Management of incidental gallbladder cancer in the nationwide CAPBIL study

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BACKGROUND: The primary aim of this study was to provide contemporary, real-world data on the management approaches and survival outcomes of patients with incidental gallbladder cancer (GBC) following cholecystectomy in the UK. The secondary aim was to identify prognostic factors associated with survival. METHODS: Patients diagnosed with incidental GBC following cholecystectomy between January 2014 and December 2022 across 24 centres were included. Data collected comprised demographics, treatment details, histopathological findings, and survival outcomes. RESULTS: During the study interval, 285 patients had incidental GBC. The median follow-up was 31 months, with 5-year disease-free survival (DFS) and overall survival (OS) of 41.5% and 45.1% respectively. Of the 193 patients (67.7%) who underwent liver resection, most (97.9%) underwent segment 4B/5 resection. Patients with incidental GBC who underwent liver resection had significantly improved DFS (51 versus 15 months, P < 0.001) and OS (72 versus 26 months, P < 0.001) compared with those who did not. In addition, patients who completed adjuvant chemotherapy had better DFS (35 versus 15 months, P = 0.021) and OS (47 versus 26 months, P = 0.009) compared with those who did not. On multivariable analysis, nodal metastases were independently associated with poorer DFS (HR 2.04 (95% c.i. 1.30 to 3.20), P = 0.002), while advanced tumour (T3-T4) stage (HR 1.70 (95% c.i. 1.04 to 2.77), P = 0.034) and nodal metastases (HR 2.15 (95% c.i. 1.33 to 3.48), P = 0.002) predicted poorer OS. CONCLUSION: Patients who underwent liver resection after incidental GBC had significantly better survival than those who did not proceed to further surgery. Adverse tumour biology was associated with poorer survival.

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