Incidental gallbladder cancer during laparoscopic cholecystectomy: Managing an unexpected finding

Table 1 Patient characteristics with gallbladder cancer n (%)

	IGBC	NIGBC
No. of patients (n = 19)	9	10
Polyposis lesions	7 (77.8)	5 (50)
Nonpolyposis lesions	1 (11.1)	5 (50)
Histopathological grade
G1	3 (33.3)	1 (10)
G2	6 (66.7)	3 (30)
G3	0	6 (60)
Lymphatic invasion
+	2 (22.2)	4 (40)
-	7 (77.8)	6 (60)
Vessel invasion
+	1 (11.1)	1 (10)
-	8 (88.9)	9 (90)
Perineural invasion
+	1 (11.1)	3 (30)
-	8 (88.9)	7 (70)
Stage
0	1 (11.1)	0
IA	4 (44.4)	2 (20)
IB	1 (11.1)	1 (10)
IIA	0	1 (10)
IIB	2 (22.2)	4 (40)
III	0	1 (10)
IV	1 (11.1)	1 (10)

Table 2 Patient characteristics: Demographic data, histopathological classification, tumor node metastasis staging

Patient	Gender	Age (yr)	Incidental	TNM 6th edition	Cystic duct	Resection	Size (mm)	Grade	Lymphatic	Vessel	Perineural	5-yr survival
1	M	63	No	pT2 N1 Mx	R0	R0	10 (NP)	G3	No	R0	No	Alive, 15 mo
2	F	82	No	pT4 N2 M1	R0	R1	45 (NP)	G3	Yes	Yes	Yes	Dead, 3 mo
3	F	60	No	pT3 N1 Mx	R1	R1	60 (P)	G3	No	No	Yes	Dead, 6 mo
4	F	72	No	pT3 N1 Mx	R0	R1	32 (NP)	G3	Yes	No	No	Dead, 8 mo
5	M	76	No	pT4 N1 Mx	R0	R1	49 (NP)	G3	Yes	No	Yes	Dead, 7 mo
6	M	81	No	pT3 N0 Mx	R0	R1	44 (NP)	G3	No	No	No	Dead, 9 mo
7	F	77	No	pT2 N0 Mx	R0	R0	20 (P)	G2	No	No	No	Dead, 24 mo
8	F	45	No	PT1a N0 Mx	R0	R0	25 (P)	G1	No	No	No	Alive, no recurrence at 5 yr
9	F	81	No	PT3 N1 Mx	R0	R1	24 (P)	G2	Yes	No	No	Dead, 28 mo
10	F	66	No	pT1b N0 Mx	R0	R0	7 (P)	G2	No	No	No	Alive, no recurrence at 5 yr
11	M	69	Yes	pT1b N0 Mx	R0	R0	15 (NP)	G1	No	No	No	Alive, 38 mo (disease recurrence)
12	M	65	Yes	PT1a Nx Mx	R0	R0	18 (P)	G1	No	No	No	Alive, no recurrence at 6 yr
13	F	72	Yes	pT2 N0 Mx	R0	R0	10 (NP)	G2	No	No	No	Alive, no recurrence at 5 yr
14	M	55	Yes	pT2 N0 M1	R1	R1	30 (P)	G2-3	No	Yes	Yes	Dead, 8 mo
15	F	78	Yes	pT2 N1 Mx	R0	R0	14 (P)	G2-3	Yes	No	No	Dead, 26 mo
16	F	57	Yes	pT1b N0 Mx	R0	R0	30 (P)	G2-3	No	No	No	Alive, no recurrence at 5 yr
17	M	71	Yes	pT2 N1 Mx	R0	R0	20 (P)	G2-3	Yes	No	No	Dead, 23 mo
18	F	61	Yes	pTis Nx Mx	R0	R0	12 (P)	G1	No	No	No	Alive, no recurrence at 5 yr
19	M	69	Yes	pT1b N0 Mx	R0	R0	5 (P)	G2	No	No	No	Alive, no recurrence at 5 yr

TNM: Tumor node metastasis; M: Male; F: Female; NP: Non polypoid; P: Polypoid.

