E281: The Importance of Biliary Spillage during Cholecystectomy for Gall Bladder Adenocarcinoma: A Systematic Review and Meta-analysis

Biliary spillage is a common complication following initial cholecystectomy for gall bladder cancer (GBC). Few retrospective studies have explored the importance of biliary spillage as a long-term prognostic factor. We perform a meta-analysis of the association between biliary spillage and survival in GBC.


Methods:

A systematic literature search was performed in February 2023. Studies evaluating the incidence of biliary spillage and its association with long-term outcomes in patients undergoing initial laparoscopic or open cholecystectomy for either incidental or resectable GBC were included. Overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) were the primary end points. Forest plot analyses were used to calculate the pooled hazard ratios of OS, DFS, and PFS.


Results:

Of the 181 published articles, 11 met inclusion criteria with a sample size of 1116 patients. The rate of biliary spillage ranged between 9% and 67%. All studies were retrospective cohort studies. On pooled analysis, biliary spillage was associated with worse OS (Hazard Ratio [HR]=1.68, 95% confidence interval [CI]=1.32-2.14). and worse DFS/PFS (HR=3.29, 95% CI=1.63-6.62). Risk of bias analysis showed that studies were of high quality. According to the GRADE tool, the results had very low quality of evidence.


Conclusions:

Our meta-analysis shows that biliary spillage is a predictor of poor survival in GBC. This may be due to peritoneal spread of disease or advanced disease at index cholecystectomy. Further research is needed to investigate the ideal treatment schedule for such patients to improve survival.