Management of Incidentally Detected Gallbladder Cancer After Cholecystectomy

Abstract

Gallbladder cancer (GBC) is rare, but cancers incidentally detected are increasing. Between 0.25% and 0.89% of all cholecystectomy specimens have an incidental GBC on pathological examination. Most patients are staged with pT2 (50%) or pT1 (33%) of GBC. Patients with GBC confined to the mucosa (T1a or less) had 5-year survival rates of up to 100% 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. GBC is PET-avid, and PET may detect residual disease and thus prevent unnecessary surgery, but data are still scarce on the use in GBC. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. Port-site metastases may occur in up to 10% and has decreased over the last decades. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. Management of incidental GBC continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.