Incidental gallbladder cancer and its contemporary management: From evaluation to targeted therapy

Abstract

Gall bladder cancer (GBC) is the commonest malignancy of biliary tract. It is locally aggressive and potentially fatal in most of the patients. With the rise in the number of laparoscopic cholecystectomies being performed worldwide, incidental presentation of GBC is becoming common. The revelation of cancer for benign cholecystectomy presents a challenge. Incidental GBC needs detailed evaluation that includes review of preoperative imaging, histopathology report of cholecystectomy and high quality imaging to look for residual or metastatic disease. It is imperative to correctly stage the disease to formulate the best treatment strategy. For assessment of disease, triple-phase Contrast Enhanced Computed Tomography (CECT) scan and staging laparoscopy have definite roles; with Positron Emission Tomography and Computed Tomography (PET/CT) useful in confirming suspicious lesions. The factors associated with poor prognosis is presence of residual disease, lymphovascular invasion, grade of tumor and presence of metastatic lymph nodes. Neoadjuvant chemotherapy can be employed for the patients who are not candidate for upfront re-resection. Surgery includes liver excision and lymphadenectomy. Adjuvant therapy is indicated for higher stage tumor for improving survival, but response rate is low. Evaluation of biomarkers can provide a target for novel therapy.