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1
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Kumar N P, Gupta Y, Nag HH. Incidental Gallbladder Cancer: A Comprehensive Review. J Gastrointest Cancer 2025; 56:94. [PMID: 40186738 DOI: 10.1007/s12029-025-01212-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2025] [Indexed: 04/07/2025]
Abstract
PURPOSE Patients undergoing cholecystectomy for a presumed benign disease may present with histopathology report revealing carcinoma in the gallbladder specimen, in which case it is referred to as incidental gallbladder cancer (IGBC). This review highlights the approach to evaluation and management of these patients. METHODS Available literature from various sources has been reviewed and presented in a narrative format. RESULTS Early referral to a tertiary centre for appropriate staging and definitive management is paramount. Once distant metastasis is ruled out, re-resection is indicated in patients with pathological T-stage ≥T1b with the aim to attain R0 resection, and perform complete staging lymphadenectomy, and has been shown to confer survival benefit. Feasibility and safety of minimally invasive approaches have been demonstrated in recent years. Role of peri-operative chemo(radio)-therapy in IGBC remains uncertain and prospective trials are warranted. CONCLUSION IGBC is being increasingly diagnosed as the number of cholecystectomies for presumed benign diseases is steadily increasing globally. Overall prognosis depends on the stage and is especially poor in those with residual disease at re-operation.
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Affiliation(s)
- Pritesh Kumar N
- Surgical Gastroenterology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Yashika Gupta
- Surgical Gastroenterology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Hirdaya H Nag
- Surgical Gastroenterology, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
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2
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Chen K, Feng X, Shi Y, Li XL, Shi ZR, Lan X. Complete response of gallbladder cancer treated with gemcitabine and cisplatin chemotherapy combined with durvalumab: A case report and review of literature. World J Gastrointest Oncol 2025; 17:98433. [PMID: 39817135 PMCID: PMC11664610 DOI: 10.4251/wjgo.v17.i1.98433] [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] [Received: 06/26/2024] [Revised: 10/10/2024] [Accepted: 11/04/2024] [Indexed: 12/12/2024] Open
Abstract
BACKGROUND Gallbladder cancer (GBC) is the most common and aggressive subtype of biliary tract cancer (BTC) and has a poor prognosis. A newly developed regimen of gemcitabine, cisplatin, and durvalumab shows promise for the treatment of advanced BTC. However, the efficacy of this treatment for GBC remains unclear. CASE SUMMARY In this report, we present a case in which the triple-drug regimen exhibited marked effectiveness in treating locally advanced GBC, thus leading to a long-term survival benefit. A 68-year-old man was diagnosed with locally advanced GBC, which rendered him ineligible for curative surgery. Following three cycles of therapy, a partial response was observed. After one year of combined therapy, a clinical complete response was successfully achieved. Subsequent maintenance therapy with durvalumab monotherapy resulted in a disease-free survival of 9 months for the patient. The patient experienced tolerable toxicities of reversible grade 2 nausea and fatigue. Tolerable adverse events were observed in the patient throughout the entirety of the treatment. CONCLUSION The combination of gemcitabine and cisplatin chemotherapy with durvalumab was proven to be an effective treatment approach for advanced GBC, with manageable adverse events. Further research is warranted to substantiate the effectiveness of the combined regimen in the context of GBC.
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Affiliation(s)
- Kai Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xu Feng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yuan Shi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xin-Lin Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Zheng-Rong Shi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Xiang Lan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Olecki EJ, Mayhew M, Perez Holguin R, Wong WG, Stahl KA, Peng JS, Dixon ME, Gusani NJ. Gallbladder Cancer Incidentally Found at Cholecystectomy: Perioperative Risk Factors. J Gastrointest Cancer 2024; 55:723-732. [PMID: 38191950 DOI: 10.1007/s12029-023-00973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Risk factors of gallbladder cancer (GBC) are not well-defined resulting in greater than 60% of GBCs being diagnosed incidentally following cholecystectomy performed for presumed benign indications. As most localized GBCs require more extensive oncologic surgery beyond cholecystectomy, this study aims to examine factors associated with incidentally found GBC to improve preoperative and intraoperative diagnoses. METHODS The American College of Surgeons National Surgical Quality Improvement Program Database from 2007 to 2017 was used to identify cholecystectomies performed with and without a final diagnosis of GBC. Univariate and multivariable logistic regressions were used to compare demographic, intraoperative, and postoperative characteristics among those with and without a diagnosis of GBC. RESULTS The incidence of GBC was observed to be 0.11% (441/403,443). Preoperative factors associated with risk of GBC included age > 60 (OR 6.51, p < .001), female sex (OR 1.75, p < .001), history of weight loss (2.58, p < .001), and elevated preoperative alkaline phosphatase level (OR 1.67, p = .001). Open approach was associated with 7 times increased risk of GBC compared to laparoscopic approach (OR 7.33, p < .001). In addition to preoperative factors and surgical approach, longer mean operative times (127 min vs 70.7 min, p < .001) were significantly associated with increased risk of GBC compared to benign final pathology. CONCLUSION This study demonstrates that those with incidentally discovered GBC at cholecystectomy are unique from those undergoing cholecystectomy for benign indications. By identifying predictors of GBC, surgeons can choose high risk individuals for pre-operative oncologic evaluation and consider better tools for identifying GBC such as intraoperative frozen pathology.
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Affiliation(s)
- Elizabeth J Olecki
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
| | - Mackenzie Mayhew
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy Perez Holguin
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - William G Wong
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Kelly A Stahl
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - June S Peng
- Program for Liver, Pancreas, & Foregut Tumors, Department of Surgery College of Medicine, The Pennsylvania State University, PA, USA
| | - Matthew E Dixon
- Division of Surgical Oncology, Department of Surgery, Rush Medical College, Chicago, IL, USA
| | - Niraj J Gusani
- Section of Surgical Oncology, Division of Surgery, Baptist MD Anderson Cancer Center, Jacksonville, FL, USA
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Krishnaraju VS, Kumar R, Mittal BR, Singh H, Aggarwal P, Singh H, Yadav TD, Nada R, Gupta V, Gupta R. Incidentally Detected Gallbladder Carcinoma: Can F-18 FDG PET/CT Aid in Staging and Prognostication? Nucl Med Mol Imaging 2024; 58:104-112. [PMID: 38633288 PMCID: PMC11018561 DOI: 10.1007/s13139-024-00841-w] [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: 05/29/2023] [Revised: 12/26/2023] [Accepted: 01/10/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose Incidental gallbladder carcinoma (IGBC) is diagnosed in post-cholecystectomy specimens for benign indications, where the role of 2-fluro-2-deoxyglucose positron emission tomography/computed tomography(FDG-PET/CT) is not clearly defined. The present study aimed to assess the benefits of staging and prognosticating with FDG-PET/CT in IGBC. Materials and Methods A retrospective observational study from a tertiary-care center from January 2010 to July 2020 was performed. The demographic, clinical, histopathological, and treatment-related histories were collected. FDG-PET/CT-image findings were compared with survival outcomes through telephonic follow-up. The chi-square test was used for comparing frequencies. The univariate and multivariate survival estimates were analyzed using the Kaplan-Meier analysis and the Cox-proportional hazard model, respectively. Log-rank test was used to compare the Kaplan-Meier curves. Results The study included 280 postcholecystectomy participants (mean age: 52 ± 11 years; women: 227) of whom 52.1% had open surgery(146/280). Residual disease in the gallbladder fossa (54.8% vs. 36.6%, p = 0.002) and liver infiltration (32.9% vs. 22.4%, p = 0.05) were seen more frequently in open surgery compared to laparoscopic surgery, while anterior abdominal wall deposits were more common in laparoscopy(35.1% vs. 24%,p = 0.041). FDG-PET/CT changed the management in 10% (n = 28) of patients compared to contrast-enhanced CT. The median survival was 14 months (95%CI-10.3-17.7). A higher stage of the disease on the FDG-PET/CT (loco-regional disease-HR 4.86, p = 0.006; metastatic disease-HR 7.53, p < 0.001) and the presence of liver infiltration (HR-1.92, p = 0.003) were independent predictors of poor survival outcomes. Conclusion FDG-PET/CT detects residual and metastatic disease in patients with IGBC, enabling the institution of appropriate management and acting as a tool for prognostication of survival.
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Affiliation(s)
- Venkata Subramanian Krishnaraju
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Rajender Kumar
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Harjeet Singh
- Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Piyush Aggarwal
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Harmandeep Singh
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Thakur Deen Yadav
- Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
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He S, Yu TN, Cao JS, Zhou XY, Chen ZH, Jiang WB, Cai LX, Liang X. Laparoscopic vs open radical resection in management of gallbladder carcinoma: A systematic review and meta-analysis. World J Clin Cases 2023; 11:6455-6475. [PMID: 37900219 PMCID: PMC10601008 DOI: 10.12998/wjcc.v11.i27.6455] [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] [Received: 05/20/2023] [Revised: 06/29/2023] [Accepted: 07/24/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Radical resection offers the only hope for the long-term survival of patients with gallbladder carcinoma (GBC) above the T1b stage. However, whether it should be performed under laparoscopy for GBC is still controversial. AIM To compare laparoscopic radical resection (LRR) with traditional open radical resection (ORR) in managing GBC. METHODS A comprehensive search of online databases, including Medline (PubMed), Cochrane Library, and Web of Science, was conducted to identify comparative studies involving LRR and ORR in GBCs till March 2023. A meta-analysis was subsequently performed. RESULTS A total of 18 retrospective studies were identified. In the long-term prognosis, the LRR group was comparable with the ORR group in terms of overall survival and tumor-free survival (TFS). LRR showed superiority in terms of TFS in the T2/tumor-node-metastasis (TNM) Ⅱ stage subgroup vs the ORR group (P = 0.04). In the short-term prognosis, the LRR group had superiority over the ORR group in the postoperative length of stay (POLS) (P < 0.001). The sensitivity analysis showed that all pooled results were robust. CONCLUSION The meta-analysis results show that LRR is not inferior to ORR in all measured outcomes and is even superior in the TFS of patients with stage T2/TNM Ⅱ disease and POLS. Surgeons with sufficient laparoscopic experience can perform LRR as an alternative surgical strategy to ORR.
