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Carcinoma detected at histological examination of the gallbladder is defined as incidental. It is a fairly rare event, but the increase in the number of cholecystectomies performed has led to a rise in detection of incidental gallbladder carcinoma. Histologically, in most cases, these are pT1 and pT2 carcinomas. Up until the 'nineties it was believed that these carcinomas could be adequately treated by simple cholecystectomy, whereas today the treatment of choice entails a second operation. This study constitutes a review of 20 years' experience. The database consists of 3012 cholecystectomies. Survival data are calculated in relation to the evolution of surgical treatment, thus making it possible to correlate tumour staging, patient survival and surgical therapy. The incidence of IGC was about 0.66% (20 cases). The survival rates of patients operated on by extended cholecystectomy, compared with those achieved previously with simple cholecystectomy, have risen from 92% to 100% at 1 year and from 26% to 66% at 5 years, respectively. The contributions made by literature reports since the 'nineties have prompted hepatobiliary surgeons to modify their attitudes towards incidental gallbladder carcinoma. Detection of previously unrecognised microinfiltrations of the serosa and of neoplastic involvement of distant lymph-node stations has led to the introduction of the concept of extended cholecystectomy. Comparison between our historical survival curve of patients treated with simple cholecystectomy and the distinctly better curve of those treated with a radical second operation accounts for the evolution of surgical treatment over the past two decades.

Primary carcinoma of the gallbladder is a progressive, lethal disease. Survival of patients with this neoplasm depends strictly on lymph node involvement and depth of tumor invasion. The aim of the study was to evaluate the results of our surgical series according to the tumor node metastasis and Japanese Society of Biliary Surgery classification systems. A retrospective analysis of our 15-year experience was performed. Of the 79 patients with gallbladder carcinoma observed at our institution between 1984 and 2001, a radical resection was carried out in 20 patients. Patients with stage I-II disease represent a minority of the cases of gallbladder carcinoma; the disease is localized in these patients, and surgical treatment provides the opportunity for good survival. Survival rates for patients with stage III-IV disease demonstrates that radical extended surgery offers the only chance for a relatively prolonged survival.

The aims of the study were to evaluate the adequacy of the surgical treatment and results of curative extended resections for gallbladder cancer. To this end we carried out a retrospective analysis of 59 patients operated on at our institution from 1983 to 2000. Nineteen patients received a curative resection with a radical intent (4 stage I-II patients and 15 stage III-IV patients, according to the AJCC classification). Kaplan-Meyer survival was 100% after one year and 66.6% after five years for stage I-II patients; 44.4% after one year and 0% after 5 years for stage III patients; 75.0% after one year and 0% after 5 years for stage IV patients. Our analysis confirms the poor prognosis of gallbladder carcinoma. In stage I-II patients surgical treatment offers a good chance of survival. In stage III-IV patients surgery affords good palliation. "Curative" extended resection is, however, a safe surgical procedure and offers a real possibility of enhancing survival.