Comparison of oncological outcomes after open and laparoscopic re-resection of incidental gallbladder cancer
Journal
British Journal of Surgery
ISSN
0007-1323
1365-2168
Date Issued
2020
Author(s)
E A Vega
X De Aretxabala
W Qiao
T E Newhook
M Okuno
F Castillo
M Sanhueza
C Diaz
N Jarufe
C Munoz
G Rencoret
M Vivanco
K Joechle
C-W D Tzeng
J-N Vauthey
E Vinuela
C Conrad
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>The safety and oncological efficacy of laparoscopic re-resection of incidental gallbladder cancer have not been studied. This study aimed to compare laparoscopic with open re-resection of incidentally discovered gallbladder cancer while minimizing selection bias.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>This was a multicentre retrospective observational cohort study of patients with incidental gallbladder cancer who underwent re-resection with curative intent at four centres between 2000 and 2017. Overall survival (OS) and recurrence-free survival (RFS) were analysed by intention to treat. Inverse probability of surgery treatment weighting using propensity scoring was undertaken.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>A total of 255 patients underwent re-resection (190 open, 65 laparoscopic). Nineteen laparoscopic procedures were converted to open operation. Surgery before 2011 was the only factor associated with conversion. Duration of hospital stay was shorter after laparoscopic re-resection (median 4 versus 6 days; P < 0·001). Three-year OS rates for laparoscopic and open re-resection were 87 and 62 per cent respectively (P = 0·502). Independent predictors of worse OS were residual cancer found at re-resection (hazard ratio (HR) 1·91, 95 per cent c.i. 1·17 to 3·11), blood loss of at least 500 ml (HR 1·83, 1·23 to 2·74) and at least four positive nodes (HR 3·11, 1·46 to 6·65). In competing-risks analysis, the RFS incidence was higher for laparoscopic re-resection (P = 0·038), but OS did not differ between groups. Independent predictors of worse RFS were one to three positive nodes (HR 2·16, 1·29 to 3·60), at least four positive nodes (HR 4·39, 1·96 to 9·82) and residual cancer (HR 2·42, 1·46 to 4·00).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>Laparoscopic re-resection for selected patients with incidental gallbladder cancer is oncologically non-inferior to an open approach. Dissemination of advanced laparoscopic skills and timely referral of patients with incidental gallbladder cancer to specialized centres may allow more patients to benefit from this operation.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Background</jats:title>
<jats:p>The safety and oncological efficacy of laparoscopic re-resection of incidental gallbladder cancer have not been studied. This study aimed to compare laparoscopic with open re-resection of incidentally discovered gallbladder cancer while minimizing selection bias.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>This was a multicentre retrospective observational cohort study of patients with incidental gallbladder cancer who underwent re-resection with curative intent at four centres between 2000 and 2017. Overall survival (OS) and recurrence-free survival (RFS) were analysed by intention to treat. Inverse probability of surgery treatment weighting using propensity scoring was undertaken.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>A total of 255 patients underwent re-resection (190 open, 65 laparoscopic). Nineteen laparoscopic procedures were converted to open operation. Surgery before 2011 was the only factor associated with conversion. Duration of hospital stay was shorter after laparoscopic re-resection (median 4 versus 6 days; P < 0·001). Three-year OS rates for laparoscopic and open re-resection were 87 and 62 per cent respectively (P = 0·502). Independent predictors of worse OS were residual cancer found at re-resection (hazard ratio (HR) 1·91, 95 per cent c.i. 1·17 to 3·11), blood loss of at least 500 ml (HR 1·83, 1·23 to 2·74) and at least four positive nodes (HR 3·11, 1·46 to 6·65). In competing-risks analysis, the RFS incidence was higher for laparoscopic re-resection (P = 0·038), but OS did not differ between groups. Independent predictors of worse RFS were one to three positive nodes (HR 2·16, 1·29 to 3·60), at least four positive nodes (HR 4·39, 1·96 to 9·82) and residual cancer (HR 2·42, 1·46 to 4·00).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>Laparoscopic re-resection for selected patients with incidental gallbladder cancer is oncologically non-inferior to an open approach. Dissemination of advanced laparoscopic skills and timely referral of patients with incidental gallbladder cancer to specialized centres may allow more patients to benefit from this operation.</jats:p>
</jats:sec>
Subjects
lymph-node dissection
;
residual disease
;
radical cholecystectomy
;
management
;
stratification
;
carcinoma
;
survival
;
score
;
adult
;
aged
;
aged, 80 and over
;
chile
;
cholecystectomy, laparoscopic
;
female
;
follow-up studies
;
gallbladder neoplasms
;
humans
;
incidental findings
;
laparotomy
;
male
;
middle aged
;
neoplasm staging
;
propensity score
;
reoperation
;
retrospective studies
;
survival rate
;
young adult
;
adult
;
article
;
biliary tract drainage
;
bleeding
;
cancer prognosis
;
cancer recurrence
;
cancer staging
;
cancer surgery
;
cancer survival
;
cholecystectomy
;
cholelithiasis
;
cohort analysis
;
comparative study
;
cystic duct
;
daily life activity
;
female
;
follow up
;
gallbladder cancer
;
hospitalization
;
human
;
laparoscopic surgery
;
liver resection
;
lymph node
;
lymph node dissection
;
major clinical study
;
male
;
metastasis
;
multicenter study
;
observational study
;
oncological parameters
;
oncological procedure
;
overall survival
;
priority journal
;
prospective study
;
recurrence free survival
;
retrospective study
;
risk assessment
;
surgical technique
;
tumor invasion
;
aged
;
chile
;
clinical trial
;
epidemiology
;
gallbladder tumor
;
incidental finding
;
laparoscopic cholecystectomy
;
laparotomy
;
middle aged
;
mortality
;
procedures
;
propensity score
;
reoperation
;
survival rate
;
very elderly
;
young adult