Editorial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2016; 8(8): 541-544
Published online Aug 27, 2016. doi: 10.4240/wjgs.v8.i8.541
Unexpected gallbladder cancer: Surgical strategies and prognostic factors
Gennaro Clemente
Gennaro Clemente, Department of Surgical Sciences, Hepatobiliary Unit, “A. Gemelli” Medical School, 00168 Rome, Italy
Author contributions: Clemente G contributed all to this paper.
Conflict-of-interest statement: Clemente G declares no conflict of interest related to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gennaro Clemente, MD, Department of Surgical Sciences, Hepatobiliary Unit, “A. Gemelli” Medical School, Largo Gemelli 8, 00168 Rome, Italy. gennaro.clemente@unicatt.it
Telephone: +39-6-30157251 Fax: +39-6-3010908
Received: March 19, 2016
Peer-review started: March 22, 2016
First decision: April 11, 2016
Revised: May 7, 2016
Accepted: June 14, 2016
Article in press: June 16, 2016
Published online: August 27, 2016
Processing time: 160 Days and 14.1 Hours
Abstract

Gallbladder cancer is the most common tumor of the biliary tract and it is associated with a poor prognosis. Unexpected gallbladder cancer is a cancer incidentally discovered, as a surprise, at the histological examination after cholecystectomy for gallstones or other indications. It is a potentially curable disease, with an intermediate or good prognosis in most cases. An adequate surgical strategy is mandatory to improve the prognosis and an adjunctive radical resection may be required depending on the depth of invasion. If the cancer discovered after cholecystectomy is a pTis or a pT1a, a second surgical procedure is not mandatory. In the other cases (pT1b, pT2 and pT3 cancer) a re-resection (4b + 5 liver segmentectomy, lymphadenectomy and port-sites excision in some cases) is required to obtain a radical excision of the tumor and an accurate disease staging. The operative specimens of re-resection should be examined by the pathologist to find any “residual” tumor. The “residual disease” is the most important prognostic factor, significantly reducing median disease-free survival and disease-specific survival. The other factors include depth of parietal invasion, metastatic nodal disease, surgical margin status, cholecystectomy for acute cholecystitis, histological differentiation, lymphatic, vascular and peri-neural invasion and overall TNM-stage.

Keywords: Gallbladder cancer; Laparoscopic cholecystectomy; Liver resection; Lymphadenectomy; Incidental gallbladder cancer; Unexpected gallbladder cancer

Core tip: Unexpected gallbladder cancer is diagnosed, as a surprise, after cholecystectomy for gallstones. A second surgical procedure consisting in a re-resection may be required depending on the depth of invasion. The discovery of cancer represents a challenge for the surgeon who must inform the patient many days after cholecystectomy and must evaluate the indication for a re-resection. The presence of a residual disease in the operative specimen after re-resection is the most important prognostic factor.