Indication of Reoperation in Incidental Gallbladder Cancer

Incidental gallbladder cancer is a rare condition found during cholecystectomies for presumed benign disease. Reoperation for adequate oncological treatment may be required based on surgical and pathological findings, potentially involving hepatic resection and lymph node dissection. After incidental oncological diagnosis, proper systemic staging through imaging techniques is essential. Contrast-enhanced computed tomography and magnetic resonance imaging provide valuable information for surgery planning and exclusion of locoregional and metastatic disease. Positron emission tomography can identify occult metastatic disease, but recent surgery may interfere with its findings. Staging laparoscopy is useful for detecting peritoneal dissemination in advanced disease cases. There is a lack of consensus on the ideal time interval for revision surgery. Simple cholecystectomy is considered adequate for T1a tumors, while hepatic resection and lymphadenectomy significantly improve survival for T2 or higher-stage tumors. The management of T1b patients remains controversial, with recent literature suggesting no significant survival advantages with reoperation. The extent of revisional surgery varies, with options ranging from liver bed wedge resection to anatomical segmentectomy 4b and 5. Lymphadenectomy, including cystic duct and portal lymph nodes, is considered the standard of care, while extended lymphadenectomy does not confer survival benefits. Common bile duct resection is recommended only for positive cystic duct margins with residual disease. Cholecystectomy port site excision is not routinely recommended, as it does not impact overall survival or distant disease recurrence.