Anatomical hepatic resection versus wedge resection for gallbladder cancer: analysis of multi-center database

Abstract

Background: To compare anatomical hepatic resection (AHR) to wedge resection (WR) for gallbladder cancer. Methods: Hepatic resections for GBCA at 13 medical centers (2002-2017) were included. WR was defined as non-anatomical resection of 2-3 cm of the gallbladder fossa. AHR was defined as identifying and dividing the vasculobiliary pedicle for hepatic segments 4b and 5. Overall postoperative morbidity (OM), 90-day major (Clavien ≥3) morbidity (MM), mortality, and hospital length of stay (LOS) were compared using bivariate and multivariate analysis. Results: In 753 patients with GBCA, 341 (45%) underwent cholecystectomy only and 112 (15%) underwent hepatic resection. Four resection cases were excluded, because they involved extended right hepatectomy. Of the remaining 108 cases, 25 (23%) underwent AHR. OM, MM and mortality were 44%, 25% and 1.8% respectively. Patients undergoing AHR were more likely to have hepaticojejunostomy (28% vs. 6%, p < 0.001) and open surgery (76% vs. 53%, p = 0.041). There was an association of AHR with OM (60% vs. 40%, p = 0.082), but this difference was not statistically significant. There was no difference in mortality (4% vs. 1.2%, p = 0.363), MM (32% vs. 24%, p = 0.429), organ/space infection (24% vs. 19%, p = 0.587), bile leak (12% vs. 10%, p = 0.869), and LOS (7.8 ± 4.7 vs. 6.7 ± 4.7 days, p = 0.307) between groups. Patients undergoing AHR and WR had comparable 5-year overall survival (43% vs. 46%, p = 0.113), disease-free survival (44% vs. 54%, p = 0.510) and disease-specific survival (59% vs. 51%, p = 0.657). Conclusion: AHR for GBCA is associated with more complex hepatic resection than WR without improved long-term oncologic outcomes. Further studies with larger sample size are needed to confirm these findings.