Can Incidental Cancer be Predicted Before Cholecystectomies for Benign Diseases?

Abstract

Objective: Gallbladder cancer is a rare disease with a high mortality rate. The gold standard of treatment is based on early diagnosis and eradication of the disease with effective surgery. Almost 70% of cases are detected incidentally in the final pathology report of routine cholecystectomies. Our study aims to predict incidental gallbladder cancer in patients scheduled for surgery for benign reasons.

Methods: Biological characteristics, medical history, family history of hepatobiliary disease, radiological imaging, and laboratory parameters were analyzed in 2852 patients operated on for benign reasons in the general surgery department over 63 months. Patients with incidental gallbladder cancer were compared with patients with cholecystitis. The effects of independent variables in predicting cancer between the two groups were analyzed.

Results: Of 2852 patients who underwent cholecystectomy, 13 (0.45%) had incidental gallbladder cancer. The cancer incidence rate was 0.28% (2/700) in men and 0.51% (11/2139) in women. This difference was not statistically significant (p: 0.34). Among the biological characteristics, history of acute cholecystitis (p: 0.001), and laboratory findings, neutrophil-to-lymphocyte ratio (NLR) (p: 0.001) were the most striking variables. When variables with proven statistical value were tested by logistic regression analysis, NLR (p: 0.001), biliary polyps (p: 0.001), and gallstones (p: 0.038) were ranked as the most valuable cancer predictors, respectively.

Conclusions: In older patients with a history of acute cholecystitis, especially if there are large stones, polyps, and wall thickening on imaging, the possibility of cancer should be considered considering the NLR value, and surgery should be performed under optimal conditions by informing the patient and relatives.