Degree of biliary tract violation during treatment of gallbladder adenocarcinoma is independently associated with development of peritoneal carcinomatosis

Thomas L. Sutton, Brett S. Walker, Stephanie Radu, Elizabeth N. Dewey, C. Kristian Enestvedt, Erin Maynard, Susan L. Orloff, Nima Nabavizadeh, Brett C. Sheppard, Charles D. Lopez, Kevin G. Billingsley, Skye C. Mayo

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Gallbladder cancer (GBC) is often incidentally diagnosed after cholecystectomy. Intra-operative biliary tract violations (BTV) have been recently associated with development of peritoneal disease (PD). The degree of BTV may be associated with PD risk, but has not been previously investigated. Methods: We reviewed patients with initially non-metastatic GBC treated at our institution from 2003 to 2018. Patients were grouped based on degree of BTV during their treatment: major (e.g., cholecystotomy with bile spillage, n = 27, 29%), minor (e.g., intra-operative cholangiogram, n = 18, 19%), and no violations (n = 48, 55%). Overall survival (OS) and peritoneal disease-free survival (PDFS) were evaluated with Kaplan-Meier and Cox proportional hazards modeling. Results: Ninety-three patients were identified; the median age was 64 years (range 31–87 years). Seventy-six (82%) were incidentally diagnosed. The median follow-up was 23 months; 20 (22%) patients developed PD. The 3-year PDFS for patients with major, minor, and no BTV was 52%, 83%, and 98%, respectively (major vs. none: p < 0.001; minor vs. none: p < 0.01). BTV was not associated with 5-year OS (HR 1.53, p = 0.16). Conclusion: Increasing degree of BTV is associated with higher risk of peritoneal carcinomatosis in patients with GBC and should be considered during preoperative risk stratification. Reporting biliary tract violations during cholecystectomy is encouraged.

Original languageEnglish (US)
Pages (from-to)581-588
Number of pages8
JournalJournal of surgical oncology
Volume124
Issue number4
DOIs
StatePublished - Sep 15 2021

Keywords

  • bile spillage
  • cholecystectomy
  • gallbladder cancer
  • incidental gallbladder cancer
  • neoadjuvant therapy
  • peritoneal disease

ASJC Scopus subject areas

  • Surgery
  • Oncology

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