Incidental versus non-incidental gallbladder cancer: index cholecystectomy before oncologic re-resection negatively impacts survival in T2b tumors

Eduardo A. Vega, Eduardo Vinuela, Masayuki Okuno, Katharina Joechle, Marcel Sanhueza, Cristian Diaz, Nicolas Jarufe, J. Martinez, Andres Troncoso, Alfonso Diaz, Y. S. Chun, Ching Wei D. Tzeng, Jeffrey E. Lee, Jean Nicolas Vauthey, Claudius Conrad

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Background: Conflicting data exists whether non-oncologic index cholecystectomy (IC) leading to discovery of incidental gallbladder cancer (IGBC) negatively impacts survival. This study aimed to determine whether a subgroup of patients derives a disadvantage from IC. Methods: Patients with IGBC and non-IGBC treated at an academic USA and Chilean center during 1999–2016 were compared. Patients with T1, T4 tumor or preoperative jaundice were excluded. T2 disease was classified into T2a (peritoneal-side tumor) and T2b (hepatic-side tumor). Disease-specific survival (DSS) and its predictors were analyzed. Results: Of the 196 patients included, 151 (77%) had IGBC. One hundred thirty-six (90%) patients of whom 118 (87%) had IGBC had T2 disease. Three-year DSS rates were similar between IGBC and non-IGBC for all patients. However, for T2b patients, 3-year survival rate was worse for IGBC (31% vs 85%; p = 0.019). In multivariate analysis of T2 patients, predictors of poor DSS were hepatic-side tumor hazard ratio [HR], 2.9; 95% CI, 1.6–5.4; p = 0.001) and N1 status (HR, 2.4; 95% CI, 1.6–3.6; p < 0.001). Conclusions: Patients with T2b gallbladder cancer specifically benefit from a single operation. These patients should be identified preoperatively and referred to hepatobiliary center.

Original languageEnglish (US)
Pages (from-to)1046-1056
Number of pages11
JournalHPB
Volume21
Issue number8
DOIs
StatePublished - Aug 2019

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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