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Hepatobiliary I
PTU-084 Incidental gallbladder cancer after laparoscopic cholecystectomy: treatment and surveillance policies in the UK: result of a survey
  1. G Marangoni,
  2. A Hakeem,
  3. G J Toogood,
  4. J P A Lodge,
  5. R K Prasad
  1. HPB and Transplant Unit, St James' Hospital, Leeds, UK

Abstract

Introduction Increasingly diagnosis of early gallbladder cancer (GBC) is incidentally made after laparoscopic cholecystectomy (LC). T stage correlates with nodal metastases and potential for residual disease. Although there is no controversy in the treatment of T1a and T2 tumours, there is still no agreement on what constitutes optimal management for pT1b and the extent of lymphadenectomy for pT2 tumours. Staging, timing of surgery after LC and treatment of the extrahepatic biliary tree are not standardised.

Methods The aim of this study was to assess the treatment, staging and surveillance protocols of incidentally found GBC after LC among hepatobiliary and upper GI surgeons in the UK in the light of the current published literature. A questionnaire on incidental GBC was devised and sent to the Consultant Surgeons members of the Association of Upper GI Surgeons of Great Britain and Ireland after approval from the Association of Upper GI Surgeons Committee. There were 13 questions regarding treatment protocols according to T category (pT1a/pT1b, pT2), treatment of previous port sites, staging protocols, surveillance policies, timing of surgery after LC, extent of lymphadenectomy and management of the extrahepatic biliary tree.

Results There were 48 completed questionnaire. Over 80% would consider simple LC an adequate treatment for T1a tumours. 30% do not advocate radical surgery for T1b and 50% would not perform regional lymphadenectomy. 5% would not further treat T2 tumours and 23% would not add regional lymphadenectomy. Over 50% would not resect port sites. About 50% would consider chest and abdomen CT only for staging. About 30% and 80% would recommend surveillance for CT or MRI for 2–5 years for T1 and T2 tumours after extended resection respectively. 72% would advocate surgery as soon as possible. 22.5% and 20% would perform coeliac trunk lymphadenectomy if staging confirms positive nodes and routinely excise the extrahepatic biliary tree respectively.

Conclusion The only chance of cure for GBC is complete tumour excision. There is heterogeneity among UK surgeons regarding treatment, staging and surveillance policies. According to the survey, UK practice does not fully comply with published evidence for T1a and T2 categories. Although there is increased evidence that T1b tumours would benefit from extended resection only 50% would perform a regional lymphnode dissection. Clear guidelines would help standardisation of staging and surveillance policies.

Competing interests None declared.

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