Incidental Gallbladder Cancer with the Laparoscopic Treatment in the MRI Era: An Experience at a Single Institution

Abstract Background: Magnetic resonance imaging (MRI) has been widely applied to the preoperative diagnosis of gallbladder diseases, among which laparoscopic cholecystectomy plays a critical role. Incidental gallbladder cancer (IGBC) is an unexpected guest of the patients who underwent cholecystectomy, forcing them to receive reoperation for complete resection. This study aimed to share our experience in pre-operative MRI evaluation and laparoscopic management of the IGBCs. Methods: Between January 2011 and January 2020, 7917 patients with gallbladder diseases and treated by laparoscopy were enrolled in this study. Results: A total of 49 patients were diagnosed as IGBCs. The incidence of IGBCs in polypoid lesions, biliary pancreatitis, cholecystitis, cholecystocholedocholithiasis and gallbladder stones was 0.42%, 1.19%, 0.62%, 1.20% and 0.49%, respectively. Moreover, 73.5% and 59.2% of the IGBCs had unremarkable preoperative imaging during the ultrasonographic and MRI evaluation respectively. Also, 14 of the patients were diagnosed as gallbladder cancer (GBC) via intraoperative histological examination, and 11 received laparoscopic extensive resection after cholecystectomy.Conclusion: The patients with biliary pancreatitis and cholecystocholedocholithiasis have a higher incidence of incidental gallbladder cancer. Preoperative MRI evaluation and intraoperative histological examination may help some incidental gallbladder cancers to achieve one-stage laparoscopic extensive resection.