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Introduction: Gallbladder cancer is the fifth most common malignancy of the gastrointestinal tract and carries a poor long-term survival, unless the disease is identified early. Most frequently, it is diagnosed incidentally after a laparoscopic cholecystectomy for benign gallbladder disease.
Methods: A retrospective review was performed for patients with incidental gallbladder cancer (IGC) at two tertiary care referral centers who underwent cholecystectomy for symptomatic cholelithiasis or cholecystitis from 1/1996 to 8/2011. Of the 26572 gallbladders that were removed during the study period, 67 (0.25%) harbored cancer. Clinicopathologic variables such as age, sex, grade, gallbladder perforation and stage were assessed for impact on overall survival.
Results: A total of 67 patients with IGC were identified. Laparoscopic cholecystectomy was performed in 58 of these patients. Most patients were female (70.1%), had gallstones (91.0%), and 31 were 70 years old or older (46.3%). Tumors were most commonly poorly differentiated (35.8%). Metastatic disease was detected in 13 (19.4%) patients, while gallbladder perforation occurred in 16 (23.9%) patients. Univariate analysis determined that only metastatic disease had effect on overall survival (HR=2.76, p=0.006). Both univariate and multivariate analyses failed to show the impact of age, sex, grade, and gallbladder perforation on overall survival. Only early T stage independently predicted overall survival (HR=0.06, p=0.003).
Discussion: In patients with IGC, advanced age, male sex, poorly differentiated tumors and presence of gallbladder perforation did not adversely affect survival. Only advanced stage, be it distant or locoregional, predicted a worse overall survival.