SP7.5 Should we analyse all cholecystectomy specimens? An analysis of the features of incidentally discovered gallbladder cancers

Abstract

Abstract Aims Gallbladder cancer is the commonest form of malignancy of the biliary tract, but is rare in Western countries. A large proportion of cases are incidentally diagnosed at surgery or from the cholecystectomy specimen. The analysis of gallbladder specimens costs our health board around £42,000 per year. The aim was to identify any predictive factors in incidentally discovered gallbladder cancers. Methods All gallbladder specimen reports at our health board between May 2012 and September 2022 were analysed and filtered so incidental cancer cases could be analysed for any predictive features. Outcomes with only dysplasia were removed. Results 16,695 eligible reports were analysed of which 32 had malignant outcomes. The median age for malignancy was 71 vs 50 for benign. 30 were adenocarcinoma and 2 were adenosquamous carcinoma. 14 presented with cholecystitis, 9 with biliary colic, 6 with choledocholithiasis and 3 with gallstone pancreatitis. Intraoperatively, 7 had normal appearances, 20 were reported at being ‘thickened’, 2 ‘contracted’, 2 with empyema and 1 with a mucocoele. 6 patients had a subtotal cholecystectomy and in all cases this was due to intraoperative difficulty. Conclusions We could not identify any single feature that predicted or excluded the presence of cancer. Given that the lower age limit for malignancy was 51, a consideration could be made for not processing specimens from patients under the age of 45 as the likelihood of diagnosing incidental carcinoma is extremely unlikely and would reduce the yearly processing by 37% with a cost saving of £15,500 per year.