Incidental Gallbladder Cancer—Current Recommendations and Management Protocols

The term “incidental gallbladder cancer” (IGBC) includes patients detected during or after cholecystectomy as an intraoperative or histological surprise. Overall, 0.25–3.0% of patients undergoing laparoscopic cholecystectomy will be incidentally detected to harbor GBC. Aggressive re-resection with or without systemic therapy offers the only chance for cure. Patients should undergo thorough staging assessment prior to re-resection. All resectable patients with pTb disease and beyond should be offered revision surgery. Timing of surgery, role of minimally invasive surgery, radiotherapy, and neoadjuvant chemotherapy in IGBC are still being evaluated and await further evidence. Minimally invasive surgery for IGBC is technically feasible however it is not recommended as a routine. Adjuvant chemotherapy is recommended in patients with pT2 disease and beyond and node-positive status. Margin-positive patients may benefit with adjuvant radiation in addition to chemotherapy. Neoadjuvant therapy in IGBC is evolving and selective use in high-risk patients (T3, T4, N1) should be considered in the setting of a clinical study.