Table 3 Patient characteristics: Type of operation and survival data

Patient	Gender	Age (yr)	Incidental	TNM 6th edition	Cystic duct	Resection	Surgery	5-yr survival
1	M	63	No	pT2 N1 Mx	R0	R0	Wedge res. (IVb + V) + lymphadenectomy (Istage)	Alive, 15 mo
2	F	82	No	pT4 N2 M1	R0	R1	Wedge res. (IVb + V) + lymphadenectomy (Istage) + CBD res.	Dead, 3 mo
3	F	60	No	pT3 N1 Mx	R1	R1	Wedge res. (IVb + V) + lymphadenectomy (Istage)	Dead, 6 mo
4	F	72	No	pT3 N1 Mx	R0	R1	Wedge res. (IVb + V) + lymphadenectomy (Istage)	Dead, 8 mo
5	M	76	No	pT4 N1 Mx	R0	R1	Wedge res. (IVb + V) + lymphadenectomy (Istage)	Dead, 7 mo
6	M	81	No	pT3 N0 Mx	R0	R1	Wedge res. (IVb + V) + lymphadenectomy (Istage)	Dead, 9 mo
7	F	77	No	pT2 N0 Mx	R0	R0	Wedge res. (IVb + V) + lymphadenectomy (Istage)	Dead, 24 mo
8	F	45	No	PT1a N0 Mx	R0	R0	Cholecystectomy, no further surgery	Alive, no recurrence at 5 yr
9	F	81	No	PT3 N1 Mx	R0	R1	Wedge res. (IVb + V) + lymphadenectomy (Istage)	Dead, 28 mo
10	F	66	No	pT1b N0 Mx	R0	R0	Wedge res. (IVb + V) + lymphadenectomy (Istage)	Alive, no recurrence at 5 yr
11	M	69	Yes	pT1b N0 Mx	R0	R0	LC (stage) - wedge res. (IVb + V) + lymphadenectomy (II stage) + PS exc	Alive, 38 mo (disease recurrence)
12	M	65	Yes	PT1a Nx Mx	R0	R0	Cholecystectomy	Alive, no recurrence at 6 yr
13	F	72	Yes	pT2 N0 Mx	R0	R0	LC (stage) - wedge res. (IVb + V) + lymphadenectomy (II stage) + PS exc	Alive, no recurrence at 5 yr
14	M	55	Yes	pT2 N0 M1	R1	R1	LC (stage) - wedge res. (IVb + V) + lymphadenectomy (II stage) + CBD and PS exc	Dead, 8 mo
15	F	78	Yes	pT2 N1 Mx	R0	R0	Cholecystectomy, refused further surgery	Dead, 26 mo
16	F	57	Yes	pT1b N0 Mx	R0	R0	LC (stage) - wedge res. (IVb + V) + lymphadenectomy (II stage) + PS exc	Alive, no recurrence at 5 yr
17	M	71	Yes	pT2 N1 Mx	R0	R0	LC (stage) - wedge res. (IVb + V) + lymphadenectomy (II stage) + PS exc	Dead, 23 mo
18	F	61	Yes	pTis Nx Mx	R0	R0	LC	Alive, no recurrence at 5 yr
19	M	69	Yes	pT1b N0 Mx	R0	R0	Cholecystectomy, refused further surgery	Alive, no recurrence at 5 yr

TNM: Tumor node metastasis; M: Male; F: Female; CBD: Common bile duct; PS: Port site; LC: Laparoscopic cholecystectomy; res: Resection of segments; exc: Excision.

Table 4 Residual disease in the lymph nodes after re-resection for each pT (%)

Pathological T	Ogura et al[22]	Tsukada et al [18]	Foster et al [23]	Pawlik et al [5]	You et al [24]	Liang et al [25]	Erich et al [26]
Tis
T1a	2.5	0			0	0	0
T1b	15.5	0			3.8	0	24.4
T1 (tot)	18	0		12.5	3.8	0	24.4
T2	44.3	46	33	31.3		29.2	44.9
T3	72		75	45.5		58.7	63.7
T4						85.36

Table 5 Five-year survival according to both stage of gallbladder cancer and type of surgery (%)

Author	T1a LC	T1b LC	T2 LC	T2 extended resection
Fong et al[36]			19	61
Wagholikar et al[37]	100	41.67
Fong et al[38]			20	60
Foster et al[23]	100	50	38	78
Chijiiwa et al[39]			17	75

LC: Laparoscopic cholecystectomy.

Table 6 Metastasis at port-site and at subcostal laparotomy (%)

Author	Metastasis at port-site	Metastasis at subcostal laparotomy
Z’graggen et al[43]	14
Wu et al[44]	16	6.5
Paolucci et al[47]	17.1
Paolucci et al[48]	14	12