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Published in: World Journal of Surgery 12/2009

01-12-2009

Incidental Gallbladder Cancer Diagnosed Following Laparoscopic Cholecystectomy

Authors: Sae Byeol Choi, Hyung Joon Han, Chung Yun Kim, Wan Bae Kim, Tae-Jin Song, Sung Ock Suh, Young Chul Kim, Sang Yong Choi

Published in: World Journal of Surgery | Issue 12/2009

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Abstract

Background

Laparoscopic cholecystectomy (LC) is the treatment of choice for benign gallbladder disease. Gallbladder cancers have been found following LC. The aim of the present study was to evaluate the survival outcome and prognosis of incidental gallbladder cancer diagnosed after LC.

Methods

From January 2002 to December 2007, 3,145 patients underwent LC at the Department of Surgery, Korea University Medical Center. Of these, 33 patients (1.05%) were diagnosed with gallbladder cancer after LC. Clinicopathological characteristics were retrospectively reviewed in this study.

Results

Of the 33 patients studied, 9 were men and 24 were women. Laparoscopic cholecystectomy alone was performed in 26 patients, and additional radical surgery was performed in 7 others. Regarding tumor staging, there were 2 Tis, 6 T1a, 4 T1b, 17 T2, and 4 T3 tumors. Male patients had a significantly higher incidence of moderately and poorly differentiated tumors (P < 0.001), T2 and T3 tumors (P = 0.02), additional second operations (P = 0.046), and recurrence (P = 0.016). The cumulative 1-, 3-, and 5-year survival rates were 87.2, 73.1, and 47.0%, respectively. Univariate analysis revealed that significant prognostic factors for poorer survival were male gender (P = 0.026), age older than 65 years (P = 0.013), the presence of inflammation (P = 0.009), moderately or poorly differentiated tumor (P < 0.001), nonpolypoid gross type (P = 0.003), and pT stage (P < 0.001). Tumor differentiation was a significantly independent predictor of poor prognosis.

