# Re-resection in Incidental Gallbladder Cancer: Survival and the Incidence of Residual Disease

Source: https://onco.cc/key-papers/paper-de-savornin-lohman-re-resection-incidental-gallbladder-cancer-aso-2020/  
OnCo record `paper-de-savornin-lohman-re-resection-incidental-gallbladder-cancer-aso-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In the Dutch national registry only one in four people with a chance-found gallbladder cancer had the recommended second operation; those who did lived about four times longer, and a third of them had cancer left behind that the operation removed.

## Summary

Netherlands Cancer Registry study of 463 patients with incidental gallbladder cancer; 110 (24 percent) underwent re-resection after a median of 66 days, and their pathology reports were reviewed. Residual disease was present in 35 percent, most often in lymph nodes (23 percent); R0 resection was achieved in 92 percent. Median overall survival was 13.7 months (95 percent CI 11.6 to 15.6) without re-resection and 52.6 months (36.3 to 68.8) with it. Residual disease was the only significant prognostic factor after re-resection and was predicted by pT and pN stage. The authors note re-resection remains infrequent and is often performed after the optimal interval.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: gallbladder-evidence
- Journal: Annals of Surgical Oncology
- Year: 2020
- DOI: 10.1245/s10434-019-08074-4
- Authors: de Savornin Lohman EAJ, van der Geest LG, de Bitter TJJ, et al.
- Findings: 24 percent (110 of 463) of incidental gallbladder cancers were re-resected, after a median of 66 days.; Residual disease in 35 percent, most often lymph nodes (23 percent); R0 in 92 percent.; Median overall survival 52.6 months with re-resection vs 13.7 months without.
- What it means: A whole-country picture of the gap between guideline and practice: three quarters of eligible patients never reached the second operation. The survival difference is confounded by selection but the residual disease rate is not.
- Caveats: Unmatched comparison; patients selected for re-resection were fitter and had less advanced disease.; Registry data; reasons for not re-resecting were not captured.

## Sources

- Ann Surg Oncol 2020: https://doi.org/10.1245/s10434-019-08074-4
- PubMed: https://pubmed.ncbi.nlm.nih.gov/31741109/

## Connected records

- cancers: [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Incidental gallbladder cancer (found after cholecystectomy)](https://onco.cc/cancers/incidental-gallbladder-cancer/)
- terms: [Radical (extended) cholecystectomy](https://onco.cc/terms/radical-cholecystectomy/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/)
- journals: [Annals of surgical oncology](https://onco.cc/journals/annals-of-surgical-oncology/)
- roadmaps: [Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials](https://onco.cc/roadmaps/gallbladder-cancer-roadmap/)
- ideas: [A national incidental gallbladder cancer pathway: histology for every gallbladder, referral within two weeks, re-resection by eight](https://onco.cc/ideas/idea-gbc-national-incidental-cancer-pathway/)

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