Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection
When surgeons went back in after a gallbladder cancer had been found by chance, nearly half of patients had cancer left behind, and the deeper the original tumour the more likely it was.
Overview
Six hepatobiliary centres pooled 115 patients re-resected between 1984 and 2006 for gallbladder carcinoma discovered incidentally at cholecystectomy. T stage was T1 in 7.8 percent, T2 in 67.0 percent and T3 in 25.2 percent; the median interval to re-resection was 52 days. Residual or additional disease was found in 46.4 percent. Residual disease in the liver was found in 0, 10.4 and 36.4 percent of T1, T2 and T3 tumours and nodal metastasis in 12.5, 31.3 and 45.5 percent. A positive cystic duct margin predicted residual disease in the common bile duct (42.1 versus 4.3 percent). Common duct resection did not raise the lymph node count (median 3 in both groups).
- Residual or additional disease at re-resection in 46.4 percent of 115 patients.
- Liver residual disease by T stage: T1 0 percent, T2 10.4 percent, T3 36.4 percent; nodal metastasis 12.5, 31.3 and 45.5 percent.
- Positive cystic duct margin: residual disease in the common bile duct 42.1 vs 4.3 percent.
This is the observational backbone of the rule that T1b or deeper incidental cancers should be re-resected, and of resecting the bile duct only when the cystic duct margin is positive.
- Retrospective series from referral centres; patients selected for re-resection.
- Only nine T1 patients.
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