08 Jul, 2020

BRAZILIAN CONSENSUS ON INCIDENTAL GALLBLADDER CARCINOMA

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
DOI: 10.1590/0102-672020190001e1496
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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.


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ABCD – BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY is a periodic with a single annual volume in continuous publication, official organ of the Brazilian College of Digestive Surgery - CBCD.

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