Bile Spillage as a Prognostic Factor for Gall Bladder Cancer: A Systematic Review and Meta-Analysis

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Biliary spillage (BS) is a frequent complication after cholecystectomy for gallbladder cancer (GBC).
• The long-term prognostic significance of BS in GBC remains under-explored.

Purpose of the Study:

• To conduct a meta-analysis assessing the association between biliary spillage and survival outcomes in gallbladder cancer patients.

Main Methods:

• Systematic literature search of studies published up to February 2023.
• Inclusion of studies evaluating BS incidence and its impact on overall survival (OS), disease-free survival (DFS), and peritoneal carcinomatosis (RPC).
• Pooled analysis using forest plots to calculate hazard ratios (HRs) and odds ratios (ORs); metaregression for risk factor analysis.

Main Results:

• Eleven studies with 1116 patients met the inclusion criteria.
• Biliary spillage was significantly associated with worse OS (HR=1.68) and DFS (HR=2.19).
• BS also correlated with a higher rate of peritoneal carcinomatosis (OR=9.37) but not with tumor characteristics or conversion rates.

Conclusions:

• Biliary spillage is a significant predictor of poor survival and increased peritoneal recurrence in gallbladder cancer.
• BS is not associated with adverse tumor characteristics or surgical conversion rates.
• Further research is warranted to identify BS risk factors and optimize treatment strategies for improved patient survival.