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Background: Re-radical surgery is the only curative therapy for unsuspected gallbladder carcinoma (UGC). The aim of this study was to compare prognosis of pT3 UGC patients receiving anatomic hepatectomy (AH) or wedge hepatectomy (WH) combined with en bloc local-regional lymphadenectomy of the hepatoduodenal ligament using propensity score-matching (PSM) analysis. Materials and Methods: A retrospective study was carried out on 81 consecutive pT3 UGC patients who underwent radical re-resection at Eastern Hepatobiliary Surgery Hospital from 2006 to 2015. Overall survival (OS) was estimated using Kaplan-Meier method. The difference in OS between the AH and WH groups was analyzed using the log-rank test and the PSM method. Result: The AH and WH groups showed no significant difference in OS (P > .05) by either log-rank test or PSM analysis. Conclusions: Both AH and WH radical re-resections are effective treatments for UCG patients with pT3 tumors. [ABSTRACT FROM AUTHOR]

Background: The morbidity of unsuspected gallbladder carcinoma (UGC) has increased. This study was aimed to explore the factors which may influence the therapeutic strategies and prognosis of UCG. Additionally, long-term prognosis of laparoscopic and open surgeries of UGC was comparatively investigated. Methods: Thirty-eight cases of UGC were enrolled in this study. Statistical analysis of survival was performed using the Kaplan-Meier test and the results were examined using the log-rank test. Results: The morbidity of UGC was 0.43 %. The cancer stagings were: pT1a (one), pT1b (11), pT2 (14), pT3 (10), pT3N1 (one), and pT4 (one). The median lifespan of the entire cohort was 20.0 ± 6.5 months, one-year survival rate was 44 %, and five-year survival rate was 11 %. One-year recurrence- free survival rate was 44 % and three-year recurrence- free survival rate was 0 %. Twenty-eight patients sustained cancer recurrence and three patients sustained port-site cancer recurrence. The cancer staging (P < 0.01) and radical resection P < 0.01) were independent factors for both overall and recurrence-free survival. Radical resection improved the prognosis of the patients with pT2 stage UGC (P < 0.05), but no significant impact on the prognosis of the patients with pT1b (P = 0.362) or pT3 stage (P = 0.221)UGC. Survival rates were not significantly affected by the first operation no matter it was laparoscopic surgery or open surgery (P = 0.12). Conclusion: Radical resection surgery is recommended in pT2 stage UGC. There is no difference for the long-term prognosis between laparoscopic surgery (cholecystectomy) and open surgery of UCG. [ABSTRACT FROM AUTHOR]

Background: The long-term survival of patients with unsuspected gallbladder carcinoma (UGC) and the role of radical re-resection for this disease remain unclear. Methods: A retrospective study was carried out on 38 UGC patients. The time-to-event data were demonstrated by Kaplan-Meier curves. Comparing survival curves of two groups using the log-rank test. Results: The overall incidence of UGC in patients underwent cholecystectomy in our hospital was 0.18 % (25 of 14,073). Distribution according to actual pT-stage (the UICC) was: pT1a: n = 3; pT1b: n = 11; pT2: n = 4; pT3: n = 12; pT4: n = 8. The preoperative diagnosis included a high rate of acute biliary tract inflammation (24 of 38, 63.2 %). Compared with other gallbladder carcinoma patients, UGC group had significantly higher proportion of early stages (pT1) (36.8 %, 14 of 38 cases) ( p < 0.01), and better prognosis. The comparison of radical re-resection versus simple cholecystectomy showed a significant benefit in overall survival for the pT3 group (22.0 ± 5.48 vs. 5.0 ± 0.9 months; p = 0.02). There are median survival differences between the two subgroups of patients with pT1b tumors whether received re-resection or not. Median survival was 62.0 months and 24.0 ± 8.5 months, respectively, though the differences are not statistically significant ( p = 0.131). Conclusion: Radical re-resection is strongly recommended for patients with pT1b-stage cancer. The reoperation should be performed as soon as possible, preferably within 10 days after the initial operation. [ABSTRACT FROM AUTHOR]

Many cases have been reported of disastrous port-site recurrence after laparoscopic cholecystectomy (LC) revealed unsuspected gallbladder carcinoma (GBC). Some investigators have reported that the prognosis of patients after LC showed unsuspected GBC is not worsened by laparoscopic procedures. We retrospectively reviewed our cases and the literature to reconfirm the intrinsic risks of LC for unsuspected GBC. Of 1663 patients who underwent LC from January 1991 to December 2003 in a single institution, 9 (0.54%) with unsuspected GBC were reviewed. These 9 patients consisted of 5 men and 4 women, whose ages ranged from 58 to 87 years, with a median age of 73 years. Two patients with a pT1a tumor (limited to mucosa) and 2 patients with a pT1b tumor (muscle layer) underwent no further operation. The remaining 5 patients with a pT2 tumor (subserosa) underwent further operations with lymph node dissection. Five patients (2 patients with pT1b and 3 patients with pT2) developed recurrence and all of them died within a median period of 19 months (range 14–37 months) after LC. The causes of death were bone metastases in 1 patient (pT2), local recurrence in 2 patients (pT1b and pT2), and peritoneal metastasis in 2 patients (one elderly patient with pT1b who underwent laparoscopic common bile duct exploration, and one patient with pT2 in whom the cystic duct was damaged during surgery). Four patients (2 with pT1 and 2 with pT2) have been doing well with a median follow-up of 39.5 months (range 12–99 months) after LC. Surgeons should always prevent bile spillage during LC and when removing the resected gallbladder. When laparoscopic common bile duct exploration is planned, especially for elderly women, surgeons should also bear in mind the increasing possibility of unsuspected GBC. [ABSTRACT FROM AUTHOR]