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Lookup NU author(s): Jeremy French, Richard Charnley
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INTRODUCTION Advanced (pT2/T3) incidental gallbladder cancer is often deemed unresectable after restaging. This study assesses the impact of the primary operation, tumour characteristics and timing of management on re-resection. METHODS The records of 60 consecutive referrals for incidental gallbladder cancer in a single tertiary centre from 2003 to 2011 were reviewed retrospectively. Decision on re-resection of incidental gallbladder cancer was based on delayed interval restaging at three months following cholecystectomy. Demographics, index cholecystectomy data, primary pathology, CA19-9 tumour marker levels at referral and time from cholecystectomy to referral as well as from referral to restaging were analysed. RESULTS Thirty-seven patients with pT2 and twelve patients with pT3 incidental gallbladder cancer were candidates for radical re-resection. Following interval restaging, 24 patients (49%) underwent radical resection and 25 (51%) were deemed inoperable. The inoperable group had significantly more patients with positive resection margins at cholecystectomy (p=0.002), significantly higher median CA19-9 levels at referral (p=0.018) and were referred significantly earlier (p=0.004) than the patients who had resectable tumours. On multivariate analysis, urgent referral (p=0.036) and incomplete cholecystectomy (p=0.048) were associated significantly with inoperable disease following restaging. CONCLUSIONS In patients with incidental, potentially resectable, pT2/T3 gallbladder cancer, inappropriate index cholecystectomy may have a significant impact on tumour dissemination. Early referral of breached tumours is not associated with resectability.
Author(s): Tsirlis T, Ausania F, White SA, French JJ, Jaques BC, Charnley RM, Manas DM
Publication type: Article
Publication status: Published
Journal: Annals of the Royal College of Surgeons of England
Year: 2015
Volume: 97
Issue: 2
Pages: 131-136
Print publication date: 01/03/2015
Online publication date: 12/06/2015
Acceptance date: 22/10/2014
ISSN (print): 0035-8843
Publisher: Royal College of Surgeons of England
URL: http://doi.org/10.1308/003588414X14055925060073
DOI: 10.1308/003588414X14055925060073
PubMed id: 25723690
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