Management of Incidentally Diagnosed Gallbladder Cancer at the Time of Cholecystectomy

Early-stage gallbladder cancer (GBC) is commonly identified incidentally at the time of cholecystectomy for a presumed benign process. Because there tends to be limited preoperative imaging in this setting, tumors may be encountered during the performance of simple cholecystectomy. How to proceed when facing this situation should be guided by the surgeon’s oncologic and technical experience, since most cholecystectomies are performed by general surgeons who may not have experience with hepatopancreatobiliary (HPB) malignancies such as GBC. Extended cholecystectomy should only be performed if the surgeon feels confident that there is no metastatic disease and is comfortable performing the procedure with minimal manipulation of the lesion and without bile spillage; it may require conversion to an open approach in less experienced hands. In most instances, referral to a multidisciplinary oncology team which includes an oncologic or HPB surgeon is recommended.