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Systematic review of management of incidental gallbladder cancer after cholecystectomy.
Søreide, K; Guest, R V; Harrison, E M; Kendall, T J; Garden, O J; Wigmore, S J.
Afiliación
  • Søreide K; Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.
  • Guest RV; Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
  • Harrison EM; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
  • Kendall TJ; Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.
  • Garden OJ; Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.
  • Wigmore SJ; Division of Pathology, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.
Br J Surg ; 106(1): 32-45, 2019 01.
Article en En | MEDLINE | ID: mdl-30582640
BACKGROUND: Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer. METHODS: A systematic PubMed search of the English literature to May 2018 was conducted. RESULTS: The search identified 12 systematic reviews and meta-analyses, in addition to several consensus reports, multi-institutional series and national audits. Some 0·25-0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one-third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5-year survival rates of up to 100 per cent 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. Gallbladder cancers are PET-avid, and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. The incidence of port-site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. CONCLUSION: Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Colecistectomía / Neoplasias de la Vesícula Biliar Tipo de estudio: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Br J Surg Año: 2019 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Complicaciones Posoperatorias / Colecistectomía / Neoplasias de la Vesícula Biliar Tipo de estudio: Diagnostic_studies / Etiology_studies / Guideline / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Br J Surg Año: 2019 Tipo del documento: Article Pais de publicación: Reino Unido