Ann Surg Treat Res.  2016 Mar;90(3):131-138. 10.4174/astr.2016.90.3.131.

Incidental gallbladder cancer after routine cholecystectomy: when should we suspect it preoperatively and what are predictors of patient survival?

• Ahn Y
• Park CS
• Hwang S
• Jang HJ
• Choi KM
• Lee SG

• KMID: 2155046
• DOI: http://doi.org/10.4174/astr.2016.90.3.131

Abstract

PURPOSE
In about 1% of cases, incidental gallbladder cancers (iGBC) are found after routine cholecystectomy. The aim of this study is to compare clinical features of iGBC with benign GB disease and to evaluate factors affecting recurrence and survival.
METHODS
Between January 1998 and March 2014, 4,629 patients received cholecystectomy and 73 iGBC patients (1.6%) were identified. We compared clinical features of 4,556 benign GB disease patients with 73 iGBC patients, and evaluated operative outcomes and prognostic factors in 56 eligible patients.
RESULTS
The iGBC patients were older and concomitant diseases such as hypertension and anemia were more common than benign ones. And an age of more than 65 years was the only risk factor of iGBC. Adverse prognostic factors affecting patients' survival were age over 65, advanced histology, lymph node metastasis, and lymphovascular invasion on multivariate analysis. Age over 65 years, lymph node involvement, and lymphovascular invasion were identified as unfavorable factors affecting survival in subgroup analysis of extended cholecystectomy with bile duct resection (EC with BDR, n = 22).
CONCLUSION
Prior to routine cholecystectomy, incidental GB cancer should be suspected especially in elderly patients. And advanced age, lymph node metastasis, and lymphovascular invasion are important prognostic factors in EC with BDR cohorts.

Keyword

Gallbladder neoplasms; Cholecystectomy; Prognosis

MeSH Terms

Aged
Anemia
Bile Ducts
Cholecystectomy*
Cohort Studies
Gallbladder Neoplasms*
Gallbladder*
Humans
Hypertension
Lymph Nodes
Multivariate Analysis
Neoplasm Metastasis
Prognosis
Recurrence
Risk Factors

Figure

• 

  Fig. 1 Selection process of patients with incidentally confirmed gallbladder cancer (n = 56). GB, gallbladder; AMI, acute myocardial infarction; CVA, cerebral vascular accident.

• 

  Fig. 2 Kaplan-Meier survival curves according to types of operation in all cancer patients (n = 56). EC, extended cholecystectomy; BDR, bile duct resection.

• 

  Fig. 3 Kaplan-Meier survival curves according to pathologic T (A) and pathologic N (B) stages in extended cholecystectomy with bile duct resection subgroup (n = 22).

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