Incidental Carcinoma after Cholecystectomy for Benign Disease of the Gallbladder: A Meta-Analysis
Pooling 51 studies and more than 400,000 gallbladder operations, about six in every thousand gallbladders removed for benign disease contained an unsuspected cancer, and people whose cancer was found this way lived longer than those diagnosed with symptoms.
Overview
Meta-analysis of 51 studies and 436,636 cholecystectomies. The pooled incidence of incidental gallbladder carcinoma was 0.6 percent (95 percent CI 0.5 to 0.8) and did not differ between older and recent studies. Estimated rates by stage were 13.0 percent pTis, 34.1 percent pT1, 39.7 percent pT2, 22.7 percent pT3 and 12.5 percent pT4 (as reported). Incidental cancers had better overall survival than non-incidental cancers (hazard ratio 0.574, 95 percent CI 0.445 to 0.739) but no significant difference in disease-free survival (hazard ratio 0.931, 0.618 to 1.402). The authors call for adequate histological examination of every cholecystectomy specimen.
- Incidence of incidental gallbladder carcinoma 0.6 percent (95 percent CI 0.5 to 0.8) across 436,636 cholecystectomies.
- Overall survival better for incidental than non-incidental cancer: hazard ratio 0.574 (95 percent CI 0.445 to 0.739).
- Disease-free survival not significantly different: hazard ratio 0.931 (0.618 to 1.402).
Six per thousand is the number behind the debate on routine versus selective histology of gallbladder specimens: applied to a national cholecystectomy volume it predicts a few hundred unsuspected cancers a year in a country the size of England.
- Study-level meta-analysis with heterogeneous definitions.
- The stage percentages as reported sum to more than 100 percent and are quoted as printed.
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