Abstract
BACKGROUND: Bile spillage occurs more frequently in patients with incidental gallbladder carcinoma (iGBC) and may be associated with poor survival due to presumed high risk of peritoneal seeding. AIM: To investigate the impact of bile spillage during primary surgery on the survival of patients with iGBC. METHODS: Medical records of patients with iGBC diagnosed between 2000 and 2019 in 27 Dutch secondary centers and 5 tertiary centers were retrospectively reviewed. Patient medical records were assessed. Predictors for overall survival (OS) were determined using multivariable Cox regression. RESULTS: Of the 346 included patients with iGBC, 138 (39.9%) had bile spillage, which was associated with higher American Society of Anesthesiologists classification (P = 0.020), cholecystitis (P < 0.001), higher tumor stage (P = 0.005), and non-radical resection (P < 0.001). Bile spillage was associated with poor OS [hazard ratio = 1.97, 95% confidence interval (CI): 1.48-2.63, P < 0.001] with a median OS of 12 months (95%CI: 7-18 months) vs 34 months (95%CI: 14-55 months, P < 0.001). In multivariable analysis, spillage was not an independent prognostic factor for survival (hazard ratio = 1.21, 95%CI: 0.84-1.74, P = 0.313). CONCLUSION: Although bile spillage correlates with prognostic factors, it lacks independent prognostic significance for survival. Patients with an indication for additional treatment should be promptly referred to a specialized hepatopancreatobiliary center, irrespective of whether bile spillage has occurred.