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Gallbladder Cancer Incidentally Found at Cholecystectomy: Perioperative Risk Factors

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Abstract

Purpose

Risk factors of gallbladder cancer (GBC) are not well-defined resulting in greater than 60% of GBCs being diagnosed incidentally following cholecystectomy performed for presumed benign indications. As most localized GBCs require more extensive oncologic surgery beyond cholecystectomy, this study aims to examine factors associated with incidentally found GBC to improve preoperative and intraoperative diagnoses.

Methods

The American College of Surgeons National Surgical Quality Improvement Program Database from 2007 to 2017 was used to identify cholecystectomies performed with and without a final diagnosis of GBC. Univariate and multivariable logistic regressions were used to compare demographic, intraoperative, and postoperative characteristics among those with and without a diagnosis of GBC.

Results

The incidence of GBC was observed to be 0.11% (441/403,443). Preoperative factors associated with risk of GBC included age > 60 (OR 6.51, p < .001), female sex (OR 1.75, p < .001), history of weight loss (2.58, p < .001), and elevated preoperative alkaline phosphatase level (OR 1.67, p = .001). Open approach was associated with 7 times increased risk of GBC compared to laparoscopic approach (OR 7.33, p < .001). In addition to preoperative factors and surgical approach, longer mean operative times (127 min vs 70.7 min, p < .001) were significantly associated with increased risk of GBC compared to benign final pathology.

Conclusion

This study demonstrates that those with incidentally discovered GBC at cholecystectomy are unique from those undergoing cholecystectomy for benign indications. By identifying predictors of GBC, surgeons can choose high risk individuals for pre-operative oncologic evaluation and consider better tools for identifying GBC such as intraoperative frozen pathology.

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Authors and Affiliations

  1. Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA

    Elizabeth J. Olecki, Mackenzie Mayhew, Rolfy Perez Holguin, William G. Wong & Kelly A. Stahl

  2. Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA

    Elizabeth J. Olecki, Mackenzie Mayhew, Rolfy Perez Holguin, William G. Wong & Kelly A. Stahl

  3. Program for Liver, Pancreas, & Foregut Tumors, Department of Surgery College of Medicine, The Pennsylvania State University, PA, USA

    June S. Peng

  4. Division of Surgical Oncology, Department of Surgery, Rush Medical College, Chicago, IL, USA

    Matthew E. Dixon

  5. Section of Surgical Oncology, Division of Surgery, Baptist MD Anderson Cancer Center, Jacksonville, FL, USA

    Niraj J. Gusani

Authors
  1. Elizabeth J. Olecki
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  2. Mackenzie Mayhew
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Contributions

Substantial contributions to the conception or design of the work: Olecki, Mayhew, Perez-Holguin, Wong, Stahl, Peng, Dixon, and Gusani; drafting the work or revising it critically for important intellectual content: Olecki, Mayhew, Perez-Holguin, Wong, Stahl, Peng, Dixon, and Gusani. Final approval of the version to be published: Olecki, Mayhew, Perez-Holguin, Wong, Stahl, Peng, Dixon, and Gusani. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: Olecki, Mayhew, Perez-Holguin, Wong, Stahl, Peng, Dixon, and Gusani.

Corresponding author

Correspondence to Elizabeth J. Olecki.

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The authors declare no competing interests.

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Presented at Digestive Disease Week 2021, quick-shot oral presentation, virtual, May 21st–23rd

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Olecki, E.J., Mayhew, M., Perez Holguin, R. et al. Gallbladder Cancer Incidentally Found at Cholecystectomy: Perioperative Risk Factors. J Gastrointest Canc (2024). https://doi.org/10.1007/s12029-023-00973-w

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