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Predictors of incidental gallbladder cancer in patients undergoing cholecystectomy for benign gallbladder disease
Author(s) -
Koshenkov Vadim P.,
KoruSengul Tulay,
Franceschi Dido,
DiPasco Peter J.,
Rodgers Steven E.
Publication year - 2012
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23239
Subject(s) - medicine , gallbladder cancer , gallbladder , cholecystectomy , gallbladder disease , gastroenterology , laparoscopic cholecystectomy , cancer , receiver operating characteristic , general surgery
Background and Objectives Discovery of incidental gallbladder cancer (IGC) has become more frequent due to adoption of laparoscopy. Gallbladder spillage during operation can disseminate cancer and worsen the prognosis. Methods Patients who underwent laparoscopic or open cholecystectomy for benign gallbladder disease January 1996 to August 2011 at two tertiary care facilities were reviewed. Unmatched controls were randomly selected in 2:1 ratio. Preoperative variables were compared between the two groups. Results Sixty‐seven patients with IGC were identified and compared to 134 controls. Mean age was 68 for index cases and 49 for controls; 70% of cases and 75% of controls were female. Multivariate analysis showed that higher risk of IGC was significantly associated with age ≥ 65 (OR = 10.61, P < 0.0001), dilated bile ducts (OR = 4.76, P = 0.0028), and presence of gallbladder wall thickening (OR = 4.39, P = 0.0003). This model yielded a very good area under the curve of receiver operating characteristic (AUC = 0.83) for discriminating the patients with IGC from controls. Conclusions IGC is more likely to be found in patients when age is ≥65, with dilated bile ducts and gallbladder wall thickening. Preoperative suspicion of gallbladder cancer should prompt the surgeon to be more careful not to perforate the gallbladder during laparoscopic approach, and to have a lower threshold for conversion if necessary. J. Surg. Oncol. 2013;107:118–123. © 2012 Wiley Periodicals, Inc.