Incidental gallbladder cancer: what management?
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REVIEW
Incidental gallbladder cancer: what management? Sidi Mohammed Bouchentouf • Soundouss Raissouni • Ibrahima Sall • Hakim El Kaoui • Hicham Baba • Ahmed Bounaim • Abdelmounim Ait Ali Khalid Sair • Aziz Zentar
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Received: 20 July 2011 / Accepted: 6 October 2011 / Published online: 29 October 2011 Springer-Verlag 2011
Abstract Gallbladder cancer (GBC) represents 3.8% of all gastrointestinal cancers and usually known to be of a poor prognosis. In 0.2–2.9% of cases, this cancer is found in cholecystectomy specimens. A better understanding of spread mode of this tumor helps a better surgical management. The aim of the present review is to underline the management of GBC based on the comprehension of risk factors and anatomic features. A Medline, PubMed database search was performed to identify articles published from 2000 to 2011 using the keywords ‘carcinoma of gallbladder’, ‘incidental gallbladder cancer’, ‘gallbladder neoplasm’ and ‘cholecystectomy’. Some pathological situations such as chronic lithiasis and biliopancreatic junction abnormalities have been clearly identified as predisposing to GBC. Laparoscopy increases peritoneal and parietal tumor dissemination, thus, it should not be performed when GBC is suspected. Most determinant prognostic factors are nodal, perineural and venous involvement, invasion of the cystic duct and the tumor differentiation. The simple cholecystectomy is sufficient for tumors classified as T1a; for other cancers exceeding the muscularis, radical re-resection is required due to the high risk of recurrence. This aggressive surgery improved the overall survival of patients. There is still no standard adjuvant treatment; patients should be included in prospective trials.
S. M. Bouchentouf (&) I. Sall H. E. Kaoui H. Baba A. Bounaim A. A. Ali K. Sair A. Zentar Hopital Militaire d’instruction Mohammed V, Rabat, Morocco e-mail: [email protected] S. Raissouni National Oncology Institute, Rabat, Morocco
Keywords Gallbladder cancer Laparoscopy Re-resection
Introduction Cholecystectomy is the most frequent procedure performed in digestive surgery departments. It accounts 1 million procedures per year worldwide. The incidence of gallbladder cancer (GBC) is 3.8% of all digestive cancers and it varies according to regions. 1.3–5% is discovered incidentally when performing cholecystectomy for benign lesions [1–4]. Gallbladder cancer is known to be of a poor prognosis, however, the prognosis of GBC discovered incidentally is better than that found pre-operatively [5, 6]. Over the past decade, the management of GBC discovered incidentally is more codified. Surgery depends on the stage; when well indicated, it helps improve the prognosis. The aim of the present review is to underline the management of GBC based on the comprehension of risk factors and anatomic features.
Method A Medline, PubMed database search was performed to identify articles published from 2000 to 2011 using the keywords ‘carcinoma of gallbladder’, ‘incidental gallbladder cancer’, ‘gallbladder n
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