Progress of diagnosis and treatment in accidental gallbladder cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SONG Shaoming ¹ ,  TIAN Hongwei ^1,2 , LI Xiaofei ² ,  GUO Tiankang ¹

1. The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, P. R. China;
2. General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou 730000, P. R. China;

Corresponding author：

GUO Tiankang, Email: tiankangguo2019@163.com

Keywords：

accidental gallbladder cancer; intraoperative frozen section; reoperation; review

DOI：

10.7507/1007-9424.202005084

Video：

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Objective To understand the current progress of diagnosis and treatment of accidental gallbladder cancer.Method The relevant literatures about diagnosis and treatment of accidental gallbladder cancer and gallbladder cancer were analyzed and summarized.Results Due to the lack of specific symptoms and signs in most patients with accidental gallbladder cancer at the early stage, appropriate imaging examinations and tumor marker examinations could improve the preoperative diagnosis rate. The radical resection was the most effective method for accidental gallbladder cancer, but there were still some controversies about the scope of resection according to different tumor stages, the choice of laparoscopic cholecystectomy or open cholecystectomy, and the timing of reoperation. The postoperative adjuvant therapy could improve the prognosis of patients, but most patients didn’t receive adjuvant therapy after surgery.Conclusions Most patients with accidental gallbladder cancer are in the early stage, and most of them could obtain radical resection. If the first operation fails to achieve radical resection or postoperative pathological examination to confirm the diagnosis, comprehensive evaluation of the tumor stage and the patient’s general condition should be performed, and remedial treatment should be taken as soon as possible.

