BRAZILIAN CONSENSUS ON INCIDENTAL GALLBLADDER CARCINOMA

Grupo Internacional de Estudos de Câncer Hepatopancreatobiliar - ISG-HPB-Cancer Felipe Jose F COIMBRA Orlando Jorge M TORRES Ruslan ALIKHANOV Anil AGARWAL Patrick PESSAUX Eduardo de Souza M FERNANDES Claudemiro QUIREZE-JUNIOR Raphael Leonardo C ARAUJO André Luis GODOY Fabio Luis WAECHTER Alexandre Prado de RESENDE Marcio Fernando BOFF Gustavo Rego COELHO Marcelo Bruno de REZENDE Marcelo Moura LINHARES Marcos BELOTTO Jose Maria A MORAES-JUNIOR Paulo Cezar G AMARAL Rinaldo Danesi PINTO Tercio GENZINI Agnaldo Soares LIMA Heber Salvador C RIBEIRO Eduardo José RAMOS Marciano ANGHINONI Lucio Lucas PEREIRA Marcelo ENNE Adriano SAMPAIO André Luis MONTAGNINI Alessandro DINIZ Victor Hugo Fonseca de JESUS Bhawna SIROHI Shailesh V SHRIKHANDE Renata D`Alpino PEIXOTO Antonio Nocchi KALIL Nicolas JARUFE Martin SMITH Paulo HERMAN About the authors

ABSTRACT

Background:

Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis.

Aim:

To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil.

Methods:

Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment.

Results:

Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely.

Conclusions:

It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.

HEADINGS:
Gallbladder; Cancer; Gallbladder cancer; Incidental gallbladder; Consensus

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