Implications of the index cholecystectomy and timing of referral for radical resection of advanced incidental gallbladder cancer

• Published in: Annals of the Royal College of Surgeons of England Vol. 97; no. 2; pp. 131 - 136
• Main Authors: Tsirlis, T, Ausania, F, White, S A, French, J J, Jaques, B C, Charnley, R M, Manas, D M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-03-2015; Royal College of Surgeons
• Subjects: Age; Aged; Aged, 80 and over; Antigens, Tumor-Associated, Carbohydrate - blood; Cancer; Cholecystectomy; Female; Gallbladder; Gallbladder cancer; Gallbladder Neoplasms - pathology; Gallbladder Neoplasms - surgery; Histopathology; HPB surgery; Humans; Incidental Findings; Laparoscopy; Lymphatic system; Male; Medical imaging; Medical prognosis; Middle Aged; Multivariate analysis; Neoplasm Staging; Patients; Referral and Consultation; Retrospective Studies; Statistical analysis; Time-to-Treatment; Tumors; United Kingdom; Variables; Veins & arteries; United Kingdom > UK
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/003588414X14055925060073

Advanced (pT2/T3) incidental gallbladder cancer is often deemed unresectable after restaging. This study assesses the impact of the primary operation, tumour characteristics and timing of management on re-resection.
The records of 60 consecutive referrals for incidental gallbladder cancer in a single tertiary centre from 2003 to 2011 were reviewed retrospectively. Decision on re-resection of incidental gallbladder cancer was based on delayed interval restaging at three months following cholecystectomy. Demographics, index cholecystectomy data, primary pathology, CA19-9 tumour marker levels at referral and time from cholecystectomy to referral as well as from referral to restaging were analysed.
Thirty-seven patients with pT2 and twelve patients with pT3 incidental gallbladder cancer were candidates for radical re-resection. Following interval restaging, 24 patients (49%) underwent radical resection and 25 (51%) were deemed inoperable. The inoperable group had significantly more patients with positive resection margins at cholecystectomy (p=0.002), significantly higher median CA19-9 levels at referral (p=0.018) and were referred significantly earlier (p=0.004) than the patients who had resectable tumours. On multivariate analysis, urgent referral (p=0.036) and incomplete cholecystectomy (p=0.048) were associated significantly with inoperable disease following restaging.
In patients with incidental, potentially resectable, pT2/T3 gallbladder cancer, inappropriate index cholecystectomy may have a significant impact on tumour dissemination. Early referral of breached tumours is not associated with resectability.