AI Article Synopsis
- Gallbladder cancer, while rare, is increasingly found incidentally after cholecystectomy procedures, prompting the need for better management practices.
- A review of existing literature shows that a small percentage (0.25-0.89%) of cholecystectomy specimens have incidental gallbladder cancer, with varying survival rates based on cancer stage—higher for localized cancers (up to 100% for T1a) and recommendations for reresection for more invasive cancers (T1b or above).
- Current management approaches include monitoring and imaging strategies, but there is ongoing debate regarding the necessity and timing of reresection, with a notable lack of documentation on the effectiveness of adjuvant chemotherapy.
Article Abstract
Background: Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer.
Methods: A systematic PubMed search of the English literature to May 2018 was conducted.
Results: The search identified 12 systematic reviews and meta-analyses, in addition to several consensus reports, multi-institutional series and national audits. Some 0·25-0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one-third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5-year survival rates of up to 100 per cent after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent and timing of reresection remain controversial. Observation time may be used for new cross-sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of 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 category. The incidence of port-site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused.
Conclusion: Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1002/bjs.11035 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!