Re-resection in Incidental Gallbladder Cancer: Survival and the Incidence of Residual Disease
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.
Overview
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.
- 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.
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.
- Unmatched comparison; patients selected for re-resection were fitter and had less advanced disease.
- Registry data; reasons for not re-resecting were not captured.
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