"Missed Gall Bladder Cancer During Cholecystectomy - What Price Do We Pay?" An Experience of a Tertiary Care Center from India

Abstract

Background: The incidence of missed gall bladder cancer (GBC) is increasing with rising numbers of cholecystectomies in North India. Most of these are misrepresented as Incidental gall bladder (IGBC) cancer at referral. Our aim was to analyze the differences in presentation patterns and outcomes of missed GBC and IGBC. Material and methods: A Retrospective analysis of patients referred to as IGBC. Missed GBC were identified as IGBC presenting with any one criteria (Suspicious findings on preoperative ultrasound and/or intraoperative during the Cholecystectomy; Presentation with symptoms or metastasis within one month; pT4 lesion). The outcome of missed GBC was compared to remaining IGBC patients. Results: Sixty-seven patients were included in the study. The median age of presentation was 50 years and the majority were females (83.6%). Index-cholecystectomy was Laparoscopic, open, and lap converted to open in 44.7%,50.7 and 4.4% respectively. The median time to presentation was 30 days (15-720 days). Forty-eight (71.6%) had features of malignancy before index cholecystectomy (ultrasound-21; intraoperative findings-27). Thirty-four (50.7%) had metastatic disease at presentation (Liver-28; peritoneal-23; omental-six). Twenty-one (31.3%) underwent completed extended cholecystectomy (HDR-8; multi-visceral resections-3). Missed GBC had a poorer overall survival over IGBC (16.5Vs 35.3 months P=0.05). Conclusion: Significant proportion of IGBC were missed GBC. This emphasizes the need for careful interpretation of imaging before cholecystectomy in areas endemic to GBC.