Conclusions

Male patients exhibited aggressive tumor characteristics. Laparoscopic cholecystectomy is an adequate treatment for pT1 tumors. For pT2 and pT3 patients, additional radical surgery might be needed to achieve a tumor-free surgical margin, along with lymph node dissection.
Literature
1.
go back to reference Chijiiwa K, Sumiyoshi K, Nakayama F (1991) Impact of recent advances in hepatobiliary imaging techniques on the preoperative diagnosis of carcinoma of the gallbladder. World J Surg 15:322–327CrossRefPubMed Chijiiwa K, Sumiyoshi K, Nakayama F (1991) Impact of recent advances in hepatobiliary imaging techniques on the preoperative diagnosis of carcinoma of the gallbladder. World J Surg 15:322–327CrossRefPubMed
2.
go back to reference Chijiiwa K, Tanaka M (1996) Indications for and limitations of extended cholecystectomy in the treatment of carcinoma of the gall bladder. Eur J Surg 162:211–216PubMed Chijiiwa K, Tanaka M (1996) Indications for and limitations of extended cholecystectomy in the treatment of carcinoma of the gall bladder. Eur J Surg 162:211–216PubMed
3.
go back to reference Yamamoto H, Hayakawa N, Kitagawa Y et al (2005) Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 12:391–398CrossRefPubMed Yamamoto H, Hayakawa N, Kitagawa Y et al (2005) Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 12:391–398CrossRefPubMed
4.
go back to reference Kwon AH, Imamura A, Kitade H et al (2008) Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy. J Surg Oncol 97:241–245CrossRefPubMed Kwon AH, Imamura A, Kitade H et al (2008) Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy. J Surg Oncol 97:241–245CrossRefPubMed
5.
go back to reference Chijiiwa K, Tanaka M (1994) Carcinoma of the gallbladder: an appraisal of surgical resection. Surgery 115:751–756PubMed Chijiiwa K, Tanaka M (1994) Carcinoma of the gallbladder: an appraisal of surgical resection. Surgery 115:751–756PubMed
6.
go back to reference Yamaguchi K, Chijiiwa K, Saiki S et al (1997) Retrospective analysis of 70 operations for gallbladder carcinoma. Br J Surg 84:200–204CrossRefPubMed Yamaguchi K, Chijiiwa K, Saiki S et al (1997) Retrospective analysis of 70 operations for gallbladder carcinoma. Br J Surg 84:200–204CrossRefPubMed
7.
go back to reference Chan SY, Poon RT, Lo CM et al (2008) Management of carcinoma of the gallbladder: a single-institution experience in 16 years. J Surg Oncol 97:156–164CrossRefPubMed Chan SY, Poon RT, Lo CM et al (2008) Management of carcinoma of the gallbladder: a single-institution experience in 16 years. J Surg Oncol 97:156–164CrossRefPubMed
8.
go back to reference Kai M, Chijiiwa K, Ohuchida J et al (2007) A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma. J Gastrointest Surg 11:1025–1032CrossRefPubMed Kai M, Chijiiwa K, Ohuchida J et al (2007) A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma. J Gastrointest Surg 11:1025–1032CrossRefPubMed
9.
go back to reference Bartlett DL, Fong Y, Fortner JG et al (1996) Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann Surg 224:639–646CrossRefPubMed Bartlett DL, Fong Y, Fortner JG et al (1996) Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann Surg 224:639–646CrossRefPubMed
10.
go back to reference Foster JM, Hoshi H, Gibbs JF et al (2007) Gallbladder cancer: defining the indications for primary radical resection and radical re-resection. Ann Surg Oncol 14:833–840CrossRefPubMed Foster JM, Hoshi H, Gibbs JF et al (2007) Gallbladder cancer: defining the indications for primary radical resection and radical re-resection. Ann Surg Oncol 14:833–840CrossRefPubMed
11.
go back to reference Greene FL, Page DL, Fleming ID et al (2002) AJCC cancer staging manual, 6th edn. Springer-Verlag, New York Greene FL, Page DL, Fleming ID et al (2002) AJCC cancer staging manual, 6th edn. Springer-Verlag, New York
12.
go back to reference Choi SB, Park SW, Kim KS et al (2009) The survival outcome and prognostic factors for middle and distal bile duct cancer following surgical resection. J Surg Oncol 99:335–342CrossRefPubMed Choi SB, Park SW, Kim KS et al (2009) The survival outcome and prognostic factors for middle and distal bile duct cancer following surgical resection. J Surg Oncol 99:335–342CrossRefPubMed
13.
go back to reference Nakayama F (1991) Recent progress in the diagnosis and treatment of carcinoma of the gallbladder—introduction. World J Surg 15:313–314CrossRefPubMed Nakayama F (1991) Recent progress in the diagnosis and treatment of carcinoma of the gallbladder—introduction. World J Surg 15:313–314CrossRefPubMed
14.
