Gallbladder Cancer Discovered on Histological Specimen after Cholecystectomy: The Patients Whom do not Need Reoperation

A significant percentage of patients with a histological discovery of gallbladder cancer cannot benefit from resection of the tumor residue during complementary surgery. Despite the contribution of modern complementary examinations, the predictability of resection remains problematic. The objective of this work is to define a score that can predict the resectability of the residual tissue.

Material and Method: All patients with cancer discovered on the operating room and having a complete file were included. The patients were divided into 3 groups A: patients who underwent resection, group B is formed by patients who underwent monitoring after cholecystectomy and group C consists of patients who could not benefit tumor resection. A score consisting of several the score was established. It is made up of clinical signs (pain, jaundice, palpable mass, etc.) side 0 to 4, morphological signs in favor of the tumor residue (ultrasound and / or CT and / or MRI) side 0 to 1, and tumor markers (Ca19.9 and CEA) side from 0 to 4 points. Each criterion has an annotation from 0 to 1 and from 0 to 4 is noted between one to 4 points depending on its importance.

Results: one hundred and sixty-two were included. These are 138 women and 24 men with an average age of 67 years (26-85 years). The 3 groups A, B and C consist respectively of 79, 32 and 51 patients. The presence of a clinical symptom, an abnormal morphological examination and a high marker in the patient is significantly associated with the absence of tumor resection during additional surgery or at the time of recurrence for group B. The average time for complementary surgery was 103.8 days (30 - 387 days) for the 122 patients who underwent complementary surgery. The respective average times for group A and C are 102.2 and 109.6 (Not significant). The score increases from group A to group C. For patients of group A, 84,8% of them have a score of 0-2 while only 21,5% of group C have the same score. The resection rate goes respectively from 86,1% for the score 0 – 2 and fail to respectively to 18,5% and 07,1% for the score 3 – 7 and 8 - 13 (one resection for 68patients). Survival goes from 41.7% to 01,25% and 00% respectively for the same scores, 0 – 2, 3 -7 and equal or superior to more than 8 points. Thus, the majority of patients who benefit from resection and 5-year survival had a score between 0 - 2 (resection rate of 86.1% and 5-year survival of 41.5%), while at beyond 3 points, the resection rate and 5-year survival are only 18,5% and 07,1% and 00%.

Conclusion: This study shows that the established score allows a large proportion to predict resection and survival before additional surgery for gallbladder cancer discovered on resected specimen. It can bring means to better choice a new indication for the advanced stages and not operate systematically. The new direction could be neoadjuvant therapy.