Adverse Outcomes After Bile Spillage in Incidental Gallbladder Cancers: A Population-based Study

Area of Science:

• Oncology
• Surgical Outcomes
• Gallbladder Cancer Research

Background:

• Gallbladder cancer (GBC) is a rare but aggressive malignancy.
• Complete surgical resection is the primary curative treatment for GBC.
• Incidental GBCs are discovered post-cholecystectomy in approximately 30% of cases.
• Peritoneal dissemination is anecdotally linked to bile spillage during surgery.

Purpose of the Study:

• To investigate the impact of bile spillage during cholecystectomy on oncological outcomes in patients with incidentally discovered gallbladder cancer.
• To provide population-based evidence on the consequences of intraoperative bile spillage.

Main Methods:

• Retrospective cohort study of incidental gallbladder cancer cases in Alberta, Canada (2001-2015).
• Analysis of 82 incidental GBC cases identified from 115,484 cholecystectomies.
• Review of operative events to identify bile spillage during the index cholecystectomy.
• Comparison of patient outcomes between cases with and without bile spillage.

Main Results:

• Bile spillage occurred in 67% of incidental GBC cases.
• Peritoneal carcinomatosis was significantly more frequent with bile spillage (24% vs 4%; P=0.0287).
• Patients with bile spillage had lower rates of radical re-resection (25% vs 56%; P=0.0131) and R0 resection margins.
• Bile spillage independently predicted shorter disease-free survival (HR 1.99; P=0.0131).

Conclusions:

• Intraoperative bile spillage during cholecystectomy has significant adverse effects on oncological outcomes for incidental gallbladder cancer.
• These include increased risk of peritoneal carcinomatosis and poorer survival.
• Prompt consultation with hepatobiliary specialists is recommended for suspected GBC cases.