go back to reference Scott TE, Carroll M, Cogliano FD et al (1999) A case-control assessment of risk factors for gallbladder carcinoma. Dig Dis Sci 44:1619–1625CrossRefPubMed Scott TE, Carroll M, Cogliano FD et al (1999) A case-control assessment of risk factors for gallbladder carcinoma. Dig Dis Sci 44:1619–1625CrossRefPubMed
16.
go back to reference Ong SL, Garcea G, Thomasset SC et al (2008) Ten-year experience in the management of gallbladder cancer from a single hepatobiliary and pancreatic centre with review of the literature. HPB (Oxf) 10:446–458 Ong SL, Garcea G, Thomasset SC et al (2008) Ten-year experience in the management of gallbladder cancer from a single hepatobiliary and pancreatic centre with review of the literature. HPB (Oxf) 10:446–458
17.
go back to reference Todoroki T, Kawamoto T, Takahashi H et al (1999) Treatment of gallbladder cancer by radical resection. Br J Surg 86:622–627CrossRefPubMed Todoroki T, Kawamoto T, Takahashi H et al (1999) Treatment of gallbladder cancer by radical resection. Br J Surg 86:622–627CrossRefPubMed
18.
go back to reference Shimada H, Endo I, Togo S et al (1997) The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer 79:892–899CrossRefPubMed Shimada H, Endo I, Togo S et al (1997) The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer 79:892–899CrossRefPubMed
19.
go back to reference Yildirim E, Celen O, Gulben K et al (2005) The surgical management of incidental gallbladder carcinoma. Eur J Surg Oncol 31:45–52CrossRefPubMed Yildirim E, Celen O, Gulben K et al (2005) The surgical management of incidental gallbladder carcinoma. Eur J Surg Oncol 31:45–52CrossRefPubMed
20.
go back to reference Yagi H, Shimazu M, Kawachi S et al (2006) Retrospective analysis of outcome in 63 gallbladder carcinoma patients after radical resection. J Hepatobiliary Pancreat Surg 13:530–536CrossRefPubMed Yagi H, Shimazu M, Kawachi S et al (2006) Retrospective analysis of outcome in 63 gallbladder carcinoma patients after radical resection. J Hepatobiliary Pancreat Surg 13:530–536CrossRefPubMed
21.
go back to reference Kohya N, Miyazaki K (2008) Hepatectomy of segment 4a and 5 combined with extra-hepatic bile duct resection for T2 and T3 gallbladder carcinoma. J Surg Oncol 97:498–502CrossRefPubMed Kohya N, Miyazaki K (2008) Hepatectomy of segment 4a and 5 combined with extra-hepatic bile duct resection for T2 and T3 gallbladder carcinoma. J Surg Oncol 97:498–502CrossRefPubMed
22.
go back to reference Toyonaga T, Chijiiwa K, Nakano K et al (2003) Completion radical surgery after cholecystectomy for accidentally undiagnosed gallbladder carcinoma. World J Surg 27:266–271CrossRefPubMed Toyonaga T, Chijiiwa K, Nakano K et al (2003) Completion radical surgery after cholecystectomy for accidentally undiagnosed gallbladder carcinoma. World J Surg 27:266–271CrossRefPubMed
23.
go back to reference Kokudo N, Makuuchi M, Natori T et al (2003) Strategies for surgical treatment of gallbladder carcinoma based on information available before resection. Arch Surg 138:741–750; discussion 750CrossRefPubMed Kokudo N, Makuuchi M, Natori T et al (2003) Strategies for surgical treatment of gallbladder carcinoma based on information available before resection. Arch Surg 138:741–750; discussion 750CrossRefPubMed
24.
go back to reference You DD, Lee HG, Paik KY et al (2008) What is an adequate extent of resection for T1 gallbladder cancers? Ann Surg 247:835–838CrossRefPubMed You DD, Lee HG, Paik KY et al (2008) What is an adequate extent of resection for T1 gallbladder cancers? Ann Surg 247:835–838CrossRefPubMed
25.
go back to reference Kang CM, Choi GH, Park SH et al (2007) Laparoscopic cholecystectomy only could be an appropriate treatment for selected clinical R0 gallbladder carcinoma. Surg Endosc 21:1582–1587CrossRefPubMed Kang CM, Choi GH, Park SH et al (2007) Laparoscopic cholecystectomy only could be an appropriate treatment for selected clinical R0 gallbladder carcinoma. Surg Endosc 21:1582–1587CrossRefPubMed
26.
go back to reference Wakai T, Shirai Y, Yokoyama N et al (2001) Early gallbladder carcinoma does not warrant radical resection. Br J Surg 88:675–678CrossRefPubMed Wakai T, Shirai Y, Yokoyama N et al (2001) Early gallbladder carcinoma does not warrant radical resection. Br J Surg 88:675–678CrossRefPubMed
27.
go back to reference Muratore A, Polastri R, Bouzari H et al (2000) Radical surgery for gallbladder cancer: a worthwhile operation? Eur J Surg Oncol 26:160–163CrossRefPubMed Muratore A, Polastri R, Bouzari H et al (2000) Radical surgery for gallbladder cancer: a worthwhile operation? Eur J Surg Oncol 26:160–163CrossRefPubMed
28.
