Anatomic location of residual disease after initial cholecystectomy independently determines outcomes after re-resection for incidental gallbladder cancer

Abstract Background A better appreciation of the course and factors that influence incidental gallbladder cancer (iGBC) is needed to develop treatment strategies aimed to improve outcomes. The purpose of the study was to determine the influence of residual disease in the liver and lymph nodes on overall survival in re-resected patients with iGBC. Patients and methods Patients undergoing radical re-resection for iGBC from January 2012 to December 2018 were retrospectively identified. Patients with a 5-year follow-up and submitted to complete resection with stage I, II and III disease were analysed. The influence of residual disease (RD) in liver and lymph nodes on survival was assessed using the Kaplan-Meier curves. In addition, the rest of the group was assessed based on type of primary/secondary procedure, number of harvested lymph nodes and RD in liver and/or lymph nodes. Results In this retrospective study 48 out of 58 (83%) patients underwent re-resection. Among the group with a 5-year follow-up (re-operation between 2012–2014), 22 patients out of 28 (79%) were re-resected. Survival analysis showed that patients with no RD in the liver and lymph nodes had statistically significant better 5-year survival than those with RD. Comparing 5-year survival rate in patients with RD in the liver or lymph nodes against no RD group, patients with RD in the liver had statistically significantly worse 5-year survival, while lymph node metastases did not show any statistically significant different in 5-year survival. Besides, a statistically significant better prognosis was found in stage II disease compared to stage III, as expected. Conclusions The most important predictors of a 5-year survival in our study were RD in liver and stage of the disease. Lymph node metastases did not have any impact on the overall 5-year survival rate.

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Incidental gallbladder cancer: how residual disease affects outcome in two different South American referral centers

HPB ◽

10.1016/j.hpb.2017.02.038 ◽

2017 ◽

Vol 19 ◽

pp. S49

Author(s):

L. Gil ◽

X. de Aretxabala ◽

J. Lendoire ◽

J. Hepp ◽

O. Imventarza

Keyword(s):

Gallbladder Cancer ◽

Residual Disease ◽

South American ◽

Incidental Gallbladder Cancer

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Re-resection in Incidental Gallbladder Cancer: Survival and the Incidence of Residual Disease

Annals of Surgical Oncology ◽

10.1245/s10434-019-08074-4 ◽

2019 ◽

Vol 27 (4) ◽

pp. 1132-1142 ◽

Cited By ~ 4

Author(s):

Elise A. J. de Savornin Lohman ◽

Lydia G. van der Geest ◽

Tessa J. J. de Bitter ◽

Iris D. Nagtegaal ◽

Cornelis J. H. M. van Laarhoven ◽

...

Keyword(s):

Prognostic Factors ◽

Lymph Nodes ◽

Gallbladder Cancer ◽

Residual Disease ◽

Multivariable Analysis ◽

Optimal Timing ◽

R0 Resection ◽

Significant Prognostic Factor ◽

Netherlands Cancer Registry ◽

Incidental Gallbladder Cancer

Abstract Background Re-resection for incidental gallbladder cancer (iGBC) is associated with improved survival but little is known about residual disease (RD) and prognostic factors. In this study, survival after re-resection, RD, and prognostic factors are analyzed. Methods Patients with iGBC were identified from the Netherlands Cancer Registry, and pathology reports of re-resected patients were reviewed. Survival and prognostic factors were analyzed. Results Overall, 463 patients were included; 24% (n = 110) underwent re-resection after a median interval of 66 days. RD was present in 35% of patients and was most frequently found in the lymph nodes (23%). R0 resection was achieved in 93 patients (92%). Median overall survival (OS) of patients without re-resection was 13.7 (95% confidence interval [CI] 11.6–15.6), compared with 52.6 months (95% CI 36.3–68.8) in re-resected patients (p < 0.001). After re-resection, median OS was superior in patients without RD versus patients with RD (not reached vs. 23.1 months; p < 0.001). In patients who underwent re-resection, RD in the liver (hazard ratio [HR] 5.54; p < 0.001) and lymph nodes (HR 2.35; p = 0.005) were the only significant prognostic factors in multivariable analysis. Predictive factors for the presence of RD were pT3 stage (HR 25.3; p = 0.003) and pN1 stage (HR 23.0; p = 0.022). Conclusion Re-resection for iGBC is associated with improved survival but remains infrequently used and is often performed after the optimal timing interval. RD is the only significant prognostic factor for survival after re-resection and can be predicted by pT and pN stages.

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