Association of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall Survival

Abstract

IMPORTANCE The current recommendation is to perform re-resection for select patients with incidentally discovered gallbladder cancer. The optimal time interval for re-resection for both patient selection and long-term survival is not known. OBJECTIVE To assess the association of time interval from the initial cholecystectomy to reoperation with overall survival. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted from January 1, 2000, to December 31, 2014 at 10 US academic institutions. A total of 207 patients with incidentally discovered gallbladder cancer who underwent reoperation and had available data on the date of their initial cholecystectomy were included. EXPOSURES Time interval from the initial cholecystectomy to reoperation: group A: less than 4 weeks; group B: 4 to 8 weeks; and group C: greater than 8 weeks. MAIN OUTCOMES AND MEASURES Primary outcome was overall survival. RESULTS Of 449 patients with gallbladder cancer, 207 cases (46%) were discovered incidentally and underwent reoperation at 3 different time intervals from the date of the original cholecystectomy: group A: less than 4 weeks (25 patients, 12%); B: 4 to 8 weeks (91 patients, 44%); C: more than 8 weeks (91 patients, 44%). The mean (SD) ages of patients in groups A, B, and C were 65 (9), 64 (11), and 66 (12) years, respectively. All groups were similar for baseline demographics, extent of resection, presence of residual disease, T stage, resection margin status, lymph node involvement, and postoperative complications. Patients who underwent reoperation between 4 and 8 weeks had the longest median overall survival (group B: 40.4 months) compared with those who underwent early (group A: 17.4 months) or late (group C: 22.4 months) reoperation (log-rank P = .03). Group A and C time intervals (vs group B), presence of residual disease, an R2 resection, advanced T stage, and lymph node involvement were associated with decreased overall survival on univariable Cox regression. Only group A (hazard ratio, 2.63; 95%CI, 1.25–5.54) and group C (hazard ratio, 2.07; 95%CI, 1.17–3.66) time intervals (vs group B), R2 resection (hazard ratio, 2.69; 95%CI, 1.27–5.69), and advanced T stage (hazard ratio, 1.85; 95%CI, 1.11–3.08) persisted on multivariable Cox regression analysis. CONCLUSIONS AND RELEVANCE The optimal time interval for re-resection for incidentally discovered gallbladder cancer appears to be between 4 and 8 weeks after the initial cholecystectomy.

A predictive nomogram for lymph node metastasis of incidental gallbladder cancer: a SEER population-based study

“…Most GBC patients are at an advanced stage once confirmed and lose the opportunity for surgical treatment [3]. Fortunately, with the development of laparoscopy, an increasing number of GBCs may be confirmed at the early stage through laparoscopic cholecystectomy (LC) so that early R0 resection may be performed; thus, progression of the disease may be avoided, and the overall survival rate may be improved [4,5].…”

“…More than 50% of GBCs are diagnosed by intraoperative or postoperative pathological examination after LC [4] and are considered incidental gallbladder cancer (IGBC), in which stage T1/2 GBCs are the most common [6]. IGBC often requires radical re-resection [5].…”

Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies

“…As such, the data were likely a good representation of the current state of treatment of extrahepatic biliary cancers, with a higher level of detail than can be achieved using national databases. [11, 24–29] Finally, data on the degree/severity of the SSI was not available and therefore a “dose effect” of SSI on RFS could not be assessed.…”

Improvement in the diagnosis and treatment of T2 gallbladder carcinoma is pivotal to improvement in the overall prognosis for this disease

“…Currently, there are no prospective, large-sample randomized controlled trials indicating an acceptable interval between primary surgery and secondary radical surgery. In a large-sample retrospective study in 2017, Ethun et al (30) suggested that secondary radical surgery for incidental T1b and T2 GBC should be performed within 4-8 weeks after primary surgery to improve prognosis. Prior to 4 weeks, inflammation, edema, and adhesions caused by the primary surgery will affect radical surgery, while the rate of an R1 or R2 resection increases significantly (p = 0.05 and < 0.001).…”