Citation： SONG Shaoming, TIAN Hongwei, LI Xiaofei, GUO Tiankang. Progress of diagnosis and treatment in accidental gallbladder cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(3): 409-414. doi: 10.7507/1007-9424.202005084 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	Søreide K, Guest RV, Harrison EM, et al. Systematic review of management of incidental gallbladder cancer after cholecystectomy. Br J Surg, 2019, 106(1): 32-45.
3.	Cavallaro A, Piccolo G, Panebianco V, et al. Incidental gallbladder cancer during laparoscopic cholecystectomy: managing an unexpected finding. World J Gastroenterol, 2012, 18(30): 4019-4027.
4.	Schmidt MA, Marcano-Bonilla L, Roberts LR. Gallbladder cancer: epidemiology and genetic risk associations. Chin Clin Oncol, 2019, 8(4): 31.
5.	吕文才, 邹运, 温爽, 等. 中国胆囊癌发病率及流行趋势分析. 中华消化外科杂志, 2019, 18(2): 186-189.
6.	Hamdani NH, Qadri SK, Aggarwalla R, et al. Clinicopathological study of gallbladder carcinoma with special reference to gallstones: our 8-year experience from eastern India. Asian Pac J Cancer Prev, 2012, 13(11): 5613-5617.
7.	Hickman L, Contreras C. Gallbladder cancer: diagnosis, surgical management, and adjuvant therapies. Surg Clin North Am, 2019, 99(2): 337-355.
8.	Baiu I, Visser B. Gallbladder cancer. JAMA, 2018, 320(12): 1294.
9.	Elmasry M, Lindop D, Dunne DF, et al. The risk of malignancy in ultrasound detected gallbladder polyps: a systematic review. Int J Surg, 2016, 33 Pt A: 28-35.
10.	Sandrasegaran K, Menias CO. Imaging and screening of cancer of the gallbladder and bile ducts. Radiol Clin North Am, 2017, 55(6): 1211-1222.
11.	Koshiol J, Wozniak A, Cook P, et al. Salmonella enterica serovar Typhi and gallbladder cancer: a case-control study and meta-analysis. Cancer Med, 2016, 5(11): 3310-3235.
12.	Xu JM, Guo LH, Xu HX, et al. Differential diagnosis of gallbladder wall thickening: the usefulness of contrast-enhanced ultrasound. Ultrasound Med Biol, 2014, 40(12): 2794-2804.
13.	Li B, Xu XX, Du Y, et al. Computed tomography for assessing resectability of gallbladder carcinoma: a systematic review and meta-analysis. Clin Imaging, , 2013, 37(2): 327-333.
14.	de Savornin Lohman EAJ, de Bitter TJJ, van Laarhoven CJHM, et al. The diagnostic accuracy of CT and MRI for the detection of lymph node metastases in gallbladder cancer: a systematic review and meta-analysis. Eur J Radiol, 2019, 110: 156-162.
15.	Calabria FF, Leporace M, Bagnato A. Situs inversus totalis and cholangiocarcinoma of the gallbladder detected by ¹⁸F-FDG PET/CT. Clin Nucl Med, 2018, 43(6): 439-440.
16.	Fu Z, Chen X, Yang X, et al. Cholesterol granuloma masquerading as gallbladder carcinoma on ¹⁸F-FDG PET/CT. Clin Nucl Med, 2019, 44(6): 489-490.
17.	Zhang Y, Jiang C, Li J, et al. Prognostic significance of preoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients with gallbladder carcinoma. Clin Transl Oncol, 2015, 17(10): 810-818.
18.	Montalvo-Jave EE, Rahnemai-Azar AA, Papaconstantinou D, et al. Molecular pathways and potential biomarkers in gallbladder cancer: A comprehensive review. Surg Oncol, 2019, 31: 83-89.
19.	Cavallaro A, Piccolo G, Di Vita M, et al. Managing the incidentally detected gallbladder cancer: algorithms and controversies. Int J Surg, 2014, 12 Suppl 2: S108-S119.
20.	Goetze TO. Gallbladder carcinoma: Prognostic factors and therapeutic options. World J Gastroenterol, 2015, 21(43): 12211-12217.
21.	Tian YH, Ji X, Liu B, et al. Surgical treatment of incidental gallbladder cancer discovered during or following laparoscopic cholecystectomy. World J Surg, 2015, 39(3): 746-752.
22.	Hari DM, Howard JH, Leung AM, et al. A 21-year analysis of stage Ⅰ gallbladder carcinoma: is cholecystectomy alone adequate? HPB (Oxford), 2013, 15(1): 40-48.
