Key factors predict gallbladder cancer on routine cholecystectomy

The study covered in this summary was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key takeaway

• A few key factors predict when gallbladder cancer will be found on routine cholecystectomy, allowing for better surgical planning and treatment.

Why this matters

• More than 60% of gallbladder cancers are diagnosed incidentally following cholecystectomy for benign reasons.
• Identifying predictors allows surgeons to send high-risk individuals for oncologic evaluation beforehand and to prepare for intraoperative frozen pathology and more appropriate surgery, including extended cholecystectomy and lymph node dissection.

Study design

• The investigators analyzed 403,443 cholecystectomies in the American College of Surgeons’ NSQIP database from 2007 to 2017.
• They used multivariable logistic regression to identify risk factors for gallbladder cancers.
• Patients undergoing cholecystectomy for suspected or confirmed gallbladder cancer were excluded.

Key results

• The incidence of gallbladder cancer was 0.11% (441 of 403,443 patients).
• Preoperative factors significantly associated with gallbladder cancer included age older than 60 years (odds ratio [OR], 6.51), female sex (OR, 1.75), weight loss (OR, 2.58), and elevated alkaline phosphatase level (OR, 1.67).
• Starting with or converting to an open approach – both potential indicators of more complex disease – were associated with seven times’ higher odds of gallbladder cancer (OR, 7.33; P < .001), as were longer operative times (127 minutes vs. 70.7 minutes; P < .001).

Limitations

• There is a risk of selection bias regarding which patients were included in the database.
• Presenting symptoms, preoperative imaging findings, and pathologic staging were not available.
• The database did not record the reasons for choosing open surgery rather than laparoscopic surgery or for converting to an open approach.

Disclosures

• There was no funding for the work, and the investigators did not disclose any relevant financial relationships.

This is a summary of a preprint research study, “Gallbladder Cancer Incidentally Found at Cholecystectomy: Perioperative Risk Factors,” led by Elizabeth Olecki of Penn State University, State College. The study has not been peer reviewed. The full text can be found at researchsquare.com. A version of this article first appeared on Medscape.com.