Pancreaticobiliary Maljunction Independently Predicts Early Recurrence after Surgical Resection for Gallbladder Carcinoma without Hepaticojejunostomy: A Propensity-Weighted Cohort Study.

Abstract

Pancreaticobiliary maljunction (PBM) is a recognized congenital risk factor for gallbladder cancer (GBC), but its prognostic significance after GBC diagnosis remains unclear. This single-center retrospective cohort study included 229 patients with pathologically confirmed GBC treated between 2015 and 2025, comprising 75 with PBM and 154 with non-PBM (NPBM). The primary analysis was predefined in the surgery without hepaticojejunostomy (HJ) group to assess the prognostic association of PBM under a relatively homogeneous surgical strategy, with secondary analyses among all surgically resected patients and palliative/nonsurgical patients. Overlap weighting was used to improve baseline comparability, and survival outcomes were evaluated using complementary Cox regression models. Patients with PBM were younger and less likely to have cholelithiasis than patients with NPBM. PBM tumors more frequently showed high Ki-67 expression and aberrant p53 immunostaining patterns. PBM was associated with worse overall survival (OS) in the palliative/nonsurgical group (hazard ratio [HR] 3.10, 95% confidence interval [CI] 1.57-6.11; P < 0.001). In the surgery without HJ group, PBM was independently associated with worse recurrence-free survival (RFS) in the primary analysis (adjusted HR 2.10, 95% CI 1.13-3.89; P = 0.019). A similar trend was observed for OS, although it did not reach statistical significance. Exploratory subgroup analyses revealed a significant interaction between PBM and HJ. PBM was associated with poorer RFS after surgery without HJ and worse OS in the palliative/nonsurgical group. These findings underscore the need for intensified surveillance in PBM-associated GBC and suggest that the role of concurrent biliary reconstruction warrants prospective evaluation.