title: Predictors of incidental gallbladder cancer in patients undergoing cholecystectomy for benign gallbladder disease.
abstract: OBJECTIVE
  Discovery of incidental gallbladder cancer (IGC) has become more frequent due to adoption of laparoscopy. Gallbladder spillage during operation can disseminate cancer and worsen the prognosis.
  
  
  METHODS
  Patients who underwent laparoscopic or open cholecystectomy for benign gallbladder disease January 1996 to August 2011 at two tertiary care facilities were reviewed. Unmatched controls were randomly selected in 2:1 ratio. Preoperative variables were compared between the two groups.
  
  
  RESULTS
  Sixty-seven patients with IGC were identified and compared to 134 controls. Mean age was 68 for index cases and 49 for controls; 70% of cases and 75% of controls were female. Multivariate analysis showed that higher risk of IGC was significantly associated with age ≥ 65 (OR = 10.61, P < 0.0001), dilated bile ducts (OR = 4.76, P = 0.0028), and presence of gallbladder wall thickening (OR = 4.39, P = 0.0003). This model yielded a very good area under the curve of receiver operating characteristic (AUC = 0.83) for discriminating the patients with IGC from controls.
  
  
  CONCLUSIONS
  IGC is more likely to be found in patients when age is ≥65, with dilated bile ducts and gallbladder wall thickening. Preoperative suspicion of gallbladder cancer should prompt the surgeon to be more careful not to perforate the gallbladder during laparoscopic approach, and to have a lower threshold for conversion if necessary.
authors.affiliation: Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Vadim P
authors.initials: VP
authors.lastname: Koshenkov
authors.forename: Tulay
authors.initials: T
authors.lastname: Koru-Sengul
authors.forename: Dido
authors.initials: D
authors.lastname: Franceschi
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Dipasco
authors.forename: Steven E
authors.initials: SE
authors.lastname: Rodgers
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002763:Cholecystectomy / Q000379:methods; D041881:Cholecystitis, Acute / Q000601:surgery*; D041761:Cholecystolithiasis / Q000601:surgery*; D003661:Decision Support Techniques; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D033162:Incidental Findings; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors