INCIDENCE OF GALLBLADDER CANCER DURING CHOLECYSTECTOMY IN MEXICO. ANALYSIS OF A CURRENT COHORT IN A THIRD LEVEL CENTER.
Jorge E. Pereyra-Arzate2,3, Jorge H. Rodriguez Quintero*1,4, Florencia Lucero2,3, Mauro Garibaldi-Bernot2,3
1Surgery , Montefiore Medical Center Department of Surgery, Bronx, NY; 2Centro Medico ABC, Mexico City, Mexico City, Mexico; 3Universidad Nacional Autonoma de Mexico, Coyoacan, Distrito Federal, Mexico; 4Yeshiva University Albert Einstein College of Medicine, Bronx, NY
Gallbladder cancer is considered one of the most complex and aggressive malignancies of the gastrointestinal tract. It represents a challenge for the general surgeon that diagnoses it after a cholecystectomy.
Incidental gallbladder cancer is seen in as much as two percent of cholecystectomies according to international literature, and its prognosis is variable depending on the clinical stage at diagnosis. A considerable amount of these patients are candidates for an extended reoperation, which has demonstrated to improve survival, particularly if negative margins are achieved.
In our country, there is scarce data on the incidence of incidental gallbladder cancer. Being laparoscopic cholecystectomy one of the surgical procedures most frequently performed worldwide, this issue is of very high relevance.
The objective of this work was to study the incidence of this entity in a high-volume center.
Materials and Methods
We performed a retrospective study including all patients subjected to cholecystectomy in an academic high volume center during the period of January 2010 to December 2019 to determine the incidence of gallbladder cancer by pathologic analysis. Posteriorly, we utilized descriptive statistics to compare clinical and demographic characteristics between patients with incidental cancer and controls to identify factors associated with its presence.
5496 cholecystectomies were performed in our center during the study period. All cases were subjected to pathologic analysis. A total of 10 cases of gallbladder malignancy were diagnosed (0.18%). Sixty-six percent were female and the average age was 66.4+/- 10.8 years. Six cases were diagnosed incidentally while four had imaging that was highly suggestive of malignancy. The incidence of incidental gallbladder cancer was 0.10% in our cohort. Only two of the non-incidental cases was a primary gallbladder adenocarcinoma (50%) with the others being metastases from alternate primaries. During the comparative analysis, age and the presence of diabetes mellitus were significantly higher in the incidental gallbladder cancer group. (Age 66.4 vs. 51.1 years,p=0.001) (DM 33% vs 5%, p=0.045). Other relevant variables are summarized in (Table 1). The surgical approach was minimally invasive in most of the control cases (94.5% MIS vs. 5% Open) while converted to open were more frequent in the incidental cancer cases (66.6% MIS vs 33.3% converted to open)
The incidence of gallbladder cancer detected in our series is lower than the previously reported in international literature. Acknowledging clinical factors that are associated with the presence of this disease is important considering how frequently this operation is performed in our population.
Table 1. Clinical characteristics of patients with Incidental Gallbladder Cancer.
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