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Affiliation(s)
- Shilin He
- Department of General Surgery, Sir Run-Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Tu-Nan Yu
- Department of General Surgery, Sir Run-Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Jia-Sheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Xue-Yin Zhou
- Department of General Surgery, Sir Run-Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
- School of Medicine, Wenzhou Medical University, Wenzhou 325035, Zhejiang Province, China
| | - Zhe-Han Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
- Department of Hepatobiliary Surgery, Fuyang First People’s Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou 311400, Zhejiang Province, China
| | - Wen-Bin Jiang
- Department of General Surgery, Sir Run-Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Liu-Xin Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
| | - Xiao Liang
- Department of General Surgery, Sir Run-Run Shaw Hospital of Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang Province, China
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Yang G, Xu Q, Wan Y, Zhang L, Wang Z, Meng F. miR-193a-3p Enhanced the Chemosensitivity to Trametinib in Gallbladder Carcinoma by Targeting KRAS and Downregulating ERK Signaling. Cancer Biother Radiopharm 2023; 38:371-379. [PMID: 34287012 DOI: 10.1089/cbr.2021.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective: In this study, the authors identified miR-193a-3p as a tumor-suppressing microRNA, and its effects on the chemosensitivity to trametinib in gallbladder carcinoma (GBC) were evaluated. Materials and Methods: The levels of miR-193a-3p in clinical GBC tissues and GBC cells were determined by quantitative real-time polymerase chain reaction. The protein levels of KRAS, ERK, and phosphorylated ERK (p-ERK) were examined by Western blot. Dual-luciferase reporter assays were performed to confirm the interaction between miR-193a-3p and KRAS. The effect of miR-193a-3p knockdown or overexpression on the malignant behaviors and chemosensitivity of GBC was determined by 3-(4,5-dimethlthiazol-2-yl)-2,5-diphenyl-tetrazoliumbromide and flow cytometry assays in vitro and further examined in a xenograft model. Results: The levels of miR-193a-3p were significantly decreased in GBC cell lines, especially with KRAS mutations. In addition, miR-193a-3p overexpression retarded cell proliferation of GBC, but induced cell apoptosis. Moreover, miR-193a-3p overexpression significantly improved the chemosensitivity of GBC to trametinib both in in vitro assays and in vivo xenograft mouse model. Further mechanisms disclosed that KRAS was a target of miR-193a-3p and levels of p-ERK were increased by treatment with miR-193a-3p inhibitor in GBC. Conclusions: These data suggested that miR-193a-3p enhanced the chemosensitivity to trametinib in GBC with wild-type KRAS or KRAS mutations by directly targeting KRAS and finally downregulated ERK signaling.
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Affiliation(s)
- Ganghua Yang
- Department of Geriatric Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Qinhong Xu
- Department of Geriatric Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Yong Wan
- Department of Geriatric Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Lei Zhang
- Department of Geriatric Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Zheng Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
| | - Fandi Meng
- Department of Geriatric Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, P.R. China
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Xie H, Wang X, Xue M, Qiu Y, Ge W. Effectiveness and safety of path-based analgesic regimens designed by clinical pharmacists based on the type of biliary and pancreatic surgery. J Clin Pharm Ther 2022; 47:2302-2311. [PMID: 36440669 DOI: 10.1111/jcpt.13814] [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: 06/17/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE As the incidence of postoperative pain in patients with biliary and pancreatic diseases has gradually increased, how to control postoperative pain has received increasing research attention. By reading pain management guidelines and multidisciplinary communication and cooperation, clinical pharmacists designed multi-mode analgesia regimens based on surgical types, in order to provide strong evidence for the effectiveness and safety of postoperative analgesia regimens and better serve patients. METHODS Data from biliary or pancreatic surgery performed at Nanjing Drum Tower Hospital from 2019 to 2021 were collected. Take October 2020 as the time point to compare the outcomes before and after the implementation of the path-based postoperative analgesic regimens. The primary outcomes were NRS pain scores, sleep quality, and incidence of adverse reactions. Length of stay was a secondary outcome. RESULTS AND DISCUSSION A total of 268 and 239 patients were enrolled in the study and control groups, respectively. Four path-based postoperative analgesic management regimens significantly reduced patients' static and dynamic NRS scores in the 24 h (p < 0.05). The patients' sleep quality were better than controls (p > 0.05). The incidence of adverse reactions and the length of stay in the study group were numerically lower than controls. Moderate analysis indicated that four analgesia regimens are more precise and better meet actual clinical needs. WHAT IS NEW AND CONCLUSION Effective and safe postoperative pain management is particularly important for clinical purposes. Path-based postoperative analgesia regimens based on different types of surgery overcome the disadvantages of overly broad and generalized traditional guidelines, which play an important role in providing personalized and precise clinical services. Further, study findings provide evidence that four path-based analgesic regimens can reduce postoperative pain and reduce the length of hospital stay, which may provide a better direction for clinical postoperative pain management.
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Affiliation(s)
- Han Xie
- Department of Pharmacy, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.,State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau
| | - Xinmei Wang
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China
| | - Min Xue
- Department of Pharmacy, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yudong Qiu
- Department of General Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Weihong Ge
- Department of Pharmacy, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
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A Case of Early-Stage Gallbladder Cancer, Positive for ALDH1A1, Which Arose from Adenomyomatosis of the Gallbladder. Diagnostics (Basel) 2022; 12:diagnostics12112721. [DOI: 10.3390/diagnostics12112721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Adenomyomatosis (ADM) of the gallbladder is a condition characterized by the proliferation of Rokitansky–Aschoff sinus (RAS), in which the epithelium of the gallbladder extends into the muscular layer, causing a thickening of the gallbladder wall. Although ADM is generally considered not to be a precancerous lesion of gallbladder cancer, there are some reports of cases of gallbladder cancer from ADM. Therefore, the relationship between ADM and gallbladder cancer remains controversial. We herein report a case of early-stage gallbladder cancer, BilIN3 (high grade), arising from ADM that was positive for ALDH1A1, an important marker of stem cells and cancer stem cells.
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Valenti MR, Cavallaro A, Di Vita M, Zanghi A, Longo Trischitta G, Cappellani A. Gallbladder hemorrhage-An uncommon surgical emergency: A case report. World J Clin Cases 2022; 10:9734-9742. [PMID: 36186197 PMCID: PMC9516921 DOI: 10.12998/wjcc.v10.i27.9734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gallbladder hemorrhage is a life-threatening disorder. Trauma (accidental or iatrogenic such as a percutaneous biopsy or cholecystectomy surgery), cholelithiasis, biliary tract parasitosis, vasculitis, vascular malformations, autoimmune and neoplastic diseases and coagulopathies have been described as causes of hemorrhage within the lumen of the gallbladder. The use of non-steroidal anti-inflammatory drugs and anticoagulants may represent a risk factor. CASE SUMMARY We report the case of a 76-year-old male patient. An urgent contrast computed tomography scan demonstrated relevant distension of the gallbladder filled with hyperdense non-homogeneous content. The gallbladder walls were of regular thickness. Near the anterior wall a focus of suspected active bleeding was observed. Due to the progressive decrease in hemoglobin despite three blood transfusions, this was an indication for urgent surgery. CONCLUSION Early diagnosis of this potentially fatal pathology is essential in order to plan a strategy and eventually proceed with urgent surgical treatment.
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Affiliation(s)
- Maria Rosaria Valenti
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Andrea Cavallaro
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Maria Di Vita
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Antonio Zanghi
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Giovanni Longo Trischitta
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
| | - Alessandro Cappellani
- Department of Surgery, University of Catania Medical School, University of Catania, Catania 95123, Italy
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10
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Low SK, Giannis D, Thuong ND, Nam NH, Alshareef A, Koulas I, Geropoulos G, Moris D, Molmenti EP, Huy NT. Trends in Primary Gallbladder Cancer Incidence and Incidence-based Mortality in the United States, 1973 to 2015. Am J Clin Oncol 2022; 45:306-315. [PMID: 35700074 DOI: 10.1097/coc.0000000000000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Primary gallbladder cancer (GBC) is the most common biliary tract cancer with poor survival despite aggressive treatment. This study aimed to investigate the trends of GBC incidence and incidence-based mortality (IBM) over the last 4 decades. MATERIALS AND METHODS GBC cases diagnosed between 1973 and 2015 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Incidence rates, IBM rates, and annual percent changes (APCs) were calculated and stratified according to population and tumor characteristics. RESULTS The cohort consisted of 10,792 predominantly white (81%) and female (71%) GBC patients. The overall GBC incidence decreased by 1.65% (95% confidence interval [CI]: 1.45% to 1.84%) per year since 1973, but has plateaued since 2002. IBM decreased by 1.69% (95% CI: 1.22% to 2.16%) per year from 1980 to 2015; the rate of decrease in IBM rates was lower during 1997 to 2015 (APC: -1.19%, 95% CI: -1.68% to -0.71%) compared with 1980 to 1997 (APC: -3.13%, 95% CI: -3.68% to -2.58%). CONCLUSIONS The incidence and IBM rates of GBC have been decreasing over the last 40 years, but the decrease plateaued over the last 2 decades. The effects of treatment modalities, including laparoscopic cholecystectomy, adjuvant chemotherapy, and radiation on the incidence and IBM of GBC need to be further investigated.
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Affiliation(s)
- Soon Khai Low
- Department of Internal Medicine, Rochester General Hospital, Rochester
- Online Research Club ( http://www.onlineresearchclub.org/ )
| | - Dimitrios Giannis
- The Feinstein Institute for Medical Research
- Department of Surgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Nguyen D Thuong
- Online Research Club ( http://www.onlineresearchclub.org/ )
- School of Medicine, Vietnam National University Ho Chi Minh City, Vietnam
| | - Nguyen Hai Nam
- Online Research Club ( http://www.onlineresearchclub.org/ )
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto
| | - Abdulmueti Alshareef
- Online Research Club ( http://www.onlineresearchclub.org/ )
- Faculty of Medicine, University of Zawia, Azzawiyah, Libya
| | - Ioannis Koulas
- The Feinstein Institute for Medical Research
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Georgios Geropoulos
- Department of Thoracic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ernesto P Molmenti
- The Feinstein Institute for Medical Research
- Department of Surgery, North Shore University Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Nguyen Tien Huy
- School of Tropical Medicine and Global Health, Nagasaki University, Japan
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Alarabiyat M, Raza SS, Isaac J, Mirza D, Marudanayagam R, Roberts K, Abradelo M, Bartlett DC, Dasari BV, Sutcliffe RP, Chatzizacharias NA. Incidental gallbladder cancer diagnosis confers survival advantage irrespective of tumour stage and characteristics. World J Gastroenterol 2022; 28:1996-2007. [PMID: 35664962 PMCID: PMC9150056 DOI: 10.3748/wjg.v28.i18.1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/22/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incidental gallbladder cancer (IGBC) represents 50%-60% of gallbladder cancer cases. Data are conflicting on the role of IGBC diagnosis in oncological outcomes. Some studies suggest that IGBC diagnosis does not affect outcomes, while others that overall survival (OS) is longer in these cases compared to non-incidental diagnosis (NIGBC). Furthermore, some studies reported early tumour stages and histopathologic characteristics as possible confounders, while others not. AIM To investigate the role of IGBC diagnosis on patients' overall survival, especially after surgical treatment with curative intent. METHODS Retrospective analysis of all patient referrals with gallbladder cancer between 2008 and 2020 in a tertiary hepatobiliary centre. Statistical comparison of patient and tumour characteristics between IGBC and NIGBC subgroups was performed. Survival analysis for the whole cohort, surgical and non-surgical subgroups was done with the Kaplan-Meier method and the use of log rank test. Risk analysis was performed with univariable and multivariable Cox regression analysis. RESULTS The cohort included 261 patients with gallbladder cancer. 65% of cases had NIGBC and 35% had IGBC. A total of 90 patients received surgical treatment (66% of IGBC cases and 19% of NIGBC cases). NIGBC patients had more advanced T stage and required more extensive resections than IGBC ones. OS was longer in patients with IGBC in the whole cohort (29 vs 4 mo, P < 0.001), as well as in the non-surgical (14 vs 2 mo, P < 0.001) and surgical subgroups (29 vs 16.5 mo, P = 0.001). Disease free survival (DFS) after surgery was longer in patients with IGBC (21.5 mo vs 8.5 mo, P = 0.007). N stage and resection margin status were identified as independent predictors of OS and DFS. NIGBC diagnosis was identified as an independent predictor of OS. CONCLUSION IGBC diagnosis may confer a survival advantage independently of the pathological stage and tumour characteristics. Prospective studies are required to further investigate this, including detailed pathological analysis and molecular gene expression.
