Outcomes of incidental versus non-incidental T2 gallbladder cancer: A single-institute experience of 425 cases.

Abstract

Up to 60% of incidentally detected gallbladder cancers (GBCs) have a primary stage of pathologic T2 stage (pT2), defined by invasion of the peri-adventitial tissue by the tumour, a plane breached during a simple cholecystectomy. This study assesses the impact of incidental detection of pT2 GBCs on survival outcomes. Retrospective analysis of pT2 GBCs undergoing a curative resection was performed. Patients who received neoadjuvant chemotherapy before an upfront radical resection were excluded. Outcomes of patients undergoing upfront surgery (uGBC) and incidentally detected tumours (iGBC) were compared. From a total of 1356 patients, 425 patients with pT2 GBCs were included. Of these, 118 (27.7%) and 307 (72.23%) patients were in the uGBC and iGBC groups, respectively. Patients with iGBC had significantly higher locoregional, (62 [19.8%]vs. 11 [9.3%]; p = 0.009), liver, (36 [11.5%]vs. 4 [3.4%]; p = 0.01), and abdominal wall recurrences (23 [7.4%]vs. 1 [0.8%]; p = 0.009). Five-year disease free survivalrates were 68.7% and 49.2% in the uGBC and iGBC groups, respectively (p = 0.013). Five-year overall survivalrates were 71.7% and 64.6% in the uGBC and iGBC groups, respectively (p = 0.317). Incidentally detected pT2 GBCs have significantly poorer outcomes compared to similarly staged patients undergoing an upfront radical cholecystectomy.