Retrospective Study
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World J Gastrointest Oncol. Dec 15, 2014; 6(12): 441-443
Published online Dec 15, 2014. doi: 10.4251/wjgo.v6.i12.441
Incidental gall bladder cancers: Are they truly incidental?
Ashwin Rammohan, Sathya D Cherukuri, Jeswanth Sathyanesan, Ravichandran Palaniappan, Manoharan Govindan
Ashwin Rammohan, Jeswanth Sathyanesan, Ravichandran Palaniappan, Manoharan Govindan, The Institute of Surgical Gastroenterology and Liver Transplantation, Centre for GI Bleed, Division of HPB diseases, Stanley Medical College Hospital, Chennai 600001, India
Sathya D Cherukuri, Stanley Medical College Hospital, Chennai 600001, India
Author contributions: Rammohan A, Cherukuri SD, Sathyanesan J contributed to conception and design, acquisition, analysis and interpretation of data; Rammohan A, Cherukuri SD, Sathyanesan J, Palaniappan R drafted the article and revised it critically for important intellectual content; Sathyanesan J, Palaniappan R, Govindan M gave the final approval of the version to be published.
Correspondence to: Ashwin Rammohan, FRCS, The Institute of Surgical Gastroenterology and Liver Transplantation, Centre for GI Bleed, Division of HPB diseases, Stanley Medical College Hospital, Old Jail Road, Chennai 600001, India. ashwinrammohan@gmail.com
Telephone: +91-98-84173583 Fax: +91-44-25289595
Received: September 9, 2014
Revised: October 28, 2014
Accepted: November 7, 2014
Published online: December 15, 2014
Processing time: 100 Days and 12.5 Hours
Abstract

AIM: To seek and analyze features suggestive of gallbladder cancer (GBC) on preoperative imaging and intraoperative findings in patients diagnosed as having incidental GBC (IGBC).

METHODS: The study was conducted on 79 patients of IGBC managed in our department over a 10-year period (2003-2012). Review of preoperative imaging and operative notes was done to ascertain any suspicion of malignancy-in-retrospect.

RESULTS: Of the 79 patients, Ultrasound abdomen showed diffuse thickening, not suspicious of malignancy in 5 patients, and diffuse suspicious thickening was seen in 4 patients. Focal thickening suspicious of malignancy was present in 24 patients. Preoperative computed tomography/magnetic resonance imaging was done in 9 patients for suspicion of malignancy. In 5 patients, difficult Cholecystectomy was encountered due to dense/inflammatory adhesions. Intraoperative findings showed focal thickening of the gallbladder and a gallbladder mass in 9 and 17 patients respectively. On overall analysis, 37 patients had preoperative imaging or intraoperative findings suggestive of malignancy, which was either a missed GBC or an unsuspected/unexpected GBC. In 42 (53.2%) patients, there was no evidence suggestive of malignancy and was an unanticipated diagnosis.

CONCLUSION: Our study highlights a potential and not-so-rare pitfall of Laparoscopic Cholecystectomy. A greater awareness of this clinical entity along with a high index of suspicion and a low threshold for conversion to open procedure, especially in endemic areas may avert avoidable patient morbidity and mortality.

Keywords: Incidental gallbladder cancer; Preoperative detection; Imaging

Core tip: The true incidence of incidental gallbladder cancer (IGBC) in literature appears skewed as the preoperative and intraoperative clues towards malignancy may be missed. We aimed to seek and analyze features suggestive of GBC on preoperative imaging and intraoperative findings in patients diagnosed as having IGBC. On overall analysis, 37 patients had preoperative imaging or intraoperative findings suggestive of malignancy, which was either a missed GBC or an unsuspected/unexpected GBC. A greater awareness of this clinical entity along with a high index of suspicion and a low threshold for conversion to open procedure, may avert avoidable patient morbidity and mortality.