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Affiliation(s)
- Moath Alarabiyat
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Syed Soulat Raza
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - John Isaac
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Darius Mirza
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Ravi Marudanayagam
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Keith Roberts
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Manuel Abradelo
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - David C Bartlett
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Bobby V Dasari
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Robert P Sutcliffe
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Nikolaos A Chatzizacharias
- Department of HPB and Liver Transplantation, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2TH, United Kingdom
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12
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Nakanishi H, Miangul S, Oluwaremi TT, Sim BL, Hong SS, Than CA. Open versus laparoscopic surgery in the management of patients with gallbladder cancer: A systematic review and meta-analysis. Am J Surg 2022; 224:348-357. [DOI: 10.1016/j.amjsurg.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/06/2022] [Accepted: 03/01/2022] [Indexed: 02/07/2023]
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13
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Port-Site Metastases in Incidentally Detected Carcinoma Gall Bladder: Role of 18F-FDG PET/CT and Patient Outcome. J Gastrointest Cancer 2022; 53:16-21. [DOI: 10.1007/s12029-021-00746-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 12/29/2022]
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14
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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
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15
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Koimtzis GD, Chalklin CG, Carrington-Windo E, Ramsden M, Stefanopoulos L, Kosmidis CS. The Role of Fine Needle Aspiration Cytology in the Diagnosis of Gallbladder Cancer: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11081427. [PMID: 34441361 PMCID: PMC8393940 DOI: 10.3390/diagnostics11081427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 01/27/2023] Open
Abstract
Gallbladder cancer is the most common malignancy of the biliary tract. When diagnosed in an advanced stage it has a very poor prognosis. Therefore, early diagnosis and thorough assessment of a suspicious gallbladder polyp is essential to improve survival rate. The aim of this systematic review is to assess the role of fine needle aspiration cytology (FNAC) in the management of gallbladder cancer. For that purpose, a systematic review was carried out in the MEDLINE, EMBASE, Cochrane, Scopus and Google Scholar databases between 1 July 2004 and 22 April 2021. Six studies with 283 patients in total were included. Pooled sensitivity and specificity of FNAC were 0.85 and 0.94, respectively, while the area under the calculated summary receiver operating characteristic (SROC curve (AUC) was 0.98. No complications were reported. Based on the high diagnostic performance of FNAC in the assessment of gallbladder masses, we suggest that every suspicious mass should be evaluated further with FNAC to facilitate the most appropriate management.
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Affiliation(s)
- Georgios D. Koimtzis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.)
- Correspondence: ; Tel.: +44-77-1646-6710
| | - Christopher G. Chalklin
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.)
| | - Eliot Carrington-Windo
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.)
| | - Mark Ramsden
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK; (C.G.C.); (E.C.-W.); (M.R.)
| | - Leandros Stefanopoulos
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Christoforos S. Kosmidis
- 3rd Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki (AUTH), 54621 Thessaloniki, Greece;
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16
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Gupta A, Gupta S, Siddeek RAT, Chennatt JJ, Singla T, Rajput D, Kumar N, Sehrawat A, Kishore S, Gupta M. Demographic and clinicopathological Profile of Gall Bladder Cancer Patients: Study from a tertiary care center of the Sub-Himalayan region in Indo-Gangetic Belt. J Carcinog 2021; 20:6. [PMID: 34321956 PMCID: PMC8312375 DOI: 10.4103/jcar.jcar_3_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 01/26/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Gall bladder cancer (GBC) accounts for 80%-95% of biliary tract malignancies in the world. There is however striking variability in the global incidence of gallbladder cancer, reaching epidemic levels for some regions and ethnicities. The aim of this study was to evaluate the demographic and clinicopathological profile of the gallbladder cancer patients. MATERIALS AND METHODS All patients of carcinoma gall bladder presenting to department of surgery in hepatopancreaticobiliary unit from July 2017 to November 2020 were included in this study. A proforma containing all the relevant details including history, examination, blood, radiology, and pathological investigations was filled. RESULTS A total of 326 patients of GBC were analyzed. The majority (75%) were found to be females with a mean age of 55 years. Pain abdomen was the most common presenting symptom in 81% of patients. The most common stage of presentation was stage IV and only 6 were in stage I. Two hundred and thirty three (71.4%) patients had metastatic disease at presentation. Liver infiltration at the time of diagnosis was present in 89% of patients. The most common site of metastasis was found in the liver (23.3%). GBC was more common in patients with A blood group. Baseline serum albumin levels were found to be significantly associated with the staging of GBC. CONCLUSIONS Due to the non specific symptoms patients of GBC present at very advanced stages, high index of suspicion and health education seems to play an important role in early detection and improvement of survival.
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Affiliation(s)
- Amit Gupta
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sweety Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rohik Anjum T. Siddeek
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jaine John Chennatt
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Tanuj Singla
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Deepak Rajput
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Navin Kumar
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amit Sehrawat
- Department of Medical Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sanjeev Kishore
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manoj Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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17
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Al Omran AA, Alkhalifa AM, Alqattan AS, Alshahrani AA. Gallbladder cancer of two histological origins: A case report and review of literature. Int J Surg Case Rep 2021; 81:105704. [PMID: 33820731 PMCID: PMC8073199 DOI: 10.1016/j.ijscr.2021.105704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 02/08/2023] Open
Abstract
Gallbladder carcinosarcoma is a rare cancer with a worldwide prevalence of less than 1%. The pathogenesis of these tumors is not yet fully understood, due to the low incidence of these tumors. Only 30% are suspected pre-operatively. The prognosis of these tumors is poor even after complete resection with a survival rate range from 2.9 to 6 months. Introduction and importance Carcinosarcoma is an extremely rare subtype of gallbladder cancer with a worldwide prevalence of less than 1%. Carcinosarcomas are composed of a mixture of epithelial and mesenchymal components. Preoperative diagnosis of carcinosarcoma is challenging considering the non-specific clinical presentation and radiological findings. Case presentation A 63 years old female presented with right hypochondrium abdominal pain for 6 months. CA 19.9 level was high. Computed tomography of abdomen showed gallstones with enhancing wall thickening, along with enlarged portacaval lymph node. Endoscopic ultrasound-guided biopsy of porta hepatis lymph node was done which showed moderately differentiated adenocarcinoma. Hence, she underwent extended cholecystectomy with extended porta hepatis lymph node dissection. Final histopathological result showed carcinosarcoma (pT2a, pN1 M0). Unfortunately, she passed away 7 months post-operatively. Clinical discussion The majority of patients with carcinosarcomas are asymptomatic but can develop unspecific symptoms in advanced stages. The diagnosis is usually made incidentally on histopathological examination. Surgical resection is the mainstay treatment and longer survival can be achieved if combined with chemotherapy and radiation therapy. BILCAP trial suggested that capecitabine can improve survival in patients with gallbladder cancer. Unfortunately, even with these treatment modalities prognosis remains poor with a survival rate ranging from 2.9 to 6 months. Conclusion Gallbladder carcinosarcoma is a rare tumor with a poor prognosis. However, some cases reported a good survival rate after surgery. Further research is needed to understand the behavior of these tumors well and identify the role of chemotherapy and radiotherapy and which patients would benefit the most from surgery.
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Affiliation(s)
- Aqdas A Al Omran
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah M Alkhalifa
- Department of General Surgery, King Fahad Hospital of the University, Khobar, Saudi Arabia
| | - Abdullah Saleh Alqattan
- Department of General Surgery, Hepatobiliary Surgery Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Abdulwahab A Alshahrani
- Department of General Surgery, Hepatobiliary Surgery Section, King Fahad Specialist Hospital, Dammam, Saudi Arabia; College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
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18
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Wietsma MFT, Molloy C, Bhimani N, de Savornin Lohman EAJ, Gill AJ, Andrici J, Samra J, de Reuver PR, Hugh TJ. Gallbladder carcinoma outcomes in an Australian tertiary referral hospital. ANZ J Surg 2021; 91:603-608. [PMID: 33604992 DOI: 10.1111/ans.16663] [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: 01/05/2021] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aimed to examine the presentation, treatment, and long-term outcomes of patients with gallbladder carcinoma (GBC) managed in a surgical unit of an Australian tertiary referral hospital of a 19-year period. METHODS A retrospective review of prospectively collected data of patients with GBC managed in the Royal North Shore Upper GI Surgical department from October 1999 to March 2018. RESULTS A total of 104 patients with GBC were identified: 36 patients underwent palliative treatment, 61 patients with gallbladder adenocarcinoma underwent resection with curative intent. Seven patients were excluded. 'Simple cholecystectomy' was undertaken in eight patients, 'standard radical cholecystectomy' in 37 and 'extended radical resection' in 16. The median survival in these patients was 35 months (95% confidence interval (CI) 21.29-55.10), with a median follow up of 60 months (95% CI 38.18-78.39). This compares with an overall median survival of only 4.00 months (95% CI 2.79-6.24) in patients who did not undergo a potentially curative resection. Independent predictors of poor long-term survival included an elevated preoperative serum tumour marker, advanced tumour stage (T3/T4) or node positive disease (N1/N2). CONCLUSION The biology and stage of GBC at presentation are major factors in determining patient outcome. There is a need for better pre- and post-operative predictors to improve risk stratification, and these are likely to be in the form of molecular markers. Although the focus of surgery should be to ensure an R0 resection, patients with advanced stage disease need to be carefully selected for surgical intervention, and ideally should be managed by a multidisciplinary team in a specialist centre.