23.	de Aretxabala X, Oppliger F, Solano N, et al. Laparoscopic management of incidental gallbladder cancer. Surg Endosc, 2018, 32(10): 4251-4255.
24.	Yoon JH, Lee YJ, Kim SC, et al. What is the better choice for T1b gallbladder cancer: simple versus extended cholecystectomy. World J Surg, 2014, 38(12): 3222-3227.
25.	Vo E, Curley SA, Chai CY, et al. National failure of surgical staging for T1b gallbladder cancer. Ann Surg Oncol, 2019, 26(2): 604-610.
26.	Kwon AH, Imamura A, Kitade H, et al. Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy. J Surg Oncol, 2008, 97(3): 241-245.
27.	张铃福, 侯纯升, 郭丽梅, 等. 术中冰冻或术后石蜡病理报告 T1b 期胆囊癌的外科治疗策略. 北京大学学报(医学版), 2017, 49(6): 1034-1037.
28.	Shindoh J, de Aretxabala X, Aloia TA, et al. Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study. Ann Surg, 2015, 261(4): 733-739.
29.	Shirai Y, Wakai T, Sakata J, et al. Regional lymphadenectomy for gallbladder cancer: rational extent, technical details, and patient outcomes. World J Gastroenterol, 2012, 18(22): 2775-2783.
30.	Du J, Yang XW, Wen ZJ, et al. Relationship between prognosis and time interval from cholecystectomy to reoperation in postoperative incidental gallbladder carcinoma. Chin Med J (Engl), 2018, 131(20): 2503-2505.
31.	Ethun CG, Postlewait LM, Le N, et al. Association of optimal time interval to re-resection for incidental gallbladder cancer with overall survival: a multi-institution analysis from the US extrahepatic biliary malignancy consortium. JAMA Surg, 2017, 152(2): 143-149.
32.	Isambert M, Leux C, Métairie S, et al. Incidentally-discovered gallbladder cancer: When, why and which reoperation? J Visc Surg, 2011, 148(2): e77-e84.
33.	Zaidi MY, Abou-Alfa GK, Ethun CG, et al. Evaluation and management of incidental gallbladder cancer. Chin Clin Oncol, 2019, 8(4): 37.
34.	Cherkassky L, D’Angelica M. Gallbladder cancer: managing the incidental diagnosis. Surg Oncol Clin N Am, 2019, 28(4): 619-630.
35.	刘全达, 许小亚, 周宁新. 从穿刺孔转移思考腹腔镜机器人胆道肿瘤外科. 中华腔镜外科杂志(电子版), 2013, 6(5): 373-376.
36.	Maker AV, Butte JM, Oxenberg J, et al. Is port site resection necessary in the surgical management of gallbladder cancer? Ann Surg Oncol, 2012, 19(2): 409-417.
37.	Berger-Richardson D, Chesney TR, Englesakis M, et al. Trends in port-site metastasis after laparoscopic resection of incidental gallbladder cancer: A systematic review. Surgery, 2017, 161(3): 618-627.
38.	Ethun CG, Postlewait LM, Le N, et al. Routine port-site excision in incidentally discovered gallbladder cancer is not associated with improved survival: A multi-institution analysis from the US extrahepatic biliary malignancy consortium. J Surg Oncol, 2017, 115(7): 805-811.
39.	Go SI, Kim YS, Hwang IG, et al. Is there a role for adjuvant therapy in R0 resected gallbladder cancer?: A propensity score-matched analysis. Cancer Res Treat, 2016, 48(4): 1274-1285.
40.	Ghidini M, Tomasello G, Botticelli A, et al. Adjuvant chemotherapy for resected biliary tract cancers: a systematic review and meta-analysis. HPB (Oxford), 2017, 19(9): 741-748.
41.	Mantripragada KC, Hamid F, Shafqat H, et al. Adjuvant therapy for resected gallbladder cancer: analysis of the National Cancer Data Base. J Natl Cancer Inst, 2016, 109(2): djw202.
42.	Kasumova GG, Tabatabaie O, Najarian RM, et al. Surgical management of gallbladder cancer. Ann Surg, 2017, 266(4): 625.
43.	Engineer R, Goel M, Chopra S, et al. Neoadjuvant chemoradiation followed by surgery for locally advanced gallbladder cancers: a new paradigm. Ann Surg Oncol, 2016, 23(9): 3009-3015.
44.	Creasy JM, Goldman DA, Dudeja V, et al. Systemic chemotherapy combined with resection for locally advanced gallbladder carcinoma: surgical and survival outcomes. J Am Coll Surg, 2017, 224(5): 906-916.
