Can we do better than 'incidental' gallbladder cancer?

The term 'incidental' gallbladder cancer is used to describe the histopathologic surprise of a malignancy following simple cholecystectomy for presumed benign gallstone disease. However, there remains a persistent doubt, especially so in large volume centers - whether some of these cases should have been detected on preoperative imaging. Under the broad definition of 'incidental' gallbladder cancer are we condoning the fact that some of the 'missed' gallbladder cancers may actually have been 'potential' gallbladder cancers, or 'suspicious' gallbladder cancers? In this report we try to answer this question. There exists a group of patients in whom preoperative imaging raises the suspicion of gallbladder cancer but are yet subjected to a laparoscopic simple cholecystectomy, possibly because adequate heed was not paid to the preoperative imaging. In this situation, the correct strategy would be to subject the excised gallbladder to an intraoperative frozen section and conversion to open radical cholecystectomy if the disease is more than T1. On the basis of experience gained with this problem at the Tata Memorial Center, we attempt to introduce two new terms: 'Potential' gallbladder cancer and 'suspicious gallbladder cancer', to highlight these clinical situations so that the correct procedure is performed where indicated.