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Affiliation(s)
| | - Charles Molloy
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nazim Bhimani
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Juliana Andrici
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jaswinder Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Thomas J Hugh
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
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19
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Alabi A, Arvind AD, Pawa N, Karim S, Smith J. Incidental Gallbladder Cancer: Routine versus Selective Histological Examination After Cholecystectomy. Surg J (N Y) 2021; 7:e22-e25. [PMID: 33542953 PMCID: PMC7850885 DOI: 10.1055/s-0040-1722175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/16/2020] [Indexed: 01/05/2023] Open
Abstract
Background
Incidental gallbladder cancer is relatively rare, with an incidence ranging between 0.19 and 5.5% of all the cholecystectomies for benign disease, and carries a poor prognosis. Currently, in the literature, there appears to be some controversy about whether all gallbladder specimens should be sent for routine histopathology. The aim of this study was to investigate the need for either routine or selective histopathological evaluation of all gallbladder specimens following cholecystectomy in our institution.
Methods
The records of all patients who underwent a cholecystectomy (laparoscopic and open) for gallstone disease over a 5-year period (between January 2011 and January 2016) were reviewed retrospectively in a single university teaching hospital. Patients with radiological evidence of gallbladder cancer preoperatively were excluded. The notes of patients with incidental gallbladder cancer were reviewed and data were collected for clinical presentation and preoperative investigations including blood tests and radiological imaging.
Results
A total of 1,473 specimens were sent for histopathological evaluation, with two patients being diagnosed with an incidental gallbladder cancer (papillary adenocarcinoma in situ and moderately differentiated invasive adenocarcinoma [stage IIIa]). The incidence rate was 0.14%. All patients with incidental gallbladder cancer had macroscopically abnormal specimens.
Conclusion
Both patients in our study who were diagnosed with incidental gallbladder cancer had macroscopic abnormalities. A selective rather than routine approach to histological evaluation of gallbladder specimens especially in those with macroscopic abnormalities should be employed. This will reduce the burden on the pathology department with potential cost savings.
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Affiliation(s)
- Andrew Alabi
- Department of Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
| | - A D Arvind
- School of Medicine, Imperial College London, United Kingdom
| | - Nikhil Pawa
- Department of Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
| | - Shakir Karim
- Department of Histopathology, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
| | - Jason Smith
- Department of Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
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20
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Pitchumoni CS, Ravindran N. Biliary Neoplasms. GERIATRIC GASTROENTEROLOGY 2021:1437-1448. [DOI: 10.1007/978-3-030-30192-7_105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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21
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Hasan A, Nafie K, Aldossary MY, Ismail A, Monazea K, Baheeg M, Rady K, Elhawary R, Ibrahim AA. Unexpected histopathology results following routine examination of cholecystectomy specimens: How big and how significant? Ann Med Surg (Lond) 2020; 60:425-430. [PMID: 33251000 PMCID: PMC7677112 DOI: 10.1016/j.amsu.2020.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Routine histopathological examination (RHPE) of all gallbladder specimens is required to detect the presence of gallbladder carcinoma (GBC) or any other pathology. The work aims to study the incidence and the clinical significance of detecting unusual gallbladder findings upon the RHPE of the referred cholecystectomy specimens to a histopathology laboratory section at a referral hospital in Saudi Arabia during one year period. MATERIALS AND METHODS From May 2019 to May 2020, all histopathology reports of 444 consecutive gallbladder specimens after elective and emergency cholecystectomies were retrospectively analyzed and divided into two groups; usual findings and unusual findings which were reviewed blindly by two other pathology consultants. Frequencies, descriptive statistics, normality test, and correlations were run. The Interrater reliability between clinical and histopathological diagnosis was assessed statistically by kappa test. RESULTS The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 296 out of 444 total cases (66.7%), acute cholecystitis in 52 cases (11.7%), and other associated usual findings in 85 cases (19%). Three cases (0.7%) of incidental carcinomas and other three cases (0.7%) of dysplasia. Eosinophilic carcinomas were detected in two cases (0.45%), gallbladder complete septum was found in one case, and one case of Phrygian cap anomaly. All patients with gallbladder carcinoma were diagnosed incidentally during the histopathological examination. CONCLUSIONS RHPE of cholecystectomy materials are required to confirm the final diagnosis and document any other pathology. Failure to detect incidental occult carcinoma may be catastrophic, given the poor prognosis.
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Affiliation(s)
- Abdulkarim Hasan
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Laboratory & blood bank Department, Prince Mishari bin Saud Hospital, Baljurashi, Saudi Arabia
| | - Khalid Nafie
- Laboratory & blood bank Department, Prince Mishari bin Saud Hospital, Baljurashi, Saudi Arabia
| | | | - Amal Ismail
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Khaled Monazea
- Department of Surgery, Faculty of Medicine, Al-Azhar University, Assiut branch, Egypt
| | - Mohamad Baheeg
- Department of Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Kamal Rady
- Department of Anatomy and Embryology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Reda Elhawary
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Adel A. Ibrahim
- Department of Surgical Oncology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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22
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Nagarajan G, Kundalia K. Should every cholecystectomy specimen be sent for histopathology to identify incidental gall bladder cancer? Indian J Cancer 2020; 57:2-3. [PMID: 32129293 DOI: 10.4103/ijc.ijc_1027_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ganesh Nagarajan
- Consultant HPB and GI Surgical Oncologist, P D Hinduja Hospital, Mumbai, Maharashtra, India
| | - Kaushal Kundalia
- Fellow in HPB and Liver Transplant Surgery, Kings College London, London, United Kingdom
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23
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Alqahtani SA, Alghamdi IG. Epidemiology of Gallbladder Cancer in Saudi Arabia. Cancer Manag Res 2020; 12:9527-9537. [PMID: 33061639 PMCID: PMC7538003 DOI: 10.2147/cmar.s268226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/08/2020] [Indexed: 12/24/2022] Open
Abstract
Background Gallbladder cancer is generally rare but can be more common in some populations. The aim of this study was to present an analysis of gallbladder cancer epidemiology in Saudi Arabia. Materials and Methods A retrospective study of gallbladder cancer cases in Saudi Arabia from 2004 to 2015 was conducted. The gallbladder cancer data were accessed through the Saudi Cancer Registry (SCR) reports for 13 administrative regions. The number of gallbladder cancer cases with percentage, the crude incidence rate (CIR) and the age-standardised incidence rate (ASIR), stratified by regions, gender, and the years of diagnoses were analysed. Results A total of 1678 gallbladder cancer cases, 702 in males and 976 in females, were registered between 2004 and 2015. Saudi women and men in the 75 and above age-group were found to have the highest diagnosis rate of gallbladder cancer. In males, the overall ASIR among Saudi males was 1.1 per 100,000 (95% CI, 0.9 to 1.2). The Eastern region had the highest overall ASIR at 1.5 per 100,000 males, followed by Tabuk and Riyadh at 1.4 and 1.3 higher than other regions (F(12,143)=1.930, P<0.001). The overall ASIR among Saudi females was 1.6 per 100,000 (95% CI, 1.4 to 1.7). Riyadh had the highest overall ASIR at 2.4 per 100,000 females, followed by the Eastern region, and Qassim at 1.9 and 1.5, respectively, all higher than other provinces of the country (F(12,143)=2.496, P<0.005). The ASIR and CIR were lower among males than females (ratio 0.7). Conclusion Gallbladder cancer incidence is relatively low in Saudi Arabia. The rates were higher in females than males. ASIR showed variations between different provinces of Saudi Arabia. In females, the highest ASIR was in Riyadh. In males, ASIR was highest in the Eastern region of Saudi Arabia.
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Affiliation(s)
- Saleh A Alqahtani
- Liver Transplantation Unit, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.,Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
| | - Ibrahim G Alghamdi
- Public Health Department, College of Applied Medical Sciences, University of Al-Baha, Al-Baha, Saudi Arabia
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24
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Wu X, Li B, Zheng C, Liu W, Hong T, He X. Incidental gallbladder cancer after laparoscopic cholecystectomy: incidence, management, and prognosis. Asia Pac J Clin Oncol 2020; 16:158-164. [PMID: 32030891 PMCID: PMC7317500 DOI: 10.1111/ajco.13308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/04/2020] [Indexed: 12/29/2022]
Abstract
AIMS Although incidental gallbladder cancer (IGBC) diagnosed after laparoscopic cholecystectomy (LC) is not rare, its incidence, management, and prognosis are still unclear and controversial. The present study aimed to increase the understanding of IGBC after LC in the medical community. METHODS Patients with IGBC treated at our institution between January 2001 and December 2018 were enrolled. Data collected included demographic characteristics, treatment pattern, pathological information, and prognoses. We compared the characteristics of patients with different prognoses and calculated the cumulative overall survival rate and mean survival period for IGBC. RESULTS The cohort comprised 26 patients with a mean age of 66.4 ± 12.5 years. All patients were diagnosed with IGBC via postoperative pathology. Three patients underwent radical reoperation. As of June 2019, 26 patients were followed for a mean of 31.6 ± 29.6 months. Fourteen patients died during the follow-up period, and 12 survived without recurrence. The mean survival duration was 50.5 months. The 1-, 3-, and 5-year cumulative overall survival rates of the entire cohort were 79.8, 49.0, and 40.8%, respectively. IGBC patients with T1a stage had significantly longer survival than those with T1b or more advanced stages (96.1 vs 32.6 months, P = .006). CONCLUSIONS IGBC after LC is diagnosed in 0.2% of patients, accounting for 5.4% of all gallbladder cancer cases. IGBC patients with T1a stage had significantly longer survival than those with T1b or more advanced stages. Simple cholecystectomy is probably acceptable only in T1a lesions.
