennai, India
| | - Milind Javle
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Centre, Houston, USA
| | | | - Flavio Nervi
- Department of Gastroenterology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Volkan Adsay
- Department of Pathology, Koc University Hospitals, Istanbul, Turkey
| | - Juan Carlos Roa
- Department of Pathology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Ho-Seong Han
- Department of Surgery, College of Medicine, Seoul National University Bundang Hospital Seoul National University, Seongnam-si, South Korea
| |
Collapse
|
5
|
Rana P, Gupta P, Kalage D, Soundararajan R, Kumar-M P, Dutta U. Grayscale ultrasonography findings for characterization of gallbladder wall thickening in non-acute setting: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2022; 16:59-71. [PMID: 34826262 DOI: 10.1080/17474124.2021.2011210] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The accurate characterization of gallbladder wall thickening (GWT) into benign or malignant on ultrasound (US) is a significant challenge. METHODS We searched the MEDLINE and EMBASE databases for studies reporting two-dimensional grayscale US in benign and malignant GWT. The pooled prevalence was calculated using a generalized linear mixed method with a random-effects model. The pooled sensitivity and specificity were calculated using a bivariate random-effects model. RESULTS Of the 7309 studies screened by titles, 73 studies with 18,008 patients were included. The most common findings in xanthogranulomatous cholecystitis (XGC) were lack of wall disruption and intramural hypoechoic nodules while adenomyomatosis (ADM) was frequently associated with intramural cysts and intramural echogenic foci. Echogenic foci, lack of gallbladder wall disruption, and hypoechoic nodules had a sensitivity of 89%, 77%, and 66% and specificity of 86%, 51%, and 80%, respectively for the diagnosis of benign GWT. Focal thickening and indistinct liver interface had a sensitivity of 75% and 55% and specificity of 64% and 69%, respectively for the diagnosis of malignant GWT. CONCLUSION intramural features (echogenic foci, hypoechoic nodules), gallbladder wall disruption, and liver interface are useful US features for the characterization of GWT.
Collapse
Affiliation(s)
- Pratyaksha Rana
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daneshwari Kalage
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
6
|
Chaudhari VA, Bhandare MS, Shrikhande SV. Incidental Gallbladder Cancer—Current Recommendations and Management Protocols. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
7
|
Kellil T, Chaouch MA, Aloui E, Tormane MA, Taieb SK, Noomen F, Zouari K. Incidence and Preoperative Predictor Factors of Gallbladder Cancer Before Laparoscopic Cholecystectomy: a Systematic Review. J Gastrointest Cancer 2020; 52:68-72. [PMID: 32964323 DOI: 10.1007/s12029-020-00524-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Many cases of gallbladder cancer (GBC) were made incidentally after cholecystectomy for presumed benign disease. The aim of this review is to assess the preoperative predictor factors of gallbladder cancer. METHODS This systematic review was conducted according to PRISMA guidelines when it was applicable. We conducted bibliographic researches on October 2nd, 2019, in the following sources: The National Library of Medicine through PubMed, Cochrane database, and Google scholar. We have assessed the univariate and multivariate analysis outcomes. RESULTS We included ten studies. Incidence of incidental GBC was 0.36%. Seven studies reported age as a significant predictive factor of iGBC. Comorbidities were the second significant predictor. One study found that iGBC group was more likely to have elevated TB, DB, PAL, and ALT. Another study reported a significantly higher rate of TB, PAL, and AST. One study concluded that elevated CA19-9 combined with CEA or CA-125 was significantly more frequent in the group with iGBC. Polyps, porcelain GB, GB wall thickness, and CBD dilation were reported to be associated with iGBC. iGBC group were more likely to have solitary and larger GS and gallbladder wall thickening, essentially focal. CONCLUSION Incidence of iGBC was 0.365% varying between 0.19 and 1.6% of laparoscopic cholecystectomy and about 50% of GBC cases. This highlights the deficiency of preoperative diagnostic features. Despite the efforts made, the rate of this condition is still high, underlining the need of new radiological technologies.
