Guiding clinical decisions in incidental gallbladder cancer residual disease risk, liver resection extent, and selecting patients for adjuvant chemotherapy survival benefit

Zhenqi Tang; Chen Chen; Mai Xu; Yubo Ma; Feng Xue; Yali Cheng; Jianjun Lei; Dong Zhang; Zhimin Geng; Qi Li

doi:10.1097/JS9.0000000000004103

Guiding clinical decisions in incidental gallbladder cancer residual disease risk, liver resection extent, and selecting patients for adjuvant chemotherapy survival benefit

Int J Surg. 2025 Nov 24. doi: 10.1097/JS9.0000000000004103. Online ahead of print.

Authors

Zhenqi Tang¹, Chen Chen, Mai Xu, Yubo Ma, Feng Xue, Yali Cheng, Jianjun Lei, Dong Zhang, Zhimin Geng, Qi Li

Affiliation

¹ Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.

PMID: 41292226
DOI: 10.1097/JS9.0000000000004103

Abstract

Background: Incidental gallbladder cancer (IGBC), diagnosed post-cholecystectomy for presumed benign disease, presents critical management dilemmas. This study aimed to identify preoperative and pathological risk factors for residual disease (RD) after curative-intent resection, evaluate the impact of liver resection extent on survival stratified by RD status, and define patient subgroups benefiting from adjuvant chemotherapy (ACT).

Materials and methods: A retrospective cohort study of 209 IGBC patients undergoing curative-intent resection at [Blinded for review] was analyzed. Survival was analyzed using Kaplan-Meier method with log-rank test. Prognostic factors were identified via univariate and multivariate Cox regression analyses. Factors associated with RD were assessed using logistic regression.

Results: RD was present in 75 patients (35.9%) and was a strong independent predictor of worse recurrence-free survival (HR: 2.810, 95%CI: 1.843 ~ 4.282, P < 0.001) and overall survival (HR: 4.155, 95%CI: 2.550 ~ 6.769, P < 0.001). Independent risk factors for RD included CA19-9 > 39.0 U/ml, open cholecystectomy, primary T2 stage, primary T3 stage, perineural invasion (PNI), microvascular invasion (MVI), and station 12c lymph nodes metastasis (all P < 0.05). Among RD patients, segment IVB/V resection significantly improved median RFS (42.0 vs. 11.0 months, P < 0.001) and OS (60.0 vs. 22.0 months, P < 0.001) compared to wedge resection, while no difference was observed in non-RD patients (P > 0.05). ACT significantly improved OS in RD patients (median not reached vs. 20.0 months, P < 0.01), with a non-significant trend towards improved RFS (40.0 vs. 11.0 months, P > 0.05), but showed non-significant trends in non-RD patients (P > 0.05).

Conclusion: RD is a critical independent prognostic factor in IGBC, predicted by elevated CA19-9, open cholecystectomy, advanced T stage, PNI/MVI, and station 12c lymph nodes metastasis. For RD patients, segment IVB/V resection and ACT both significantly improve overall survival.

Keywords: adjuvant chemotherapy; anatomical liver resection; incidental gallbladder cancer; prognostic factors; residual disease.