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Affiliation(s)
- Xin Wu
- Department of General SurgeryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Binglu Li
- Department of General SurgeryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Chaoji Zheng
- Department of General SurgeryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wei Liu
- Department of General SurgeryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Tao Hong
- Department of General SurgeryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xiaodong He
- Department of General SurgeryPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Effect of lymphadenectomy in curative gallbladder cancer treatment: a systematic review and meta-analysis. Langenbecks Arch Surg 2020; 405:573-584. [PMID: 32458141 DOI: 10.1007/s00423-020-01878-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Only a small fraction of resectable gallbladder cancer (GBC) patients receive a thorough lymphadenectomy. The aim of this systematic review and meta-analysis was to investigate the effect of lymphadenectomy on survival in GBC surgery. METHODS On May 19, 2019, MEDLINE, EMBASE, and the Cochrane Library were searched for English or German articles published since 2002. Studies assessing the effect of lymphadenectomy on survival in GBC surgery were included. Fixed effect and random effects models were used to summarise the hazard ratio (HR). RESULTS Of the 530 identified articles, 18 observational studies (27,570 patients, 10 population-based, 8 cohort studies) were reviewed. In the meta-analysis, lymphadenectomy did not show a significant benefit for T1a tumours (n = 495; HR, 1.37; 95%CI, 0.65-2.86; P = 0.41). Lymphadenectomy showed a significant survival benefit in T1b (n = 1618; HR, 0.69; 95%CI, 0.50-0.94; P = 0.02) and T2 (n = 6204; HR, 0.68; 95%CI, 0.56-0.83; P < 0.01) tumours. Lymphadenectomy improved survival in the 2 studies assessing T3 tumours (n = 1961). A conclusive analysis was not possible for T4 tumours due to a low case load. Among patients undergoing lymphadenectomy, improved survival was observed in patients with a higher number of resected lymph nodes (HR, 0.57; 95%CI, 0.45-0.71; P < 0.01). CONCLUSIONS Regional lymphadenectomy improves survival in T1b to T3 GBC. A minimum of 6 retrieved lymph nodes are necessary for adequate staging, indicating a thorough lymphadenectomy. Patients with T1a tumours should be evaluated for lymphadenectomy, especially if lymph node metastases are suspected.
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Liu C, Rein L, Clarke C, Mogal H, Tsai S, Christians KK, Gamblin TC. Comparison of overall survival in gallbladder carcinoma at academic versus community cancer centers: An analysis of the National Cancer Data Base. J Surg Oncol 2020; 122:176-182. [PMID: 32383268 DOI: 10.1002/jso.25907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 02/29/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Gallbladder carcinoma (GBC) has a poor prognosis. Studies demonstrated that teaching facilities may provide a lower risk of mortality in patients undergoing pancreatic and colon resection vs nonteaching facilities. We hypothesized that survival rates are higher in academic cancer centers (ACCs) vs community cancer centers (CCCs). METHODS Patients with all stages of GBC were identified from the National Cancer Database (2007-2012). Propensity score matching adjusted for selection bias. Descriptive statistics were calculated for all variables. Overall survival (OS) was compared by facility type (ACC vs CCC) and case volume (low vs high) via multivariable Cox proportional hazards regression. RESULTS A total of 7967 patients met the inclusion criteria. Following propensity matching, 2801 patients were analyzed from each facility type. Median OS following surgery was higher for ACC (20.99 months, 95% confidence interval [CI], 19.61-22.64, P = .002) than CCC (17.68 months, 95% CI, 16.46-19.25). Following Cox modeling, GBC treatment at ACCs was a protective factor for OS (adjusted hazard ratio 0.876, 95% CI, 0.801-0.958, P = .004). DISCUSSION GBC treatment at ACCs is an independent predictor of OS. High volume ACCs are associated with improved OS compared with low volume ACCs. The site of care and case volume in ACCs may contribute to improved survival outcomes.
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Affiliation(s)
- Chrissy Liu
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Lisa Rein
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Callisia Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Harveshp Mogal
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susan Tsai
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathleen K Christians
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - T C Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Wencong M, Jinghan W, Yong Y, Jianyang A, Bin L, Qingbao C, Chen L, Xiaoqing J. FOXK1 Promotes Proliferation and Metastasis of Gallbladder Cancer by Activating AKT/mTOR Signaling Pathway. Front Oncol 2020; 10:545. [PMID: 32363163 PMCID: PMC7180204 DOI: 10.3389/fonc.2020.00545] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/26/2020] [Indexed: 01/10/2023] Open
Abstract
Gallbladder cancer (GBC) is one of the most lethal malignancies worldwide, with extremely poor prognosis. Recently, forkhead box k1 (FOXK1), a member of the FOX transcription factor family, has been reported to be correlated with tumor progression in multiple malignancies. However, the role of FOXK1 in GBC has not been elucidated. In this study, we demonstrated that the expression level of FOXK1 was elevated in human GBC tissues and associated with increased liver metastasis, poor histological differentiation, advanced TNM stage, and shorter overall survival. Knockdown of FOXK1 expression inhibited GBC cells proliferation and metastasis. Consistently, overexpression of FOXK1 promoted GBC cells progression. Mechanical investigations verified that knockdown of FOXK1 could lead to G1/S cell cycle arrest through downregulating CDK4, CDK6, cyclin D1, and cyclin E1. And FOXK1 could regulate the expression of epithelial–mesenchymal transition (EMT) related proteins E-cad, N-cad, and Vimentin. Moreover, we found that FOXK1 could regulate the activation of Akt/mTOR signaling pathway. In addition, AKT special inhibitor MK-2206 could abolish the proliferation and metastasis discrepancy between FOXK1 overexpression GBC cells and control cells, which suggested the tumorpromoting effect of FOXK1 may be partially related with the activations of Akt/mTOR signaling pathway. Collectively, our results suggested that FOXK1 promotes GBC cells progression and represent a novel prognostic biomarker and potential therapeutic target in GBC.
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Affiliation(s)
- Ma Wencong
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Wang Jinghan
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Yu Yong
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Ao Jianyang
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Li Bin
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Cheng Qingbao
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Liu Chen
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Jiang Xiaoqing
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
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Feng X, Cao JS, Chen MY, Zhang B, Juengpanich S, Hu JH, Topatana W, Li SJ, Shen JL, Xiao GY, Cai XJ, Yu H. Laparoscopic surgery for early gallbladder carcinoma: A systematic review and meta-analysis. World J Clin Cases 2020; 8:1074-1086. [PMID: 32258078 PMCID: PMC7103978 DOI: 10.12998/wjcc.v8.i6.1074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/14/2020] [Accepted: 02/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is a controversy as to whether laparoscopic surgery leads to a poor prognosis compared to the open approach for early gallbladder carcinoma (GBC). We hypothesized that the laparoscopic approach is an alternative for early GBC.
AIM To identify and evaluate the safety and feasibility of laparoscopic surgery in the treatment of early GBC.
METHODS A comprehensive search of online databases, including MEDLINE (PubMed), Cochrane libraries, and Web of Science, was performed to identify non-comparative studies reporting the outcomes of laparoscopic surgery and comparative studies involving laparoscopic surgery and open surgery in early GBC from January 2009 to October 2019. A fixed-effects meta-analysis was performed for 1- and 5-year overall survival and postoperative complications, while 3-year overall survival, operation time, blood loss, the number of lymph node dissected, and postoperative hospital stay were analyzed by random-effects models.
RESULTS The review identified 7 comparative studies and 8 non-comparative studies. 1068 patients (laparoscopic surgery: 613; open surgery: 455) were included in the meta-analysis of 1-, 3-, and 5-year overall survival with no significant differences observed [(HR = 0.54; 95%CI: 0.29-1.00; I2 = 0.0%; P = 0.051), (HR = 0.75; 95%CI: 0.34-1.65; I2 = 60.7%; P = 0.474), (HR = 0.71; 95%CI: 0.47-1.08; I2 = 49.6%; P = 0.107), respectively]. There were no significant differences in operation time [weighted mean difference (WMD) = 18.69; 95%CI: −19.98-57.36; I2 = 81.4%; P = 0.343], intraoperative blood loss (WMD = −169.14; 95%CI: −377.86-39.57; I2 = 89.5%; P = 0.112), the number of lymph nodes resected (WMD = 0.12; 95%CI: −2.95-3.18; I2 = 73.4%; P = 0.940), and the complication rate (OR = 0.69; 95%CI: 0.30-1.58; I2 = 0.0%; P = 0.377 ) between the two groups, while patients who underwent laparoscopic surgery had a reduced length of hospital stay (WMD = −5.09; 95%CI: −8.74- −1.45; I2 = 91.0%; P= 0.006).
CONCLUSION This systematic review and meta-analysis confirms that laparoscopic surgery is a safe and feasible alternative to open surgery with comparable survival and operation-related outcomes for early GBC.
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Affiliation(s)
- Xu Feng
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jia-Sheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ming-Yu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Bin Zhang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Sarun Juengpanich
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jia-Hao Hu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Win Topatana
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Shi-Jie Li
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ji-Liang Shen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Guang-Yuan Xiao
- Department of General Surgery, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing 314000, Zhejiang Province, China
| | - Xiu-Jun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Hong Yu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Gomes AF, Fernandes S, Martins J, Coutinho J. Carcinoma of the gallbladder presenting as haemorrhagic cholecystitis. BMJ Case Rep 2020; 13:e232953. [PMID: 32169978 PMCID: PMC7069262 DOI: 10.1136/bcr-2019-232953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2020] [Indexed: 12/29/2022] Open
Abstract
Gallbladder carcinoma has several atypical presentations, but one of the rarest is intraluminal haemorrhage, which occurs in 1% of patients. We report a case of gallbladder cancer diagnosed by an emergency cholecystectomy, performed for acute cholecystitis caused by a hemocholecyst.
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Affiliation(s)
- Ana Freire Gomes
- Department of Surgery, Hospital de Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisboa, Portugal
| | - Sara Fernandes
- Department of Surgery, Hospital de Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisboa, Portugal
| | - Joaquim Martins
- Department of Surgery, Hospital de Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisboa, Portugal
| | - João Coutinho
- Department of Surgery, Hospital de Santa Maria (Centro Hospitalar Universitário Lisboa Norte), Lisboa, Portugal
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Prognostic Impact of Lymph Node Excision in T1 and T2 Gallbladder Cancer: a Population-Based and Propensity Score-Matched SEER Analysis. J Gastrointest Surg 2020; 24:633-642. [PMID: 30887297 DOI: 10.1007/s11605-019-04175-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/20/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study was to assess the effect of lymphadenectomy on survival in T1/T2 gallbladder cancer (GBC). METHODS In this retrospective cohort study, patients undergoing surgery for T1/T2 GBC from 2004 to 2014 were identified in the Surveillance, Epidemiology, and End Results database. The effect of lymph node excision (LNE) on survival was assessed using Cox regression and propensity score methods. RESULTS A total of 2112 patients were identified: 11.4% had T1a, 18.5% T1b, and 70.1% had T2 tumors. Mean follow-up was 31.3 months. In 48.8% of patients, LNE was performed with a mean of 3.6 ± 4.3 nodes retrieved. Cancer-specific 5-year survival for T1 and T2 stages combined was 49.6% (95% confidence interval (CI), 45.9-53.6%) without LNE compared to 56.2% (95% CI, 52.4-60.4%) if LNE was performed (hazard ratio (HR), 0.75; 95%CI, 0.64-0.86, P < 0.001). Propensity score analyses for both stages combined confirmed this survival benefit with an HR of 0.67 (95% CI, 0.55-0.80) for the LNE group (P < 0.001). Stratified for tumor stages, LNE had no significant effect on cancer-specific survival in T1a (HR, 1.80 (95% CI, 0.76-4.26), P = 0.185) or T1b tumors (HR, 0.95 (95% CI, 0.57-1.58), P = 0.844), whereas it persistently revealed an advantage for patients with T2 tumors (HR 0.68 (95% CI, 0.55-0.83, P < 0.001). No correlation between the number of retrieved lymph nodes and the N+ rate was found (P = 0.134). CONCLUSIONS LNE is associated with improved survival in T2 GBC. No significant survival benefit was observed in T1a and T1b tumors. The retrieval of even a few lymph nodes reliably predicts the nodal status, which might assist in patient selection for re-resection in T1 GBC.
