# Systematic review of management of incidental gallbladder cancer after cholecystectomy

Source: https://onco.cc/key-papers/paper-soreide-incidental-gallbladder-cancer-review-bjs-2019/  
OnCo record `paper-soreide-incidental-gallbladder-cancer-review-bjs-2019` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A British Journal of Surgery review of what to do when a gallbladder removed for stones turns out to hold cancer: about one in 200 do, tumours confined to the lining are cured by the first operation, deeper ones need a second, and cutting out the keyhole port sites does not help.

## Summary

Systematic review (PubMed to May 2018) from Edinburgh identifying 12 systematic reviews and meta-analyses plus consensus reports, multi-institutional series and national audits. Incidental gallbladder cancer was found in 0.25 to 0.89 percent of cholecystectomy specimens; about half were pT2 and a third pT1. Five-year survival after cholecystectomy alone was up to 100 percent for T1a or less; re-resection is recommended from T1b, though its type, extent and timing remain controversial. Perforation at the first operation raised dissemination risk; PET is useful for residual disease; routine laparoscopic staging is not warranted for all stages; port-site metastases occur in about 10 percent and routine port-site resection does not affect survival; adjuvant chemotherapy is poorly documented and probably underused.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: gallbladder-evidence
- Journal: British Journal of Surgery
- Year: 2019
- DOI: 10.1002/bjs.11035
- Authors: Søreide K, Guest RV, Harrison EM, et al.
- Findings: Incidental gallbladder cancer in 0.25 to 0.89 percent of cholecystectomy specimens; about half pT2, a third pT1.; Five-year survival up to 100 percent after cholecystectomy alone for T1a or less; re-resection recommended for T1b or above.; Port-site metastases about 10 percent; routine port-site resection has no effect on survival.
- What it means: The UK-authored summary that most NHS hepatobiliary units work from; it names the open questions (type, extent and timing of re-resection; adjuvant chemotherapy) that the trials in this roadmap are trying to answer.
- Caveats: Narrative synthesis of heterogeneous retrospective data.; Predates BILCAP's publication and the immunotherapy trials.

## Sources

- Br J Surg 2019: https://doi.org/10.1002/bjs.11035
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30582640/

## Connected records

- cancers: [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Incidental gallbladder cancer (found after cholecystectomy)](https://onco.cc/cancers/incidental-gallbladder-cancer/)
- technologies: [PET/CT](https://onco.cc/technologies/pet-ct/)
- terms: [Radical (extended) cholecystectomy](https://onco.cc/terms/radical-cholecystectomy/)
- roadmaps: [Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials](https://onco.cc/roadmaps/gallbladder-cancer-roadmap/)

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