Collapse
Affiliation(s)
- Tarek Kellil
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia.
| | - Emna Aloui
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | | | - Sahbi Khaled Taieb
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Faouzi Noomen
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Khadija Zouari
- Department of Visceral Surgery, Fattouma Bourguiba Hospital, Monastir, Tunisia
| |
Collapse
|
8
|
Søreide K, Guest RV, Harrison EM, Kendall TJ, Garden OJ, Wigmore SJ. Systematic review of management of incidental gallbladder cancer after cholecystectomy. Br J Surg 2019; 106:32-45. [PMID: 30582640 DOI: 10.1002/bjs.11035] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/16/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer. METHODS A systematic PubMed search of the English literature to May 2018 was conducted. RESULTS The search identified 12 systematic reviews and meta-analyses, in addition to several consensus reports, multi-institutional series and national audits. Some 0·25-0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one-third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5-year survival rates of up to 100 per cent after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent and timing of reresection remain controversial. Observation time may be used for new cross-sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of disease dissemination. Gallbladder cancers are PET-avid, and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. The incidence of port-site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. CONCLUSION Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.
Collapse
Affiliation(s)
- K Søreide
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R V Guest
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - E M Harrison
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - T J Kendall
- Division of Pathology, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - O J Garden
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - S J Wigmore
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| |
Collapse
|
9
|
Krishnamurthy G, Singh H, Ganti SD, Verma GR. Bile Duct Hamartoma Mimicking Liver Metastasis in Suspected Porcelain Gallbladder: a Case Report. J Gastrointest Cancer 2019; 50:1022-1025. [PMID: 30613924 DOI: 10.1007/s12029-018-00198-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gautham Krishnamurthy
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Harjeet Singh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Sravya Deepika Ganti
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Ganga Ram Verma
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Tanveer SM, Mukarram HS, Nayyar HS, Ul Ain MQ, Neelofar S. Incidental gallbladder cancer: Missing links in Pakistani population. INTERNATIONAL JOURNAL OF HEPATOBILIARY AND PANCREATIC DISEASES 2017. [DOI: 10.5348/ijhpd-2017-65-oa-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
12
|
Krishnatreya M, Kataki AC. Randomized-Control Screening Trials to Lower Gall Bladder Cancer Mortality in High Risk Populations. Asian Pac J Cancer Prev 2016; 17:2325-7. [DOI: 10.7314/apjcp.2016.17.4.2325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
13
|
Mahadevan A, Dagoglu N, Tseng JF, Khawaja K, Evenson A. Therapeutic Potential of Adjuvant Stereotactic Body Radiotherapy for Gallbladder Cancer. Cureus 2015; 7:e299. [PMID: 26430573 PMCID: PMC4572715 DOI: 10.7759/cureus.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Surgical treatment remains the only curative treatment for gallbladder cancer. However, even after liver resection, locoregional failure seems to be a significant problem. While there is no Level I evidence, multiple studies have shown benefit for adjuvant radiation in high-risk patients. After extensive liver resection, tolerance to conventional chemoradiation may be limited by potential liver toxicity. Stereotactic body radiotherapy has been used safely and effectively in hepatobiliary malignancies. We present a case report, highlighting the potential therapeutic role of adjuvant stereotactic body radiotherapy (SBRT) for gallbladder cancer.
Collapse
Affiliation(s)
- Anand Mahadevan
- Department of Radiation Therapy, Beth Israel Deaconess Medical Center
| | - Nergiz Dagoglu
- Department of Radiation Oncology, Istanbul University Istanbul Medical Faculty
| | | | - Khalid Khawaja
- Department of Surgery, Beth Israel Deaconess Medical Center
| | - Amy Evenson
- Department of Surgery, Beth Israel Deaconess Medical Center
| |
Collapse
|