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31
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Ramos E, Lluis N, Llado L, Torras J, Busquets J, Rafecas A, Serrano T, Mils K, Leiva D, Fabregat J. Prognostic value and risk stratification of residual disease in patients with incidental gallbladder cancer. World J Surg Oncol 2020; 18:18. [PMID: 31980034 PMCID: PMC6982379 DOI: 10.1186/s12957-020-1794-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022] Open
Abstract
Background and aim Given their poor prognosis, patients with residual disease (RD) in the re-resection specimen of an incidental gallbladder carcinoma (IGBC) could benefit from a better selection for surgical treatment. The Gallbladder Cancer Risk Score (GBRS) has been proposed to preoperatively identify RD risk more precisely than T-stage alone. The aim of this study was to assess the prognostic value of RD and to validate the GBRS in a retrospective series of patients. Material and methods A prospectively collected database including 59 patients with IGBC diagnosed from December 1996 to November 2015 was retrospectively analyzed. Three locations of RD were established: local, regional, and distant. The effect of RD on overall survival (OS) was analyzed with the Kaplan-Meier method. To identify variables associated with the presence of RD, characteristics of patients with and without RD were compared using Fisher’s exact test. The relative risk of RD associated with clinical and pathologic factors was studied with a univariate logistic regression analysis. Results RD was found in 30 patients (50.8%). The presence of RD in any location was associated with worse OS (29% vs. 74.2%, p = 0.0001), even after an R0 resection (37.7% vs 74.2%, p = 0.003). There was no significant difference in survival between patients without RD and with local RD (74.2% vs 64.3%, p = 0.266), nor between patients with regional RD and distant RD (16.1% vs 20%, p = 0.411). After selecting patients in which R0 resection was achieved (n = 44), 5-year survival rate for patients without RD, local RD, and regional RD was, respectively, 74.2%, 75%, and 13.9% (p = 0.0001). The GBRS could be calculated in 25 cases (42.3%), and its usefulness to predict the presence of regional or distant RD (RDRD) was confirmed (80% in high-risk patients and 30% in intermediate risk p = 0.041). Conclusion RDRD, but not local RD, represents a negative prognostic factor of OS. The GBRS was useful to preoperatively identify patients with high risk of RDRD. An R0 resection did not improve OS of patients with regional RD.
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Affiliation(s)
- Emilio Ramos
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Nuria Lluis
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Llado
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jaume Torras
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juli Busquets
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Rafecas
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Serrano
- Department of Pathology, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Kristel Mils
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - David Leiva
- Department of Radiology, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Fabregat
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
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Yuza K, Sakata J, Prasoon P, Hirose Y, Ohashi T, Toge K, Miura K, Nagahashi M, Kobayashi T, Wakai T. Long-term outcomes of surgical resection for T1b gallbladder cancer: an institutional evaluation. BMC Cancer 2020; 20:20. [PMID: 31907021 PMCID: PMC6945689 DOI: 10.1186/s12885-019-6507-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 12/30/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is no comprehensive agreement concerning the overall performance of radical resection for T1b gallbladder cancer (GBC). This research focused on addressing whether T1b GBC may spread loco-regionally and whether radical resection is necessary. METHODS A retrospective analysis was conducted of 1032 patients with GBC who underwent surgical resection at our centre and its affiliated institutions between January 1982 and December 2018. A total of 47 patients with T1b GBC, 29 (62%) of whom underwent simple cholecystectomy and 18 (38%) of whom underwent radical resection with regional lymph node dissection, were enrolled in the study. RESULTS GBC was diagnosed pre-operatively in 16 patients (34%), whereas 31 patients (66%) had incidental GBC. There was no blood venous or perineural invasion in any patient on histology evaluation, except for lymphatic vessel invasion in a single patient. There were no metastases in any analysed lymph nodes. The open surgical approach was more prevalent among the 18 patients who underwent radical resection (open in all 18 patients) than among the 29 patients who underwent simple cholecystectomy (open in 21; laparoscopic in 8) (P = 0.017). The cumulative 10- and 20-year overall survival rates were 65 and 25%, respectively. The outcome following simple cholecystectomy (10-year overall survival rate of 66%) was akin to that following radical resection (64%, P = 0.618). The cumulative 10- and 20-year disease-specific survival rates were 93 and 93%, respectively. The outcome following simple cholecystectomy (10-year disease-specific survival rate of 100%) was equivalent to that following radical resection (that of 86%, P = 0.151). While age (> 70 years, hazard ratio 5.285, P = 0.003) and gender (female, hazard ratio 0.272, P = 0.007) had a strong effect on patient overall survival, surgical procedure (simple cholecystectomy vs. radical resection) and surgical approach (open vs. laparoscopic) did not. CONCLUSIONS Most T1b GBCs represent local disease. As pre-operative diagnosis, including tumour penetration of T1b GBC, is difficult, the decision of radical resection is justified. Additional radical resection is not required following simple cholecystectomy provided that the penetration depth is restricted towards the muscular layer and that surgical margins are uninvolved.
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Affiliation(s)
- Kizuki Yuza
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Jun Sakata
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Pankaj Prasoon
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Yuki Hirose
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Taku Ohashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Koji Toge
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Kohei Miura
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Masayuki Nagahashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Takashi Kobayashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan.
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Kanlioz M, Ekici U, Ayva Y. Analysis of Incidental Gallbladder Cancer in Cholecystectomies. Cureus 2019; 11:e5710. [PMID: 31720178 PMCID: PMC6823073 DOI: 10.7759/cureus.5710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 09/14/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To study incidental gallbladder cancer (IGBC) incidence in patients who underwent cholecystectomy. METHODS The records of patients who underwent cholecystectomy between 2004-2019 were retrospectively reviewed. The demographic information, preoperative radiological findings of the patients diagnosed with gallbladder cancer (GBC), as a result of routine histopathological examination and operation records, were reviewed and findings were recorded. The preoperative radiological records of the patients with GBC and, if any, findings of GBC suspected during surgery were recorded. RESULTS Between 2004-2019, a total of 6314 patients underwent cholecystectomy. Of the patients, 5404 (85.59%) were female and 910 (14.41%) were male. The median age was 47 years (min:19, max:94) and the mean age was 47.28±14.60 years. Nine out of 6314 patients (0.14%) were diagnosed with GBC by postoperative histopathological examination. All patients with GBC were female and their mean age was 64.33±11.08 years. Two out of nine GBC cases were prediagnosed with GBC in preoperative radiological findings; the remaining seven (0.11%) had IGBC without any preoperative findings. CONCLUSION Asian populations are reported to have a higher incidence of GBC. Turkey is located in the transition zone between Asia and Europe. However, the GBC rates in our study remain far below the rates reported in Asian publications. We believe that our results may be affected by the predominantly Mediterranean-type diet and the relatively higher socioeconomic level of the region where we conducted our study. Consequently, we recommend routine histopathological examination after cholecystectomies in regions with a high incidence of GBC.
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Affiliation(s)
- Murat Kanlioz
- General Surgery, Beylikdüzü Kolan Hospital, Istanbul, TUR
| | - Ugur Ekici
- General Surgery, İstanbul Gelisim University, Istanbul, TUR
| | - Yaşar Ayva
- Pathology, Sincan State Hospital, Ankara, TUR
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Wang JK, Ma WJ, Wu ZR, Yang Q, Hu HJ, Liu F, Li FY. Is combined extra-hepatic bile-duct resection justified for advanced gallbladder carcinoma? Gastroenterol Rep (Oxf) 2019; 7:426-433. [PMID: 31857904 PMCID: PMC6911994 DOI: 10.1093/gastro/goz018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/26/2019] [Accepted: 04/08/2019] [Indexed: 02/05/2023] Open
Abstract
Background Whether the extra-hepatic bile duct (EHBD) should be routinely resected for gallbladder carcinoma (GBC) remains controversial. The current study aimed to determine the clinical impact of combined EHBD resection during curative surgery for advanced GBC. Methods In total, 213 patients who underwent curative surgery for T2, T3 or T4 GBC were enrolled. The clinicopathological features were compared between the patients treated with EHBD resection and those without EHBD resection. Meanwhile, univariable and multivariable Cox-proportional hazards regression models were used to identify risk factors for overall survival (OS). Results Among the 213 patients identified, 87 (40.8%) underwent combined EHBD resection. Compared with patients without EHBD resection, patients with EHBD resection suffered more post-operative complications (33.3% vs. 21.4%, P = 0.046). However, the median OS of the EHBD resection group was longer than that of the non-EHBD resection group (25 vs. 11 months, P = 0.008). Subgroup analyses were also performed according to tumor (T) category and lymph-node metastasis. The median OS was significantly longer in the EHBD resection group than in the non-EHBD resection group for patients with T3 lesion (15 vs. 7 months, P = 0.002), T4 lesion (11 vs. 6 months, P = 0.021) or lymph-node metastasis (12 vs. 7 months, P < 0.001). No survival benefit of EHBD resection was observed in GBC patients with T2 lesion or without lymph-node metastasis. T category, lymph-node metastasis, margin status, pre-operative CA19-9 level and EHBD resection were identified as independent prognostic factors for OS of patients with advanced GBC (all P values <0.05). Conclusions EHBD resection can independently affect the OS in advanced GBC. For GBC patients with T3 lesion, T4 lesion and lymph-node metastasis, combined EHBD resection is justified and may improve OS.
