# Surgical setting of initial cholecystectomy influences prognosis in incidentally detected gallbladder carcinoma

## TL;DR

Gallbladder cancer detected after surgery for benign disease has better outcomes when diagnosed at tertiary hospitals compared to peripheral centers due to earlier detection and better care.

## Contribution

This study identifies that the initial surgical setting significantly influences survival outcomes in incidentally detected gallbladder cancer.

## Key findings

- Patients diagnosed at peripheral centers had longer delays between surgeries and higher metastasis rates.
- Overall survival was significantly better in the tertiary group compared to the peripheral group.
- Timely referral and specialized care at tertiary centers improve survival outcomes for incidentally detected gallbladder cancer.

## Abstract

Gallbladder cancer (GBC) is a common biliary malignancy in India, with many cases diagnosed incidentally as gallbladder carcinoma (IGBC) after cholecystectomy for presumed benign disease. IGBC often has a better prognosis due to earlier stage detection. However, limited access to high-quality imaging, especially in peripheral centres, contributes to missed preoperative diagnoses. Routine histopathological examination has improved detection rates. This study aims to compare survival outcomes and identify prognostic factors in IGBC patients treated at peripheral versus tertiary care centres.

This retrospective study reviewed medical records of patients diagnosed with IGBC following cholecystectomy for presumed benign disease between 2015 and 2022 at a North Indian tertiary hospital. Patients were grouped based on initial surgery site (tertiary versus peripheral centres). Management followed National Comprehensive Cancer Network guidelines, with T1a patients advised follow-up and T1b or higher undergoing radical resection. Data on clinical, pathological and treatment parameters were analysed. Survival outcomes were assessed using Kaplan–Meier and Cox regression methods.

Of 39 IGBC patients reviewed, 30 were included in the final analysis. No significant differences were observed between tertiary and peripheral groups in demographics, symptoms or pathology. However, patients from peripheral centres had longer delays between surgeries and higher rates of metastasis. Overall survival was significantly better in the tertiary group (3- and 5-year OS: 88.2% and 72.8%) compared to the peripheral group (53.6% and 26.9%, p = 0.01). Multivariate analysis did not identify significant independent prognostic factors.

Patients undergoing cholecystectomy at peripheral centres for presumed benign disease and later diagnosed with IGBC have poorer survival, primarily due to delayed diagnosis, limited resources and late referral. In contrast, timely referral, standardised evaluation and specialised care at tertiary centres significantly improve survival outcomes.