The incidence of carcinoma gall bladder detected after cholecystectomy for benign diseases varies from 0.3 % to 2.9 %. Because of incidental detection these patients are more likely to have early stage disease. This study describes the results of multimodality treatment of incidental CGB, who presented to our hospital for further therapy after simple cholecystectomy elsewhere.
To analyze the treatment outcomes of incidentally detected carcinoma of gall bladder.
A retrospective review of treatment results of all patients with incidentally detected gallbladder cancers undergoing multimodality management from 1999 to 2012 at the Department of Surgical Oncology, All India Institute of Medical Sciences(AIIMS, New Delhi) was performed.
Sixty-two patients with incidental CGB were re-explored for completion radical cholecystectomy. Thirty (48.3%) and 32(51.7%) patients had laparoscopic and open cholecystectomy respectively for gall stones. The median time of re-exploration after initial surgery was 65 days (Range 19 to 145 days). Twenty patients were found inoperable due to locally advanced unresectable or metastatic disease. Among 42 patients who underwent curative resection, 11(26.1%) developed recurrence over a median follow-up of 16.1 months. Nineteen patients received adjuvant concurrent chemo-radiotherapy after curative resection. The 3 year disease-free and overall-survival for curatively resected patients were stage I (94%& 96%), II (85% &88% ), III (53% &57% ), and IV(32% &35%) respectively.
Incidentally detected carcinoma of gall bladder represents a comparatively favorable sub-group of population of gall bladder cancers where aggressive and timely surgical intervention along with multimodality adjuvant therapy can provide optimal outcomes. Although curative resection at the time of initial surgery itself is ideal, revision surgery should be offered to all patients wherever possible.