Anatomic Location of Residual Disease after Initial Cholecystectomy Independently Determines Outcomes after Re-Resection for Incidental Gallbladder Cancer
Langenbeck's archives of surgery(2021)
摘要
Purpose This study aimed to elucidate the impact of anatomic location of residual disease (RD) after initial cholecystectomy on survival following re-resection of incidental gallbladder cancer (IGBC). Methods Patients with pT2 or pT3 gallbladder cancer (36 with IGBC and 171 with non-IGBC) who underwent resection were analyzed. Patients with IGBC were classified as follows according to the anatomic location of RD after initial cholecystectomy: no RD (group 1); RD in the gallbladder bed, stump of the cystic duct, and/or regional lymph nodes (group 2); and RD in the extrahepatic bile duct and/or distant sites (group 3). Results Timing of resection (IGBC vs. non-IGBC) did not affect survival in either multivariate or propensity score matching analysis. RD was found in 16 (44.4%) of the 36 patients with IGBC; R0 resection following re-resection was achieved in 32 patients (88.9%). Overall survival (OS) following re-resection was worse in group 3 ( n = 7; 5-year OS, 14.3%) than in group 2 ( n = 9; 5-year OS, 55.6%) ( p = 0.035) or in group 1 ( n = 20; 5-year OS, 88.7%) ( p < 0.001). There was no survival difference between groups 1 and 2 ( p = 0.256). Anatomic location of RD was independently associated with OS (group 2, HR 2.425, p = 0.223; group 3, HR 9.627, p = 0.024). Conclusion The anatomic location of RD independently predicts survival following re-resection, which is effective for locoregional disease control in IGBC, similar to resection for non-IGBC. Not all patients with RD have poor survival following re-resection for IGBC.
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关键词
Gallbladder neoplasms,Incidental gallbladder cancer,Re-resection,Residual disease,Survival
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