{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T16:20:32Z","timestamp":1771258832004,"version":"3.50.1"},"reference-count":24,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T00:00:00Z","timestamp":1623369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Gallbladder cancer (GBC) is often incidentally diagnosed after cholecystectomy. Intra\u2010operative biliary tract violations (BTV) have been recently associated with development of peritoneal disease (PD). The degree of BTV may be associated with PD risk, but has not been previously investigated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed patients with initially non\u2010metastatic GBC treated at our institution from 2003 to 2018. Patients were grouped based on degree of BTV during their treatment: major (e.g., cholecystotomy with bile spillage, <jats:italic>n<\/jats:italic>\u2009=\u200927, 29%), minor (e.g., intra\u2010operative cholangiogram, <jats:italic>n<\/jats:italic>\u2009=\u200918, 19%), and no violations (<jats:italic>n<\/jats:italic>\u2009=\u200948, 55%). Overall survival (OS) and peritoneal disease\u2010free survival (PDFS) were evaluated with Kaplan\u2010Meier and Cox proportional hazards modeling.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Ninety\u2010three patients were identified; the median age was 64 years (range 31\u201387 years). Seventy\u2010six (82%) were incidentally diagnosed. The median follow\u2010up was 23 months; 20 (22%) patients developed PD. The 3\u2010year PDFS for patients with major, minor, and no BTV was 52%, 83%, and 98%, respectively (major vs. none: <jats:italic>p<\/jats:italic>\u2009&lt; \u20090.001; minor vs. none: <jats:italic>p<\/jats:italic>\u2009&lt; \u20090.01). BTV was not associated with 5\u2010year OS (HR 1.53, <jats:italic>p<\/jats:italic>\u2009= \u20090.16).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Increasing degree of BTV is associated with higher risk of peritoneal carcinomatosis in patients with GBC and should be considered during preoperative risk stratification. Reporting biliary tract violations during cholecystectomy is encouraged.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.26569","type":"journal-article","created":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T13:05:34Z","timestamp":1623416734000},"page":"581-588","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Degree of biliary tract violation during treatment of gallbladder adenocarcinoma is independently associated with development of peritoneal carcinomatosis"],"prefix":"10.1002","volume":"124","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2894-7154","authenticated-orcid":false,"given":"Thomas L.","family":"Sutton","sequence":"first","affiliation":[{"name":"Department of Surgery Oregon Health &amp; Science University (OHSU), Division of General Surgery  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett S.","family":"Walker","sequence":"additional","affiliation":[{"name":"Department of Surgery Oregon Health &amp; Science University (OHSU), Division of General Surgery  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie","family":"Radu","sequence":"additional","affiliation":[{"name":"OHSU School of Medicine  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth N.","family":"Dewey","sequence":"additional","affiliation":[{"name":"Department of Surgery Oregon Health &amp; Science University (OHSU), Division of General Surgery  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"C. 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Health &amp; Science University (OHSU), Division of General Surgery  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles D.","family":"Lopez","sequence":"additional","affiliation":[{"name":"OHSU Department of Medicine Division of Hematology\/Oncology  Portland Oregon USA"},{"name":"The Knight Cancer Institute at OHSU  Portland Oregon USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin G.","family":"Billingsley","sequence":"additional","affiliation":[{"name":"Department of Surgery Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Skye C.","family":"Mayo","sequence":"additional","affiliation":[{"name":"The Knight Cancer Institute at OHSU  Portland Oregon USA"},{"name":"OHSU Department of Surgery Division of Surgical Oncology  Portland Oregon 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