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Management of incidental gallbladder cancer in a national cohort
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping.
Skåne Univ Hosp, Sweden; Lund Univ, Sweden.
Jonkoping Univ, Sweden.
Ryhov Hosp, Sweden.
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2019 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 106, no 9, p. 1216-1227Article in journal (Refereed) Published
Abstract [en]

Background Incidental gallbladder cancer is a rare event, and its prognosis is largely affected by the tumour stage and treatment. The aim of this study was to analyse the management, treatment and survival of patients with incidental gallbladder cancer in a national cohort over a decade. Methods Patients were identified through the Swedish Registry of Gallstone Surgery (GallRiks). Data were cross-linked to the national registry for liver surgery (SweLiv) and the Cancer Registry. Medical records were collected if registry data were missing. Survival was measured as disease-specific survival. The study was divided into two intervals (2007-2011 and 2012-2016) to evaluate changes over time. Results In total, 249 patients were identified with incidental gallbladder cancer, of whom 92 (36 center dot 9 per cent) underwent re-resection with curative intent. For patients with pT2 and pT3 disease, median disease-specific survival improved after re-resection (12 center dot 4 versus 44 center dot 1 months for pT2, and 9 center dot 7 versus 23 center dot 0 months for pT3). Residual disease was present in 53 per cent of patients with pT2 tumours who underwent re-resection; these patients had a median disease-specific survival of 32 center dot 2 months, whereas the median was not reached in patients without residual disease. Median survival increased by 11 months for all patients between the early and late periods (P = 0 center dot 030). Conclusion Re-resection of pT2 and pT3 incidental gallbladder cancer was associated with improved survival, but survival was impaired when residual disease was present. A higher re-resection rate and more R0 resections in the later time period may have been associated with improved survival.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019. Vol. 106, no 9, p. 1216-1227
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-159068DOI: 10.1002/bjs.11205ISI: 000474059700001PubMedID: 31259388OAI: oai:DiVA.org:liu-159068DiVA, id: diva2:1338400
Available from: 2019-07-22 Created: 2019-07-22 Last updated: 2019-08-23
In thesis
1. Incidental Gallbladder Cancer: Incidence, predictors, management and outcome in a Swedish population
Open this publication in new window or tab >>Incidental Gallbladder Cancer: Incidence, predictors, management and outcome in a Swedish population
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Cholecystectomy is a common surgical procedure and incidental gallbladder cancer is a rare and unexpected finding at a cholecystectomy performed upon benign indications. Whether to perform routine or selective histopathology of the gallbladder specimen is still a subject for discussion. The prognosis of gallbladder cancer is largely affected by tumour stage and treatment.

Aims: The overall aim was to study whether routine histological examination of the gallbladder specimen is of clinical and health economic value; determine if there are any predictive factors of incidental gallbladder cancer at benign cholecystectomy and compare the management and outcome of incidental gallbladder cancer patients in Sweden.

Methods: All studies were based on registry data from GallRiks (The Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography) between 2007 and 2016, with some modifications between studies. Complemental cross-linkage was made to national registries, and medical records were reviewed. Papers I, II and III were population-based observational studies with prospectively and retrospectively collected data. Paper IV was a health economic evaluation based on the results from papers I and III.

Results and conclusions: Hospitals submitting >75 per cent of gallbladder specimens diagnosed a higher proportion of incidental gallbladder cancer than did hospitals submitting ≤25 per cent of samples (paper I). Incidental gallbladder cancer was more prevalent in older patients, women and patients with acute or previous cholecystitis, as well as ongoing jaundice. The risk model based on predictive preoperative factors was further improved by adding a macroscopic assessment of the gallbladder (paper II). Predictive factors for gallbladder cancer appeared to have an impact on which specimens were submitted in hospitals with a selective approach of histopathology (paper I). For pT2 and pT3 patients, re-resection improved diseasespecific survival, although these groups differed in terms of age and comorbidity (paper III). Residual disease was an independent factor for impaired survival. A change to routine histopathology of gallbladder specimens in Sweden would lead to increased costs with little improved health outcomes. Instead, a more standardized approach to selective histology would be needed (paper IV).

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2019
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1695
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-159835 (URN)9789176850152 (ISBN)
Public defence
2019-09-27, Hasselqvistsalen, Hus 511, Campus US, Linköping, 09:00 (English)
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Available from: 2019-08-23 Created: 2019-08-23 Last updated: 2019-08-23Bibliographically approved

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Lundgren, LindaGimm, OliverSandström, Per A

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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health SciencesDepartment of Surgery in Linköping
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