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Affiliation(s)
- Jun-Ke Wang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Zhen-Ru Wu
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Qin Yang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
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Kim HS, Park JW, Kim H, Han Y, Kwon W, Kim SW, Hwang YJ, Kim SG, Kwon HJ, Vinuela E, Járufe N, Roa JC, Han IW, Heo JS, Choi SH, Choi DW, Ahn KS, Kang KJ, Lee W, Jeong CY, Hong SC, Troncoso A, Losada H, Han SS, Park SJ, Yanagimoto H, Endo I, Kubota K, Wakai T, Ajiki T, Adsay NV, Jang JY. Optimal surgical treatment in patients with T1b gallbladder cancer: An international multicenter study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 25:533-543. [PMID: 30562839 DOI: 10.1002/jhbp.593] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is no consensus on the optimal treatment of T1b gallbladder cancer (GBC) due to the lack of evidence and the difficulty of anatomy and pathological standardization. METHODS A total of 272 patients with T1b GBC who underwent surgical resection at 14 centers with specialized hepatobiliary-pancreatic surgeons and pathologists in Korea, Japan, Chile, and the United States were studied. Clinical outcomes including disease-specific survival (DSS) rates according to the types of surgery were analyzed. RESULTS After excluding patients, the 237 qualifying patients consisted of 90 men and 147 women. Simple cholecystectomy (SC) was performed in 116 patients (48.9%) and extended cholecystectomy (EC) in 121 patients (51.1%). The overall 5-year DSS was 94.6%, and it was similar between SC and EC patients (93.7% vs. 95.5%, P = 0.496). The 5-year DSS was similar between SC and EC patients in America (82.3% vs. 100.0%, P = 0.249) as well as in Asia (98.6% vs. 95.2%, P = 0.690). The 5-year DSS also did not differ according to lymph node metastasis (P = 0.688) or tumor location (P = 0.474). CONCLUSIONS SC showed similar clinical outcomes (including recurrence) and survival outcomes as EC; therefore, EC is not needed for the treatment of T1b GBC.
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Affiliation(s)
- Hyeong Seok Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Woo Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.,Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea
| | - Hongbeom Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Yoon Jin Hwang
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Sang Geol Kim
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyung Jun Kwon
- School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Eduardo Vinuela
- Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Nicolas Járufe
- Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Juan Carlos Roa
- Department of Pathology, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - In Woong Han
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Jin Seok Heo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Seong-Ho Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Dong Wook Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea
| | - Keun Soo Ahn
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Koo Jeong Kang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Woohyung Lee
- Department of Surgery, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Andres Troncoso
- Surgery Department, Universidad de la Frontera, Temuco, Chile
| | - Hector Losada
- Surgery Department, Universidad de la Frontera, Temuco, Chile
| | - Sung-Sik Han
- Department of Surgery, Center for Liver Cancer, National Cancer Center, Goyang, South Korea
| | - Sang-Jae Park
- Department of Surgery, Center for Liver Cancer, National Cancer Center, Goyang, South Korea
| | | | - Itaru Endo
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Keiichi Kubota
- Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tetsuo Ajiki
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nazmi Volkan Adsay
- Department of Pathology, Koc University, Istanbul, Turkey.,Department of Pathology, Emory University School, Atlanta, GA, USA
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
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Abstract
INTRODUCTION Gallbladder polyps (GBPs) are generally harmless, but the planning of diagnosis and treatment of the GBP is of clinical importance due to the high mortality risk of delays in the diagnosis of gallbladder carcinomas that show polypoid development. MATERIALS AND METHODS GBPs are usually incidentally detected during ultrasonographic (USG) examinations of the abdomen. The risk of carcinoma development from polypoid lesions in the literature is reported as 0-27%. There is no consensus about the management of the GBPs. Herein, we reviewed the contemporary data to update our knowledge about diagnosis and treatment of gallbladder polyps. RESULTS Polyps can be identified in five different groups, primarily as neoplastic and non-neoplastic. Cholesterol polyps account for 60% of all cases. The most common (25%) benign polypoid lesions after cholesterol polyps are adenomyomas. CONCLUSION Ultrasonography and endoscopic ultrasonography seems to be the most important tool in differential diagnosis and treatment. Ultrasonography should be repeated in every 3-12 months in cases that are thought to be risky. Nowadays, the most common treatment approach is to perform cholecystectomy in patients with polyps larger than 10 mm in diameter. Radical cholecystectomy and/or segmental liver resections should be planned in cases of malignancy. HOW TO CITE THIS ARTICLE Dilek ON, Karsu S, et al. Diagnosis and Treatment of Gallbladder Polyps: Current Perspectives. Euroasian J Hepatogastroenterol 2019;9(1):40-48.
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Affiliation(s)
- Osman Nuri Dilek
- Department of Surgery, Izmir Katip Çelebi University School of Medicine, Izmir, Turkey
| | - Sebnem Karasu
- Department of Radiology, Izmir Katip Çelebi University School of Medicine, Izmir, Turkey
| | - Fatma Hüsniye Dilek
- Department of Pathology, Izmir Katip Çelebi University School of Medicine, Izmir, Turkey
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Aldossary MY, Alayed AA, Amr SS, Alqahtani S, Alnahawi M, Alqahtani MS. Gallbladder cancer in Eastern Province of Saudi Arabia: A retrospective cohort study. Ann Med Surg (Lond) 2018; 35:117-123. [PMID: 30294442 PMCID: PMC6170934 DOI: 10.1016/j.amsu.2018.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/17/2018] [Accepted: 09/16/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is paucity in the literature regarding gallbladder cancer in Saudi Arabia, possibly because it is not among the top 10 cancers diagnosed nationwide according to the Saudi Cancer Registry. Moreover, national or regional data on gallbladder cancer in Saudi Arabia have not been analyzed. The purpose of this study was to describe the presentation, disease stage, histology, and survival rates for gallbladder cancer in Saudi patients at a single institution between January 1, 2010 and December 31, 2017. MATERIALS AND METHODS This was a retrospective study of 76 patients who presented to our hospital between January 1, 2010 and December 31, 2017, with established diagnosis of gallbladder carcinoma. The diagnosis was made either histopathologically following simple laparoscopic cholecystectomy or biopsy from metastatic liver lesion in patients with gallbladder mass, or the high suspicion of gallbladder carcinoma based on incidental radiological findings. Presentation, disease stage, histology, and treatment modalities were analyzed using descriptive statistics and frequency distributions. Survival rates were analyzed and presented using Kaplan-Meier curves. RESULTS Based on initial analyses the disease was more frequent among women (62.0%) than men (39.0%). Surgical resection was attempted in 40.8% patients. The average age at presentation and diagnosis of gallbladder carcinoma was 62.4 years. The disease had two peaks, one at 51.0 years and the other between 66.0 and 70.0 years. The median survival time for the overall at-risk patients was only 1.0 year, while for stage IVB patients was 7.2 months. Adenocarcinoma not otherwise specified (NOS) was the most common histopathology type (75.0%), with most patients presenting with stage IVB disease (75.0%). Gallbladder carcinoma was incidentally detected in 42.1%, including three cases (3.9%) diagnosed at our hospital. CONCLUSIONS Gallbladder cancer is a rare type of cancer in Saudi Arabia, and most patients are treated surgically, despite being mostly diagnosed at the advanced stage of the disease.
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Affiliation(s)
- Mohammed Yousef Aldossary
- Department of General Surgery, Hepatobiliary Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Amal Ali Alayed
- Department of General Surgery, Hepatobiliary Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Samir S. Amr
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Shareef Alqahtani
- Department of General Surgery, Hepatobiliary Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mamdouh Alnahawi
- Department of General Surgery, Hepatobiliary Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mohammed Saad Alqahtani
- Department of General Surgery, Hepatobiliary Unit, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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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: 0.7] [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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Zhao X, Li XY, Ji W. Laparoscopic versus open treatment of gallbladder cancer: A systematic review and meta-analysis. J Minim Access Surg 2018; 14:185-191. [PMID: 28782743 PMCID: PMC6001297 DOI: 10.4103/jmas.jmas_223_16] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: The aim of this review was to evaluate the effect of laparoscopic surgery on the treatment of patients with gallbladder cancer (GBC). Methods: A comprehensive search of Medline and Cochrane Library was conducted to identify relevant articles. A meta-analysis was subsequently performed. Results: A total of 20 studies including 1217 patients met the inclusion criteria. The meta-analysis showed that the 5-year survival rate was significant higher in laparoscopic group than open group (48.4% vs. 38.5%; odds ratio [OR], 1.63; 95% confidence interval [CI], 1.22–2.19; P = 0.001). Although the scar recurrence rate was significant higher in laparoscopic group than open group (7.1% vs. 4.0%; OR, 2.10; 95% CI, 1.11–3.96; P = 0.02), the overall recurrence rates between two groups were not significant different (44.8% vs. 42.2%; OR, 0.86; 95% CI, 0.64–1.14; P = 0.29). In addition, compared with open extended cholecystectomy (EC), laparoscopic EC (LEC) was associated with less intraoperative blood loss, shorter post-operative hospital stays and insignificant less complication rate (10.0% vs. 18.3%; OR, 0.51; 95% CI, 0.15–1.73; P = 0.28). Conclusion: Laparoscopic simple cholecystectomy does not lead to a worse prognosis when applied on patients with GBC. LEC can be performed in specialised expert centres on elective patients.
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Affiliation(s)
- Xin Zhao
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Xiang Yang Li
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
| | - Wu Ji
- Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
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Surgical Management of Gallbladder Cancer: Simple Versus Extended Cholecystectomy and the Role of Adjuvant Therapy. Ann Surg 2017; 266:625-631. [PMID: 28692469 DOI: 10.1097/sla.0000000000002385] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess if simple cholecystectomy with adjuvant therapy could provide outcomes comparable to extended cholecystectomy. BACKGROUND Current guidelines recommend extended/radical cholecystectomy for T2/T3 gallbladder cancer; however, many tumors are discovered incidentally at laparoscopic cholecystectomy. METHODS The national Cancer Data Base 2004 to 2014 was queried for patients with pT2/T3 gallbladder adenocarcinoma who underwent resection. Adjuvant therapy was defined as chemotherapy, with or without radiotherapy, within 90 days of surgery. Baseline characteristics and overall survival were compared by χ and Kaplan-Meier method, respectively. One-to-one propensity score matching for receipt of adjuvant therapy was used to account for potential selection bias. RESULTS A total of 6825 patients were identified. Diagnosis was made predominantly (78.9%) at the time of surgery or on pathology; 31.8% (2168) received adjuvant therapy. The majority, 88.8% (6060), had a simple cholecystectomy. Patients who received adjuvant therapy versus surgery alone were more likely to: be younger, privately insured, have no comorbidities, pT3 disease, positive lymph nodes, positive resection margins, and extended cholecystectomy. After matching, median survival was significantly longer for extended cholecystectomy with adjuvant therapy (23.3 months) than cholecystectomy with adjuvant therapy (16.4 months), which was significantly longer than either simple (12.4 months) or extended (10.7 months) cholecystectomy alone (all log-rank P<0.001). CONCLUSIONS Adjuvant therapy prolongs survival after resection of T2/T3 tumors. Simple cholecystectomy with adjuvant therapy appears to be superior to extended resection alone in the short term and may serve as a potential alternative to re-resection in select high-risk individuals.
