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Competing-Risk Nomogram for Predicting Cancer-Specific Survival in Multiple Primary Colorectal Cancer Patients after Surgery
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Clues to predict incidental gallbladder cancer.

Naeem Goussous1, Hadia Maqsood1, Kalpesh Patel1

  • 1Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA.

Hepatobiliary & Pancreatic Diseases International : HBPD INT
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Summary

Incidental gallbladder cancer (iGBC) is often missed during surgery. Gallbladder wall thickening without pericholecystic fluid on ultrasound can help predict iGBC, improving patient outcomes.

Keywords:
Bile spillageCarcinomatosisCholecystectomyGallbladder cancerIncidental findings

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Area of Science:

  • Oncology
  • Radiology
  • Gastroenterology

Background:

  • Incidental gallbladder cancer (iGBC) diagnosed post-cholecystectomy can lead to adverse outcomes like repeat surgery and reduced survival, particularly if bile spillage occurs.
  • Preoperative suspicion of iGBC is crucial to avoid these negative consequences.

Purpose of the Study:

  • To identify preoperative predictors of incidental gallbladder cancer (iGBC) to improve diagnostic accuracy.
  • To evaluate the impact of intraoperative bile spillage on patient survival in iGBC cases.

Main Methods:

  • Retrospective analysis of 5796 cholecystectomies performed between 2000 and 2013.
  • Blind review of ultrasound images by a radiologist for cases and controls.
  • Statistical analyses including logistic regression and Kaplan-Meier survival analysis (P ≤ 0.01).

Main Results:

  • 0.45% (26/5796) of cases were diagnosed with iGBC.
  • iGBC patients were older, had higher rates of laparoscopic-to-open conversion, and showed gallbladder wall thickening (GBWT) without pericholecystic fluid (PCCF) more frequently (73.9% vs 47.4%).
  • GBWT without PCCF and advanced age were significant predictors of iGBC; bile spillage led to carcinomatosis and worse survival.

Conclusions:

  • Preoperative predictors for iGBC include age, GBWT, dilated common bile duct, elevated alkaline phosphatase, and the number of imaging modalities used.
  • The presence of GBWT without PCCF on ultrasound is a key indicator for iGBC suspicion.
  • Intraoperative bile spillage significantly worsens survival outcomes for patients with iGBC.