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A Single-Institution Experience

Ioannis T. Konstantinidis, MD; Vikram Deshpande, MD; Muriel Genevay, MD; David Berger, MD; Carlos Fernandez-del Castillo, MD; Kenneth K. Tanabe, MD; Hui Zheng, PhD; Gregory Y. Lauwers, MD; Cristina R. Ferrone, MD

Arch Surg. 2009;144(5):441-447.

Objectives  To determine the prevalence of incidentally found cases of gallbladder cancer, the incidence of residual disease at reexploration, and the changes in the mode of presentation, treatment, and survival of patients with gallbladder cancer during a period of more than 4 decades.

Design  Retrospective case series.

Setting  University-affiliated tertiary care center.

Patients  Between January 1, 1962, and March 1, 2008, 402 patients with gallbladder cancer were identified and their clinicopathologic data were analyzed.

Interventions  Surgical treatment, radiotherapy, and chemotherapy.

Main Outcome Measures  Incidentally discovered gallbladder cancer, incidence of residual disease, and differences in presentation, treatment, and survival.

Results  Surgical exploration was performed in 260 patients (64.7%), of whom 151 (58.1%) underwent resection. The median age of the patients was 72 years, and 72.3% were female. Between January 1, 1994, and March 1, 2008, 6881 laparoscopic cholecystectomies were performed, and there were 17 incidentally discovered cases of gallbladder cancer (0.25%). Residual disease on reexploration was identified in 0 of 2 patients with T1 tumor, 3 of 13 patients with T2 tumor, and 8 of 10 patients with T3 tumor (P = .01). Patients with stage IV disease (34 [13.1%] diagnosed from 1962-1979; 34 [13.1%] diagnosed from 1980-1997; and 22 [8.5%] diagnosed from 1998-2008) had a median survival of 4 months (range, 0-37 months). Concomitant liver resections increased in the third study period (11.1%, 10.1%, and 54.3%; P < .001), with an increase in negative margins (33.3%, 42.0%, and 63.0%; P = .01). Cox regression analysis identified T stage and surgical margin status as significant prognostic factors.

Conclusions  Gallbladder cancer is incidentally found during 0.25% of laparoscopic cholecystectomies. As T stage increases, the likelihood of residual disease on reexploration increases. Although many patients with gallbladder cancer present with incurable disease and have very poor survival, the overall prognosis is improving, likely because of more extensive operations.

Author Affiliations: Departments of Surgery (Drs Konstantinidis, Berger, Fernandez-del Castillo, Tanabe, and Ferrone), Pathology (Drs Deshpande, Genevay, and Lauwers), and Biostatistics (Dr Zheng), Massachusetts General Hospital, Harvard Medical School, Boston; and Service of Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland (Dr Genevay).

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Arch Surg. 2009;144(5):447.
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