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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2013 December;26(6):389-93
Incidental diagnosis of gallbladder cancer after VLC: our experience and review of the literature
De Werra C., Di Micco R., Aloia S., Bracciano L., Del Giudice R., Cervotti M., Galloro G., Bucci L.
Department of General, Geriatric Oncologic Surgery and Advanced Technologies University Federico II, Naples, Italy
Aim: Incidental gallbladder cancer (GBC) is a more and more frequent medical entity discovered on the specimen after a cholecystectomy for a benign disease. Our aim is to value the importance of incidental diagnosis of gallbladder cancer based on our experience.
Methods: Data on patients treated with videolaparoscopic cholecystectomy (VLC) from January 2000 to December 2010 for lithiasis were retrospectively analyzed. In all cases all precautions were taken to reduce eventual cancer spreading (endobag, CO2 drainage through trocars and avoidance of gallbladder injuries).
Results: From 2000 to 2010, 318 patients underwent to VLC after preoperative US positive for gallstones. VLC has been realized in all patients with a rate of conversion of 0%. In 3 of these patients (0.9%) the GBC was incidentally discovered during pathological exam of specimen, the survival for all patients has been longer than three years. The casual finding of cancer during VLC has become a frequent event, from 0.2 to 2.9% of cases in literature (0.9% in our personal experience). Good results were obtained for pTis and pT1b in general experience of the literature, while higher stages regardless comorbidities frequent in old patients, leaves less choice in therapy.
Conclusion: The incidental diagnosis of GBC gives the possibility to treat at an earlier stage a very aggressive disease, thus improving the prognosis, VLC in all patient with gallstones and other risk factors (abnormal biliary junction and polyps >1 cm) is a good way to modify the survival in GBC.