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Piccolo G, Piozzi GN. Laparoscopic Radical Cholecystectomy for Primary or Incidental Early Gallbladder Cancer: The New Rules Governing the Treatment of Gallbladder Cancer. Gastroenterol Res Pract 2017; 2017:8570502. [PMID: 28690639 PMCID: PMC5485370 DOI: 10.1155/2017/8570502] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/15/2017] [Indexed: 12/18/2022] Open
Abstract
AIM To evaluate the technical feasibility and oncologic safety of laparoscopic radical cholecystectomy (LRC) for primary or incidental early gallbladder cancer (GBC) treatment. METHODS Articles reporting LRC for GBC were reviewed from the first case reported in 2010 to 2015 (129 patients). 116 patients had a preoperative diagnosis of gallbladder cancer (primary GBC). 13 patients were incidental cases (IGBC) discovered during or after a laparoscopic cholecystectomy. RESULTS The majority of patients who underwent LRC were pT2 (62.7% GBC and 63.6% IGBC). Parenchyma-sparing operation with wedge resection of the gallbladder bed or resection of segments IVb-V were performed principally. Laparoscopic lymphadenectomy was carried out according to the reported depth of neoplasm invasion. Lymph node retrieved ranged from 3 to 21. Some authors performed routine sampling biopsy of the inter-aorto-caval lymph nodes (16b1 station) before the radical treatment. No postoperative mortality was documented. Discharge mean day was POD 5th. 16 patients had post operative morbidities. Bile leakage was the most frequent post-operative complication. 5 y-survival rate ranged from 68.75 to 90.7 months. CONCLUSION Laparoscopy can not be considered as a dogmatic contraindication to GBC but a primary approach for early case (pT1b and pT2) treatment.
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Affiliation(s)
- Gaetano Piccolo
- Department of Surgery, University of Catania, Via S. Sofia 78, 95123 Catania, Italy
| | - Guglielmo Niccolò Piozzi
- Department of Surgery, Università Degli Studi di Milano, Via Festa del Perdono 7, 20122 Milano, Italy
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Gallbladder Carcinoma in the United States: A Population Based Clinical Outcomes Study Involving 22,343 Patients from the Surveillance, Epidemiology, and End Result Database (1973-2013). HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2017. [PMID: 28638176 PMCID: PMC5468561 DOI: 10.1155/2017/1532835] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction Gallbladder carcinoma (GBC) is the most common malignancy of the biliary tract and the third most common gastrointestinal tract malignancy. This study examines a large cohort of GBC patients in the United States in an effort to define demographics, clinical, and pathologic features impacting clinical outcomes. Methods Demographic and clinical data on 22,343 GBC patients was abstracted from the SEER database (1973–2013). Results GBC was presented most often among Caucasian (63.9%) females (70.7%) as poorly or moderately differentiated (42.5% and 38.2%) tumors, with lymph node involvement (88.2%). Surgery alone was the most common treatment modality for GBC patients (55.0%). Combination surgery and radiation (10.6%) achieved significantly longer survival rates compared to surgery alone (4.0 ± 0.2 versus 3.7 ± 0.1 years, p = 0.004). Overall mortality was 87.0% and cancer-specific mortality was 75.4%. Conclusions GBC is an uncommon malignancy that presents most often among females in their 8th decade of life, with over a third of cases presenting with distant metastasis. The incidence of GBC has doubled in the last decade concurrent with increases in cholecystectomy rates attributable in part to improved histopathological detection, as well as laparoscopic advances and enhanced endoscopic techniques. Surgical resection confers significant survival benefit in GBC patients.
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Updated Management of Malignant Biliary Tract Tumors: An Illustrative Review. J Vasc Interv Radiol 2016; 27:1056-69. [DOI: 10.1016/j.jvir.2016.01.149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/12/2015] [Accepted: 01/27/2016] [Indexed: 12/18/2022] Open
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Gani F, Buettner S, Margonis GA, Ethun CG, Poultsides G, Tran T, Idrees K, Isom CA, Fields RC, Krasnick B, Weber SM, Salem A, Martin RCG, Scoggins C, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Shenoy R, Maithel SK, Pawlik TM. Assessing the impact of common bile duct resection in the surgical management of gallbladder cancer. J Surg Oncol 2016; 114:176-80. [PMID: 27198742 DOI: 10.1002/jso.24283] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/23/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although radical re-resection for gallbladder cancer (GBC) has been advocated, the optimal extent of re-resection remains unknown. The current study aimed to assess the impact of common bile duct (CBD) resection on survival among patients undergoing surgery for GBC. METHODS Patients undergoing curative-intent surgery for GBC were identified using a multi-institutional cohort of patients. Multivariable Cox-proportional hazards regression was performed to identify risk factors for a poor overall survival (OS). RESULTS Among the 449 patients identified, 26.9% underwent a concomitant CBD resection. The median number of lymph nodes harvested did not differ based on CBD resection (CBD, 4 [IQR: 2-9] vs. no CBD, 3 [IQR: 1-7], P = 0.108). While patients who underwent a CBD resection had a worse OS, after adjusting for potential confounders, CBD resection did not impact OS (HR = 1.40, 95%CI 0.87-2.27, P = 0.170). Rather, the presence of advanced disease (T3: HR = 3.11, 95%CI 1.22-7.96, P = 0.018; T4: HR = 7.24, 95%CI 1.70-30.85, P = 0.007) and the presence of disease at the surgical margin (HR = 2.58, 95%CI 1.26-5.31, P = 0.010) were predictive of a worse OS. CONCLUSIONS CBD resection did not yield a higher lymph node count and was not associated with an improved survival. Routine CBD excision in the re-resection of GBC is unwarranted and should only be performed selectively. J. Surg. Oncol. 2016;114:176-180. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Faiz Gani
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Stefan Buettner
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Cecilia G Ethun
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Stanford, California
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Stanford, California
| | - Kamran Idrees
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chelsea A Isom
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Bradley Krasnick
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Sharon M Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Robert C G Martin
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Charles Scoggins
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Harveshp D Mogal
- Department of Surgery, Wake Forest University, Winston-Salem, North Carolina
| | - Carl Schmidt
- Department of Surgery, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Eliza Beal
- Department of Surgery, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | | | - Rivfka Shenoy
- Department of Surgery, New York University, New York, New York
| | - Shishir K Maithel
- Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Timothy M Pawlik
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
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45
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Jang JY, Heo JS, Han Y, Chang J, Kim JR, Kim H, Kwon W, Kim SW, Choi SH, Choi DW, Lee K, Jang KT, Han SS, Park SJ. Impact of Type of Surgery on Survival Outcome in Patients With Early Gallbladder Cancer in the Era of Minimally Invasive Surgery: Oncologic Safety of Laparoscopic Surgery. Medicine (Baltimore) 2016; 95:e3675. [PMID: 27258495 PMCID: PMC4900703 DOI: 10.1097/md.0000000000003675] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Laparoscopic surgery has been widely accepted as a feasible and safe treatment modality in many cancers of the gastrointestinal tract. However, most guidelines on gallbladder cancer (GBC) regard laparoscopic surgery as a contraindication, even for early GBC. This study aims to evaluate and compare recent surgical outcomes of laparoscopic and open surgery for T1(a,b) GBC and to determine the optimal surgical strategy for T1 GBC.The study enrolled 197 patients with histopathologically proven T1 GBC and no history of other cancers who underwent surgery from 2000 to 2014 at 3 major tertiary referral hospitals with specialized biliary-pancreas pathologists and optimal pathologic handling protocols. Median follow-up was 56 months. The effects of depth of invasion and type of surgery on disease-specific survival and recurrence patterns were investigated.Of the 197 patients, 116 (58.9%) underwent simple cholecystectomy, including 31 (15.7%) who underwent open cholecystectomy and 85 (43.1%) laparoscopic cholecystectomy. The remaining 81 (41.1%) patients underwent extended cholecystectomy. Five-year disease-specific survival rates were similar in patients who underwent simple and extended cholecystectomy (96.7% vs 100%, P = 0.483), as well as being similar in patients in the simple cholecystectomy group who underwent open and laparoscopic cholecystectomy (100% vs 97.6%, P = 0.543). Type of surgery had no effect on recurrence patterns.Laparoscopic cholecystectomy for T1 gallbladder cancer can provide similar survival outcomes compared to open surgery. Considering less blood loss and shorter hospital stay with better cosmetic outcome, laparoscopic cholecystectomy can be justified as a standard treatment for T1b as well as T1a gallbladder cancer when done by well-experienced surgeons based on exact pathologic diagnosis.
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Affiliation(s)
- Jin-Young Jang
- From the Department of Surgery and Cancer Research Institute (J-YJ, YH, JC, JRK, HK, WK, S-WK), Seoul National University College of Medicine; Department of Surgery (JSH, WK, SHC, DWC), Sungkyunkwan University School of Medicine; Department of Pathology (KL), Seoul National University College of Medicine; Department of Pathology and Translational Genomics (K-TJ), Sungkyunkwan University School of Medicine, Seoul; and Center for Liver Cancer (S-SH, S-JP), National Cancer Center, Gyeonggido, Republic of Korea
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46
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Emmett CD, Barrett P, Gilliam AD, Mitchell AI. Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma. Ann R Coll Surg Engl 2015; 97:526-9. [PMID: 26274738 DOI: 10.1308/rcsann.2015.0013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Gallstone disease is treated commonly with cholecystectomy. Malignant disease of the gallbladder may present similarly and has a poor prognosis. It is common for cholecystectomy specimens to be sent for histological examination to exclude malignancy. However, the incidence of incidental gallbladder carcinoma (IGBC) is low and it has therefore been suggested that macroscopic inspection of the gallbladder by the surgeon, followed by selective histological examination of abnormal specimens, may be safe and cost saving. Methods All cholecystectomies performed between 1 May 2003 and 1 September 2009 were identified from clinical coding. Pathology records were used to identify gallbladder malignancies; these were searched manually to identify IGBC. Pathology reports and case notes were cross-referenced to determine whether there were macroscopic abnormalities present. Annual cost savings were estimated by comparing the number of gallbladder specimens over one year (May 2013 - April 2014) with the total number of cholecystectomies performed in that time. Results Of 4,776 cholecystectomies identified, 12 (0.25%) were cases of IGBC. These cases had a higher median age (68 vs 54 years, p<0.001) and a higher proportion were emergency operations (50% vs 12%, p<0.001). All cases had some form of macroscopic abnormality, most commonly wall thickening (n=6, 50%). Only two cases (17%) had a visible tumour present. Conclusions All cases of IGBC in this study had a macroscopically abnormal gallbladder. Our findings suggest it is safe to adopt a selective approach to histological examination. Savings of almost £20,500 per annum have been achieved.
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Affiliation(s)
- C D Emmett
- County Durham and Darlington NHS Foundation Trust , UK
| | - P Barrett
- County Durham and Darlington NHS Foundation Trust , UK
| | - A D Gilliam
- County Durham and Darlington NHS Foundation Trust , UK
| | - A I Mitchell
- County Durham and Darlington NHS Foundation Trust , UK
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