Nodal Metastases Impacts Residual Disease Status Following Definitive Oncological Resection of Gallbladder Cancer

Abstract

Introduction: Most of gallbladder cancer (GBCA) cases are diagnosed incidentally following cholecystectomy. Due to the high recurrence rate following re-resection of incidental GBCA, the OPT-IN trial is examining the benefit of doublet neoadjuvant chemotherapy for patients with incidental T2/T3 GBCA. The aim of this study is to predict demographic and clinicopathological factors that influence residual disease (RD) status following definitive oncological resection. Methods: This is a retrospective study of patients who underwent radical resection for GBCA between 2012-2020. Multivariate logistic regression was performed to predict factors affecting R1 resection following initial procedure and RD status following re-resection. Results: A total of 43 patients underwent initial resection for GBCA including cholecystectomy (n=36) and radical cholecystectomy (n=7). Thirty-five (81.4%) were diagnosed incidentally. R1 resection was found in 14 patients (33%). Pathological T3 (pT3) stage was associated with a higher rate of R1 resection following the initial procedure (8 out of 11 patients; p=0.001). On multivariate analysis, pT3 stage demonstrated an odd ratio (OR) of 41.05 for R1 resection (p=0.046) in this group. Thirty-three patients eventually underwent definitive oncological resection following cholecystectomy. Nodal disease was significantly associated with RD in final specimens on both univariate (83.3%, p=0.002) and multivariate analyses (OR:17.12; p=0.009). Conclusion: Following initial resection, pT3 stage is a significant predictor of R1 resection for both incidental and non-incidental GBCA. RD after definitive resection correlates with the presence of nodal metastases. Patients with incidental GBCA may benefit from systemic chemotherapy prior to definitive resection as being examined in the OPT-IN trial.