|
KMID : 1143920210250040492
|
|
Annals of Hepato-Biliary-Pancreatic Surgery
2021 Volume.25 No. 4 p.492 ~ p.499
|
|
|
Determinants of curative resection in incidental gallbladder carcinoma with special reference to timing of referral
|
|
Rahul
Haldeniya Kulbhushan
Singh Ashish
Bhatt Neha
Mishra Prabhakar
Singh Rajneesh Kumar
Saxena Rajan
|
|
|
Abstract
|
|
|
Backgrounds/Aims: Re-resection of incidental gallbladder carcinoma (IGBC) is possible in a select group of patients. However, the optimal timing for re-intervention lacks consensus.
Methods: A retrospective analysis was performed for a prospective database of 91 patients with IGBC managed from 2009 to 2018. Patients were divided into three groups based on the duration between the index cholecystectomy and re-operation or final staging: Early (E), < 4 weeks; Intermediate (I), > 4 weeks and < 12 weeks; and Late (L), > 12 weeks. Demographic data, tumor characteristics, and operative details of patients were analyzed to determine factors affecting the re-resectability of IGBC.
Results: Twenty-two patients in ‘E’, 48 in ‘I’, and 21 in ‘L’ groups were evenly matched. Nearly two thirds were asymptomatic. Curative resection was possible in 48 (52.7%) patients. Metastasis was detected during staging laparoscopy (SL)/laparotomy in 26 (28.6%) patients. The yield of SL was more in the ‘L’ group (30.8%) than in the ‘I’ (11.1%) or ‘E’ (nil) group, avoiding unnecessary laparotomy in 13.6%. Only 28.5% of patients in the ‘L’ group could undergo curative resection (R0/R1 resection), significantly less than that in the ‘E’ (50.0%) or ‘I’ group (64.6%) (both p < 0.001). On multivariate analysis, presentation in intermediate period and tumor differentiation increased the chance of curative resection (p < 0.05).
Conclusions: Asymptomatic patients in the ‘I’ group with well differentiated IGBC have the best chance of obtaining a curative resection.
|
|
|
KEYWORD
|
|
|
Incidental gall bladder cancer, Curative resection determinants, Post-cholecystectomy interval
|
|
|
FullTexts / Linksout information
|
|
|
|
|
|
Listed journal information
|
|
 
|