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Systematic review of management of incidental gallbladder cancer after cholecystectomy

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Abstract

Background: Gallbladder cancer is rare but incidentally detected cancers after cholecystectomy are increasing. Optimal management of incidental gallbladder cancer is debated and thus the aim of this study was to review the available data for current best practice.
Methods: A systematic PubMed search of the English literature until May 2018 was conducted. Of particular interest were consensus reports, guidelines, systematic reviews and meta-analyses, multicentre studies and trials.
Results: The search identified 12 systematic reviews and metanalyses; 7 consensus reports or guidelines; 15 multi-institutional series and, data from 6 national audits or registries that were used to construct the review. Some 0.25-0.89 per cent of all cholecystectomy were found to harbour incidental gallbladder cancer on pathology. Most patients are staged with pT2 (about half) or pT1 (about one third) cancers. Cancers confined to the mucosa (≤T1a) had an excellent prognosis with 5-year survival up to 100 per cent and are considered cured by cholecystectomy alone. In cancers invading the muscle-layer of the gallbladder wall cancer (≥T1b), re-resection is recommended, however the type, extent and timing of re-resection remain controversial. Observation time may be used to facilitate new cross-sectional imaging with computed tomography and MRI. Perforation at initial surgery had higher risk for disease dissemination. Gallbladder cancers are PET-avid and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T-stage. Port site metastases occur in about 10 per cent. Routine resection of port sites is not recommended, as there is no effect on survival. The effect of adjuvant chemotherapy is poorly documented, likely underused and should be considered for patients with ≥T1b cancer.
Conclusion: Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to re-resection.

ID: 75744932