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Incidence, management, and outcome of incidental gallbladder carcinoma: analysis of the database of the Swiss association of laparoscopic and thoracoscopic surgery

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Abstract

Background

Little is known about the long-term survival of patients with incidental gallbladder carcinoma (IGBC). The role of radical resection for this disease is discussed controversially in the literature. We present the long-term survival and the results of re-resection versus simple cholecystectomy of the database of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) from 1994 to 2004.

Methods

Eighty-nine patients with histologically confirmed carcinoma of the gallbladder were identified out of 30,960 patients undergoing laparoscopic cholecystectomy. Sixty-nine patients were included in our study. Long-term survival by different T-stage and comparison of patients with extended resection versus simple cholecystectomy were calculated using the log-rank test. The time-to-event data are demonstrated by Kaplan–Meier curves.

Results

The overall incidence of IGBC in patients who underwent laparoscopic cholecystectomy was 0.28% (89 of 30,960). Fifty patients underwent simple cholecystectomy [n = 2: carcinoma in situ (CIS); n = 2: pT1a; n = 10: pT1b; n = 23: pT2; n = 8: pT3; n = 5: pT4], whereas extended resection was performed in 19 cases (n = 2: pT1b; n = 11: pT2; n = 6: pT3). The comparison of simple cholecystectomy versus extended re-resection of the gallbladder bed and regional lymph node resections showed a significant benefit in overall survival for the pT2 and pT3 group (p < 0.05). The pT1b group showed no significant benefit in overall survival (p = 0.34).

Conclusion

IGBC has a low incidence (0.28%). We present a large study of patients with IGBC, comparing the overall survival by different histological findings. We observed a significant benefit for the group with pT2 and pT3. Therefore we recommend extended resection of the gallbladder bed and the regional lymph nodes for patient with incidental histologically confirmed pT2 and pT3 carcinoma of the gallbladder after performance of laparoscopic cholecystectomy. For patients with pT1b stage no recommendations can be given based on this study.

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Acknowledgment

The authors would like to thank the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS) and the following clinics and colleagues for supporting the study and the registry: Hospital of Aarau (Chairman: Schlumpf R, MD), Hospital of Aarberg (de Montmollin Ch, MD), Hospital of Altstätten (Rechner J, MD), Hospital of Bruderholz (Huber A, MD), Hopital Tiefenau (Bachmann R, MD), Fischer C, MD (Berne), Hospital Sonnenhof (Moser J, MD), Hospital of Biel (Laffer U, MD), Hospital of Bulach (Neff U, MD), Hospital of Flawil (Itin H, MD), Hospital of Frauenfeld (Oehy K, MD), Hospital of Fribourg (Krähenbühl L, MD), Hospital of Grabs (De Lorenzi D, MD), Hospital of Herisau (Schibli M, MD), Hospital of Ilanz (Mäder P, MD), Hospital of Langenthal (Haenni K, MD), University Hospital of Lausanne (Gillet M, MD), Osterwalder A, MD (Lugano), Hospital of Lugano (Martinoli S, MD), Hospital of Lucerne (Metzger J, MD), Hospital of Mendrisio (Fasolini F, MD), Hospital of Nyon (Blaser A, MD), Hospital of Olten (Rothenbühler J, MD), Hospital of Payerne (Vionnet M, MD), Hospital of Porrentruy (Worreth M, MD), Hospital of Schaffhausen (Schweizer W, MD), Hospital of Uster (Melcher G, MD), Hospital of Uznach (Rüegger R, MD), Hospital of Wetzikon (Stieger R, MD), Hospital of Wil (Gilg M, MD), Hospital of Winterthur (Decurtins M, MD), Hospital of Zofingen (Fartab M, MD), Hirslanden Zurich (Krayenbühl Ch, MD/Wehrli H, MD/Ricklin T, MD), Hospital Waid Zurich (Buchmann P, MD), Hospital Triemli Zurich (Metzger U, MD), and Hospital of Zweisimmen (Minnig R, MD).

Disclosures

Authors Philippe Marc Glauser, Daniel Strub, Samuel Andreas Käser, Diana Mattiello, Franziska Rieben, and Christoph Andreas Maurer have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Hospital of Liestal, 4410, Liestal, Switzerland

    Philippe Marc Glauser, Daniel Strub, Samuel Andreas Käser, Diana Mattiello & Christoph Andreas Maurer

  2. Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS), Aarberg, Switzerland

    Franziska Rieben & Christoph Andreas Maurer

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  1. Philippe Marc Glauser
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Correspondence to Christoph Andreas Maurer.

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Glauser, P.M., Strub, D., Käser, S.A. et al. Incidence, management, and outcome of incidental gallbladder carcinoma: analysis of the database of the Swiss association of laparoscopic and thoracoscopic surgery. Surg Endosc 24, 2281–2286 (2010). https://doi.org/10.1007/s00464-010-0952-y

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