Gallbladder Cancer Incidentally Found at Cholecystectomy: Perioperative Risk Factors.

Autor: Olecki EJ; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA. eolecki@pennstatehealth.psu.edu.; Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA. eolecki@pennstatehealth.psu.edu., Mayhew M; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.; Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA., Perez Holguin R; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.; Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA., Wong WG; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.; Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA., Stahl KA; Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.; Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA., Peng JS; Program for Liver, Pancreas, & Foregut Tumors, Department of Surgery College of Medicine, The Pennsylvania State University, PA, USA., Dixon ME; Division of Surgical Oncology, Department of Surgery, Rush Medical College, Chicago, IL, USA., Gusani NJ; Section of Surgical Oncology, Division of Surgery, Baptist MD Anderson Cancer Center, Jacksonville, FL, USA.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal cancer [J Gastrointest Cancer] 2024 Jun; Vol. 55 (2), pp. 723-732. Date of Electronic Publication: 2024 Jan 09.
DOI: 10.1007/s12029-023-00973-w
Abstrakt: Purpose: Risk factors of gallbladder cancer (GBC) are not well-defined resulting in greater than 60% of GBCs being diagnosed incidentally following cholecystectomy performed for presumed benign indications. As most localized GBCs require more extensive oncologic surgery beyond cholecystectomy, this study aims to examine factors associated with incidentally found GBC to improve preoperative and intraoperative diagnoses.
Methods: The American College of Surgeons National Surgical Quality Improvement Program Database from 2007 to 2017 was used to identify cholecystectomies performed with and without a final diagnosis of GBC. Univariate and multivariable logistic regressions were used to compare demographic, intraoperative, and postoperative characteristics among those with and without a diagnosis of GBC.
Results: The incidence of GBC was observed to be 0.11% (441/403,443). Preoperative factors associated with risk of GBC included age > 60 (OR 6.51, p < .001), female sex (OR 1.75, p < .001), history of weight loss (2.58, p < .001), and elevated preoperative alkaline phosphatase level (OR 1.67, p = .001). Open approach was associated with 7 times increased risk of GBC compared to laparoscopic approach (OR 7.33, p < .001). In addition to preoperative factors and surgical approach, longer mean operative times (127 min vs 70.7 min, p < .001) were significantly associated with increased risk of GBC compared to benign final pathology.
Conclusion: This study demonstrates that those with incidentally discovered GBC at cholecystectomy are unique from those undergoing cholecystectomy for benign indications. By identifying predictors of GBC, surgeons can choose high risk individuals for pre-operative oncologic evaluation and consider better tools for identifying GBC such as intraoperative frozen pathology.
(© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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