Introduction
Gallbladder carcinoma (GBC) is the most common malignant tumor of the biliary tract and the sixth malignancy of the gastrointestinal tract1, 2. It is frequently diagnosed at an advanced stage due to non-specific symptoms and aggressive biological behavior3. Radical resection is the most effective treatment, yet reported 5-year survival rates following operation vary greatly, from 10% to 100%4-6. Indeed, long-term survival appears in patients with early-stage tumors. These patients are usually diagnosed incidentally, after cholecystectomy for presumed benign gallbladder disease. As the growing number of laparoscopic cholecystectomies executed, incidental gallbladder carcinoma (iGBC) is a progressively relevant clinical issue7,8.
Re-exploration and re-resection are currently recommended for T1b, T2, and T3 iGBC patients without definite distant metastasis9. The extent of re-resection involves a partial hepatectomy of segment IVB+V, either as wedge resection or multi-segments resection and hepatoduodenal lymph nodes dissection10. However, there are few data on the timing of re-resection, especially immediate re-resection and delayed re-resection.
In this study, we compared the outcomes of immediate and delayed re-resection in iGBC patients, and to define optimal re-resection time that may improve prognosis.
Aims & Methods
For incidental gallbladder carcinoma (iGBC) patients with T1b and higher tumors are recommended to undergo radical re-resection, it is not clear whether immediate re-resection is more beneficial to long-term survival compared with delayed re-resection. To assess whether immediate re-resection is more beneficial to long-term survival compared with delayed re-resection.
This single centre retrospective observational cohort study of patients with iGBC was conduct from June 2006 and February 2015. Patients who underwent radical re-resection for T1b or higher iGBC were enrolled. The oncological outcomes of patients who underwent immediate re-resection were compared with those of patients treated with delayed re-resection.
Results
A total of 78 patients were included. 31 patients underwent immediate re-resection and 47 patients underwent delayed re-resection. The baseline demography, extent of resection, resection margin, T stage, lymph node involvement and postoperative complications were similar between the two groups. Patients in immediate re-resection group had less intraoperative blood loss and shorter hospital stay compared with those in delayed re-resection group. Kaplan-Meier analysis indicates that the overall survival rate of patients with delayed re-resection significantly decreased than those with immediate re-resection. Multivariate analysis showed that delayed re-resection (HR = 5.110, 95%CI: 1.595-16.371, P = 0.006), R1 resection (HR = 4.502, 95%CI: 1.345-15.070, P = 0.015) and lymph node positivity (HR = 6.025, 95%CI: 1.286-28.220, P = 0.023) were adverse prognostic factors for overall survival.
Conclusion
Immediate re-resection for selected patients with incidental gallbladder carcinoma is oncologically superior to delayed approach. To improve iGBC detection and timely referral of iGBC patients to immediate re-resection may allow more patients to benefit from this operation.
References
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Disclosure
No conflicts of interest regarding the current abstract.