go back to reference Chijiiwa K, Nakano K, Ueda J et al (2001) Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg 192:600–607CrossRefPubMed Chijiiwa K, Nakano K, Ueda J et al (2001) Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg 192:600–607CrossRefPubMed
29.
go back to reference Sasaki R, Uesugi N, Itabashi H et al (2005) Clinicopathological study of depth of subserosal invasion in patients with pT2 gallbladder carcinoma. J Surg Oncol 92:83–88CrossRefPubMed Sasaki R, Uesugi N, Itabashi H et al (2005) Clinicopathological study of depth of subserosal invasion in patients with pT2 gallbladder carcinoma. J Surg Oncol 92:83–88CrossRefPubMed
30.
go back to reference Sakamoto Y, Kosuge T, Shimada K et al (2006) Clinical significance of extrahepatic bile duct resection for advanced gallbladder cancer. J Surg Oncol 94:298–306CrossRefPubMed Sakamoto Y, Kosuge T, Shimada K et al (2006) Clinical significance of extrahepatic bile duct resection for advanced gallbladder cancer. J Surg Oncol 94:298–306CrossRefPubMed
31.
go back to reference Weiland ST, Mahvi DM, Niederhuber JE et al (2002) Should suspected early gallbladder cancer be treated laparoscopically? J Gastrointest Surg 6:50–56; discussion 56–57CrossRefPubMed Weiland ST, Mahvi DM, Niederhuber JE et al (2002) Should suspected early gallbladder cancer be treated laparoscopically? J Gastrointest Surg 6:50–56; discussion 56–57CrossRefPubMed
32.
go back to reference Wanebo HJ, Castle WN, Fechner RE (1982) Is carcinoma of the gallbladder a curable lesion? Ann Surg 195:624–631CrossRefPubMed Wanebo HJ, Castle WN, Fechner RE (1982) Is carcinoma of the gallbladder a curable lesion? Ann Surg 195:624–631CrossRefPubMed
33.
go back to reference Miyazaki M, Itoh H, Ambiru S et al (1996) Radical surgery for advanced gallbladder carcinoma. Br J Surg 83:478–481CrossRefPubMed Miyazaki M, Itoh H, Ambiru S et al (1996) Radical surgery for advanced gallbladder carcinoma. Br J Surg 83:478–481CrossRefPubMed
34.
go back to reference Benoist S, Panis Y, Fagniez PL (1998) Long-term results after curative resection for carcinoma of the gallbladder. French University Association for Surgical Research. Am J Surg 175:118–122CrossRefPubMed Benoist S, Panis Y, Fagniez PL (1998) Long-term results after curative resection for carcinoma of the gallbladder. French University Association for Surgical Research. Am J Surg 175:118–122CrossRefPubMed
35.
go back to reference Wakai T, Shirai Y, Yokoyama N et al (2003) Depth of subserosal invasion predicts long-term survival after resection in patients with T2 gallbladder carcinoma. Ann Surg Oncol 10:447–454CrossRefPubMed Wakai T, Shirai Y, Yokoyama N et al (2003) Depth of subserosal invasion predicts long-term survival after resection in patients with T2 gallbladder carcinoma. Ann Surg Oncol 10:447–454CrossRefPubMed
36.
go back to reference Jensen EH, Abraham A, Habermann EB et al (2009) A critical analysis of the surgical management of early-stage gallbladder cancer in the United States. J Gastrointest Surg 13:722–727CrossRefPubMed Jensen EH, Abraham A, Habermann EB et al (2009) A critical analysis of the surgical management of early-stage gallbladder cancer in the United States. J Gastrointest Surg 13:722–727CrossRefPubMed
37.
go back to reference Paolucci V (2001) Port site recurrences after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 8:535–543CrossRefPubMed Paolucci V (2001) Port site recurrences after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 8:535–543CrossRefPubMed
38.
go back to reference Ricardo AE, Feig BW, Ellis LM et al (1997) Gallbladder cancer and trocar site recurrences. Am J Surg 174:619–622; discussion 622–613CrossRefPubMed Ricardo AE, Feig BW, Ellis LM et al (1997) Gallbladder cancer and trocar site recurrences. Am J Surg 174:619–622; discussion 622–613CrossRefPubMed
39.
go back to reference Pearlstone DB, Curley SA, Feig BW (1998) The management of gallbladder cancer: before, during, and after laparoscopic cholecystectomy. Semin Laparosc Surg 5:121–128PubMed Pearlstone DB, Curley SA, Feig BW (1998) The management of gallbladder cancer: before, during, and after laparoscopic cholecystectomy. Semin Laparosc Surg 5:121–128PubMed
Metadata
Title
Incidental Gallbladder Cancer Diagnosed Following Laparoscopic Cholecystectomy
Authors
Sae Byeol Choi
Hyung Joon Han
Chung Yun Kim
Wan Bae Kim
Tae-Jin Song
Sung Ock Suh
Young Chul Kim
Sang Yong Choi
Publication date
01-12-2009
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 12/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-009-0249-2

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