Retrospective Cohort Study
Copyright ©The Author(s) 2025.
World J Gastrointest Surg. Jul 27, 2025; 17(7): 106919
Published online Jul 27, 2025. doi: 10.4240/wjgs.v17.i7.106919
Table 1 Characteristics of patients with incidental gallbladder carcinoma with or without bile spillage during primary surgery
Characteristic
Bile spillage (n = 138)
No bile spillage (n = 208)
P value
Age at diagnosis > 65 years104 (75.4)115 (55.3)< 0.001
Sex (female)86 (62.3)132 (63.5)0.829
ASA class0.020
I/II87 (63.0)156 (75.5)
III/IV44 (31.9)44 (21.2)
Unknown7 (5.1)8 (3.8)
Primary surgery
Indication primary surgery
Cholecystolithiasis66 (47.8)115 (55.3)0.174
Cholecystitis58 (42.0)51 (24.5)< 0.001
Gallbladder wall abnormality112 (8.7)31 (14.9)0.087
Other2 (1.4)11 (5.3)0.066
Primary surgery type
Laparoscopic cholecystectomy70 (50.7)139 (66.8)0.003
Open cholecystectomy15 (10.9)21 (10.1)0.818
Converted cholecystectomy39 (28.3)35 (16.8)0.011
Other14 (10.1)13 (6.3)0.186
Perioperative suspicion of GBC0.757
Reported17 (12.3)28 (13.5)
Unreported121 (87.7)180 (86.5)
Pathology
T stage0.005
Is/1a9 (6.5)31 (14.9)
1b17 (12.3)12 (5.8)
249 (35.5)97 (46.6)
3/434 (24.6)39 (18.8)
x29 (21.0)29 (13.9)
Morphology
Adenocarcinoma115 (83.3)177 (85.1)0.658
Other8 (5.8)19 (9.1)0.257
Unknown15 (10.9)11 (5.3)0.054
Resection margin< 0.001
R051 (37.0)117 (56.3)
R1 52 (37.7)51 (24.5)
R214 (10.1)12 (5.8)
Unknown21 (15.2)28 (13.5)
Regional lymph node metastasis0.027
N05 (3.6)26 (12.5)
N114 (10.1)20 (9.6)
Nx119 (86.2)162 (77.9)
1Gallbladder wall lesions described as gallbladder polyp, adenomyomatosis, or unspecified wall abnormality.
Data are presented as n (%). GBC: Gallbladder cancer; ASA: American Society of Anesthesiologists Physical Status Classification.
Table 2 Treatment trajectory and recurrence of disease in patients with incidental gallbladder carcinoma with or without bile spillage during primary surgery
Characteristic
Bile spillage (n = 138)
No bile spillage (n = 208)
P value
Additional imaging performed (n = 324)77 (60.6)137 (69.5)0.098
Patient referred to hepatopancreatobiliary center0.001
Yes46 (33.3)103 (49.5)
No75 (54.3)78 (37.5)
Primary center was hepatopancreatobiliary center15 (10.9)25 (12.0)
Unknown2 (1.45)2 (1.0)
Additional surgery with curative intent (n = 327)34 (26.2)76 (38.6)0.020
Staging laparoscopy performed before additional surgery (n = 110)6 (17.6)5 (6.6)0.042
Irresectable during staging laparoscopy or re-resection (n = 110)14 (41.2)17 (22.4)0.043
R1 margin at re-resection (n = 65)4 (25.0)2 (4.1)0.012
Lymph node involvement at re-resection (n = 77)8 (38.1)19 (33.9)0.733
(Neo) adjuvant chemotherapy (n = 317)9 (7.0)15 (7.9)0.765
(Neo) adjuvant radiotherapy (n = 315)5 (4.0)3 (1.6)0.188
Recurrence
In any organ (n = 218)55 (65.5)57 (42.5)< 0.001
Local/Liver40 (47.6)40 (29.9)0.008
Peritoneal16 (19.0)16 (11.9)0.149
Lymph nodes9 (10.7)11 (8.2)0.533
Port site5 (6.0)0 (0.0)0.004
Other16 (19.0)17 (12.7)0.202
Not otherwise specified4 (4.8)7 (5.2)0.879
Unknown21 (20.0)33 (19.8)0.962
Time to recurrence (months)19.9 (6.9–12.8)14.7 (11.3–18.0)0.004
1Median months to recurrence after log rank resting with 95% confidence interval in brackets.
