Incidental pT2‐T3 gallbladder cancer after a cholecystectomy: outcome of staging at 3 months prior to a radical resection. Issue 8 (7th January 2013)

• Record Type: Journal Article
• Authors: Ausania, Fabio; Tsirlis, Theodoris; White, Steven A.; French, Jeremy J.; Jaques, Bryon C.; Charnley, Richard M.; Manas, Derek M.
• Is Part Of: HPB. Volume 15:Issue 8(2013:Aug.)
• Page Start: 633
• Page End: 637
• Publication Date: 2013-01-07
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12032
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="hpb12032-sec-0001" sec-type="section"> <title>Introduction</title> <p>Patients with incidental pT2‐T3 gallbladder cancer (IGC) after a cholecystectomy may benefit from a radical re‐resection although their optimal treatment strategy is not well defined. In this Unit, such patients undergo delayed staging at 3 months after a cholecystectomy to assess the evidence of a residual tumour, extra hepatic spread and the biological behaviour of the tumour. The aim of this study was to evaluate the outcome of patients who had delayed staging at 3 months after a cholecystectomy.</p> </sec> <sec id="hpb12032-sec-0002" sec-type="section"> <title>Methods</title> <p>From July 2003 to July 2011, 56 patients with T2‐T3 gallbladder cancer were referred to this Unit of which 49 were diagnosed incidentally on histology after a cholecystectomy. All 49 patients underwent delayed pre‐operative staging using multi‐detector computed tomography (MDCT) followed selectively by laparoscopy at 3 months after a cholecystectomy. Data were collected from a prospectively held database. The peri‐operative and long‐term outcomes of patients were analysed. SPSS software was used for statistical analysis.</p> </sec> <sec id="hpb12032-sec-0003" sec-type="section"> <title>Results</title> <p>There were 38 pT2 and 11 pT3 tumours. After delayed staging, 24/49 (49%) patients underwent a radical resection, 24/49 (49%) were found to be inoperable on pre‐operative assessment and 1/49 (2%) patient underwent an exploratory laparotomy and were found to be unresectable. The overall median survival from referral was 20.7 months (54.8 months for the group who had a radical re‐resection versus 9.7 months for the group who had unresectable disease, <italic>P</italic> < 0.001). These results compare favourably with the reported outcome of fast‐track management for incidental pT2‐T3 gallbladder cancer from other major series in the literature.</p> </sec> <sec id="hpb12032-sec-0004" sec-type="section"> <title>Conclusion</title> <p>Delayed staging in patients with incidental T2‐T3 gallbladder cancer after a cholecystectomy is a useful strategy to select patients who will benefit from a resection and avoid unnecessary major surgery.</p> </sec> </abstract>