Abstract
BackgroundRe-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.MethodsPatients with iGBC were identified from the Netherlands Cancer Registry, and pathology reports of re-resected patients were reviewed. Survival and prognostic factors were analyzed.ResultsOverall, 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).ConclusionRe-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.
Highlights
Re-resection for incidental gallbladder cancer is associated with improved survival but little is known about residual disease (RD) and prognostic factors
All patients diagnosed with incidental gallbladder cancer (iGBC) from 2000 to 2016 were identified from the Netherlands Cancer Registry (NCR)
All patients with pre- or perioperative suspicion of Gallbladder cancer (GBC) were excluded since the NCR categorizes these patients as suspected GBC
Summary
Re-resection for incidental gallbladder cancer (iGBC) is associated with improved survival but little is known about residual disease (RD) and prognostic factors. Survival after re-resection, RD, and prognostic factors are analyzed. 463 patients were included; 24% (n = 110) underwent re-resection after a median interval of 66 days. 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 reresection, 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
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