Incidental gallbladder cancer: Review of 3856 cholecystectomies
Keywords:Gallbladder, Incidental cancer, Cholecystectomy
Aim: Gallbladder cancer (GBC) is a rare but fatal disease that causes more than 5000 new cases per year in the United States. In the pre-operative period, it is diagnosed in less than 20% of the cases of GBC. The remaining cases are diagnosed after laparoscopic cholecystectomy or intraoperative. Following the 0.25-3% of laparoscopic cholecystectomy, GBC is incidentally detected during histopathology. However, the incidental GBC constitutes 74-92% of all GBCs. The most important step in this disease is the correct staging. Staging determines disease management and treatment options and predicts survival. Curative surgeries in the treatment of GBC are limited to local resectable disease. In this study, it was aimed to present cases of GBC which was diagnosed incidentally after cholecystectomy and premalignant gallbladder lesions (BillIn: Biliary intraepithelial neoplasia).
Methods: 3856 patients who underwent cholecystectomy between 2009 and 2017 constituted the study universe. Patients who were diagnosed as incidental GBC (eight patients (0.21%)) and BillIn (five patients (0.12%)) were examined as a result of histopathological examination. The patients were recorded in terms of demographic data, histopathology, surgical reports and follow-up.
Results: A total of 13 (0.33%) patients were detected in the study group, including GBC and BillIn. The mean age of patients was 54.8±14.3 (age range 33-83), seven male and six women. Although cholecystectomy was performed more frequently in women (72.7%) as determined in the study universe, GBC was seen more frequently in male gender (p<0.05). Distribution of tumor stage in malignant patients was identified; four patients were observed in T2, three patients T1a and T3 GBC in one patient, BillIn in five patients.
Conclusion: GBC and BillIn are rare histopathological findings which are detected after cholecystectomy performed due to gallstone disease. Mean survival time of GBC is lower than other gastrointestinal cancers. The recent pre-operative examinations and a frozen-section examination in case of malignancy suspicion has been suggested in the literature, therefore surgeons should be prepared for advanced therapies.
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