Management of incidental gallbladder cancer in a nationwide CAPBIL study

INTRODUCTION: To provide contemporary, real-world data on the management approaches and survival outcomes of patients with incidental gallbladder cancer (GBC) following cholecystectomy in the United Kingdom. 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 period, 285 patients had incidental GBC. Median follow-up was 31 months, with 5-year disease-free (DFS) and overall (OS) survival of 41.5% and 45.1%, respectively. Of the 193 (67.7%) patients 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 vs 15 months, p<0.001) and OS (72 vs 26 months, p<0.001) compared with those who did not. In addition, patients who completed adjuvant chemotherapy had better DFS (35 vs 15 months, p=0.021) and OS (47 vs 26 months, p=0.009) compared to those who did not. On multivariable analysis, nodal metastases were independently associated with poorer DFS (HR 2.04, 95% CI 1.30-3.20, p=0.002), while advanced tumour (T3-T4) stage (HR 1.70, 95% CI 1.04-2.77, p=0.034) and nodal metastases (HR 2.15, 95% CI 1.33-3.48, 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.