Data are presented as n (%).
Table 3 Analysis of overall survival in patients with incidental gallbladder carcinoma
Characteristic1 (n)
Unadjusted HR (95%CI)
P value2
Adjusted HR (95%CI) (n = 261)
P value3
Age at diagnosis ≥ 65 years (334)42.01 (1.46-2.77)< 0.0011.80 (1.22-2.66)0.003
ASA III/IV (319)41.81 (1.32-2.47)< 0.0011.56 (1.09-2.25)0.016
Cholecystitis indication for surgery (334)41.89 (1.40-2.54)< 0.0012.13 (1.50-3.04)< 0.001
Surgery type laparoscopic (334)50.43 (0.32-0.58)< 0.001
Surgery type converted (334)52.44 (1.75-3.41)< 0.001
Bile spillage (334)41.97 (1.48-2.63)< 0.0011.21 (0.84-1.74)0.313
pT stage primary surgery (278)41.77 (1.45-2.15)< 0.0011.48 (1.17-1.89)0.001
Positive resection margin at primary surgery (287)42.82 (2.05-3.89)< 0.0012.42 (1.65-3.55)< 0.001
pN1 at primary surgery (64)3.46 (1.59-7.50)< 0.001
1Hazard ratios were compared with patients who were negative for the variable for all characteristics except for pT stage.
2P value of log rank testing.
3P value of remaining significant independent variables after multivariable Cox regression analysis.
4This characteristic was added to multivariable Cox regression analysis.
5Surgery type was not added to multivariable Cox regression analysis as it is directly connected to the other variables used.
HR: Hazard ratio; ASA: American Society of Anesthesiologists Physical Status Classification; CI: Confidence interval.
Table 4 Analysis of overall survival in patients with incidental gallbladder carcinoma after exclusion of patients with perioperative suspicion of gallbladder carcinoma
Characteristic1 (n)
Unadjusted HR (95%CI)
P value2
Adjusted HR (95%CI) (n = 218)
P value3
Age at diagnosis ≥ 65 years (291)42.19 (1.55-3.10)< 0.0012.04 (1.35-3.11)< 0.001
ASA III/IV (279)41.98 (1.42-2.76)< 0.0011.64 (1.11-2.41)0.012
Cholecystitis indication for surgery (291)41.91 (1.39-2.63)< 0.0011.98 (1.36-2.88)< 0.001
Surgery type laparoscopic (291)50.42 (0.31-0.58)< 0.001
Surgery type converted (291)52.33 (1.61-3.37)< 0.001
Bile spillage (291)42.04 (1.50-2.79)< 0.0011.10 (0.74-1.62)0.646
pT stage primary surgery (245)41.77 (1.44-2.19)< 0.0011.52 (1.17-1.96)0.001
Positive resection margin at primary surgery (256)42.85 (2.03-4.01)< 0.0012.44 (1.64-3.63)< 0.001
pN1 at primary surgery (53)3.01 (1.31-6.92)0.010
1Hazard ratios were compared with patients who were negative for the variable for all characteristics except for pT stage.
2P value of log rank testing.
3P value of remaining significant independent variables after multivariable Cox regression analysis.
4This characteristic was added to multivariable Cox regression analysis.
5Surgery type was not added to multivariable Cox regression analysis as it is directly connected to the other variables used.
HR: Hazard ratio; ASA: American Society of Anesthesiologists Physical Status Classification; CI: Confidence interval.