Systematic review of management of incidental gallbladder cancer after cholecystectomy
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.
Overview
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.
- 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.
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.
- Narrative synthesis of heterogeneous retrospective data.
- Predates BILCAP's publication and the immunotherapy trials.
Similar pages
not linked directly; found by shared links- Key paperIncidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection
Shares Incidental gallbladder cancer (found after cholecystectomy), Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
- Key paperAssociation of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall Survival: A Multi-Institution Analysis From the US Extrahepatic Biliary Malignancy Consortium
Shares Incidental gallbladder cancer (found after cholecystectomy), Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
- Key paperOptimal surgical treatment in patients with T1b gallbladder cancer: An international multicenter study
Shares Incidental gallbladder cancer (found after cholecystectomy), Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
- Key paperCarcinoma of the gallbladder: staging, treatment, and prognosis
Shares Incidental gallbladder cancer (found after cholecystectomy), Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
- Key paperRe-resection in Incidental Gallbladder Cancer: Survival and the Incidence of Residual Disease
Shares Incidental gallbladder cancer (found after cholecystectomy), Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
- Key paperTiming of revision surgery for incidental gallbladder cancer: a systematic review and individual patient data meta-analysis
Shares Incidental gallbladder cancer (found after cholecystectomy), Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
- Key paperManagement of incidental gallbladder cancer in the nationwide CAPBIL study
Shares Incidental gallbladder cancer (found after cholecystectomy), Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.
- IdeaTest whether T1b gallbladder cancer needs the second operation at all
Shares Incidental gallbladder cancer (found after cholecystectomy), Radical (extended) cholecystectomy, Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials, Gallbladder cancer and the tag gallbladder-evidence.