45.	中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科专业委员会. 胆囊癌诊断和治疗指南(2019 版). 中华外科杂志, 2020, 58(4): 243-251.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. Søreide K, Guest RV, Harrison EM, et al. Systematic review of management of incidental gallbladder cancer after cholecystectomy. Br J Surg, 2019, 106(1): 32-45.
3. Cavallaro A, Piccolo G, Panebianco V, et al. Incidental gallbladder cancer during laparoscopic cholecystectomy: managing an unexpected finding. World J Gastroenterol, 2012, 18(30): 4019-4027.
4. Schmidt MA, Marcano-Bonilla L, Roberts LR. Gallbladder cancer: epidemiology and genetic risk associations. Chin Clin Oncol, 2019, 8(4): 31.
5. 吕文才, 邹运, 温爽, 等. 中国胆囊癌发病率及流行趋势分析. 中华消化外科杂志, 2019, 18(2): 186-189.
6. Hamdani NH, Qadri SK, Aggarwalla R, et al. Clinicopathological study of gallbladder carcinoma with special reference to gallstones: our 8-year experience from eastern India. Asian Pac J Cancer Prev, 2012, 13(11): 5613-5617.
7. Hickman L, Contreras C. Gallbladder cancer: diagnosis, surgical management, and adjuvant therapies. Surg Clin North Am, 2019, 99(2): 337-355.
8. Baiu I, Visser B. Gallbladder cancer. JAMA, 2018, 320(12): 1294.
9. Elmasry M, Lindop D, Dunne DF, et al. The risk of malignancy in ultrasound detected gallbladder polyps: a systematic review. Int J Surg, 2016, 33 Pt A: 28-35.
10. Sandrasegaran K, Menias CO. Imaging and screening of cancer of the gallbladder and bile ducts. Radiol Clin North Am, 2017, 55(6): 1211-1222.
11. Koshiol J, Wozniak A, Cook P, et al. Salmonella enterica serovar Typhi and gallbladder cancer: a case-control study and meta-analysis. Cancer Med, 2016, 5(11): 3310-3235.
12. Xu JM, Guo LH, Xu HX, et al. Differential diagnosis of gallbladder wall thickening: the usefulness of contrast-enhanced ultrasound. Ultrasound Med Biol, 2014, 40(12): 2794-2804.
13. Li B, Xu XX, Du Y, et al. Computed tomography for assessing resectability of gallbladder carcinoma: a systematic review and meta-analysis. Clin Imaging, , 2013, 37(2): 327-333.
14. de Savornin Lohman EAJ, de Bitter TJJ, van Laarhoven CJHM, et al. The diagnostic accuracy of CT and MRI for the detection of lymph node metastases in gallbladder cancer: a systematic review and meta-analysis. Eur J Radiol, 2019, 110: 156-162.
15. Calabria FF, Leporace M, Bagnato A. Situs inversus totalis and cholangiocarcinoma of the gallbladder detected by ¹⁸F-FDG PET/CT. Clin Nucl Med, 2018, 43(6): 439-440.
16. Fu Z, Chen X, Yang X, et al. Cholesterol granuloma masquerading as gallbladder carcinoma on ¹⁸F-FDG PET/CT. Clin Nucl Med, 2019, 44(6): 489-490.
17. Zhang Y, Jiang C, Li J, et al. Prognostic significance of preoperative neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in patients with gallbladder carcinoma. Clin Transl Oncol, 2015, 17(10): 810-818.
18. Montalvo-Jave EE, Rahnemai-Azar AA, Papaconstantinou D, et al. Molecular pathways and potential biomarkers in gallbladder cancer: A comprehensive review. Surg Oncol, 2019, 31: 83-89.
19. Cavallaro A, Piccolo G, Di Vita M, et al. Managing the incidentally detected gallbladder cancer: algorithms and controversies. Int J Surg, 2014, 12 Suppl 2: S108-S119.
20. Goetze TO. Gallbladder carcinoma: Prognostic factors and therapeutic options. World J Gastroenterol, 2015, 21(43): 12211-12217.
21. Tian YH, Ji X, Liu B, et al. Surgical treatment of incidental gallbladder cancer discovered during or following laparoscopic cholecystectomy. World J Surg, 2015, 39(3): 746-752.
22. Hari DM, Howard JH, Leung AM, et al. A 21-year analysis of stage Ⅰ gallbladder carcinoma: is cholecystectomy alone adequate? HPB (Oxford), 2013, 15(1): 40-48.
23. de Aretxabala X, Oppliger F, Solano N, et al. Laparoscopic management of incidental gallbladder cancer. Surg Endosc, 2018, 32(10): 4251-4255.
24. Yoon JH, Lee YJ, Kim SC, et al. What is the better choice for T1b gallbladder cancer: simple versus extended cholecystectomy. World J Surg, 2014, 38(12): 3222-3227.
25. Vo E, Curley SA, Chai CY, et al. National failure of surgical staging for T1b gallbladder cancer. Ann Surg Oncol, 2019, 26(2): 604-610.
26. Kwon AH, Imamura A, Kitade H, et al. Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy. J Surg Oncol, 2008, 97(3): 241-245.
27. 张铃福, 侯纯升, 郭丽梅, 等. 术中冰冻或术后石蜡病理报告 T1b 期胆囊癌的外科治疗策略. 北京大学学报(医学版), 2017, 49(6): 1034-1037.
28. Shindoh J, de Aretxabala X, Aloia TA, et al. Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study. Ann Surg, 2015, 261(4): 733-739.
29. Shirai Y, Wakai T, Sakata J, et al. Regional lymphadenectomy for gallbladder cancer: rational extent, technical details, and patient outcomes. World J Gastroenterol, 2012, 18(22): 2775-2783.
30. Du J, Yang XW, Wen ZJ, et al. Relationship between prognosis and time interval from cholecystectomy to reoperation in postoperative incidental gallbladder carcinoma. Chin Med J (Engl), 2018, 131(20): 2503-2505.
31. Ethun CG, Postlewait LM, Le N, et al. Association of optimal time interval to re-resection for incidental gallbladder cancer with overall survival: a multi-institution analysis from the US extrahepatic biliary malignancy consortium. JAMA Surg, 2017, 152(2): 143-149.
32. Isambert M, Leux C, Métairie S, et al. Incidentally-discovered gallbladder cancer: When, why and which reoperation? J Visc Surg, 2011, 148(2): e77-e84.
33. Zaidi MY, Abou-Alfa GK, Ethun CG, et al. Evaluation and management of incidental gallbladder cancer. Chin Clin Oncol, 2019, 8(4): 37.
34. Cherkassky L, D’Angelica M. Gallbladder cancer: managing the incidental diagnosis. Surg Oncol Clin N Am, 2019, 28(4): 619-630.
35. 刘全达, 许小亚, 周宁新. 从穿刺孔转移思考腹腔镜机器人胆道肿瘤外科. 中华腔镜外科杂志(电子版), 2013, 6(5): 373-376.
36. Maker AV, Butte JM, Oxenberg J, et al. Is port site resection necessary in the surgical management of gallbladder cancer? Ann Surg Oncol, 2012, 19(2): 409-417.
37. Berger-Richardson D, Chesney TR, Englesakis M, et al. Trends in port-site metastasis after laparoscopic resection of incidental gallbladder cancer: A systematic review. Surgery, 2017, 161(3): 618-627.
38. Ethun CG, Postlewait LM, Le N, et al. Routine port-site excision in incidentally discovered gallbladder cancer is not associated with improved survival: A multi-institution analysis from the US extrahepatic biliary malignancy consortium. J Surg Oncol, 2017, 115(7): 805-811.
39. Go SI, Kim YS, Hwang IG, et al. Is there a role for adjuvant therapy in R0 resected gallbladder cancer?: A propensity score-matched analysis. Cancer Res Treat, 2016, 48(4): 1274-1285.
40. Ghidini M, Tomasello G, Botticelli A, et al. Adjuvant chemotherapy for resected biliary tract cancers: a systematic review and meta-analysis. HPB (Oxford), 2017, 19(9): 741-748.
41. Mantripragada KC, Hamid F, Shafqat H, et al. Adjuvant therapy for resected gallbladder cancer: analysis of the National Cancer Data Base. J Natl Cancer Inst, 2016, 109(2): djw202.
42. Kasumova GG, Tabatabaie O, Najarian RM, et al. Surgical management of gallbladder cancer. Ann Surg, 2017, 266(4): 625.
43. Engineer R, Goel M, Chopra S, et al. Neoadjuvant chemoradiation followed by surgery for locally advanced gallbladder cancers: a new paradigm. Ann Surg Oncol, 2016, 23(9): 3009-3015.
44. Creasy JM, Goldman DA, Dudeja V, et al. Systemic chemotherapy combined with resection for locally advanced gallbladder carcinoma: surgical and survival outcomes. J Am Coll Surg, 2017, 224(5): 906-916.
45. 中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科专业委员会. 胆囊癌诊断和治疗指南(2019 版). 中华外科杂志, 2020, 58(4): 243-251.

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Progress of diagnosis and treatment in accidental gallbladder cancer

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