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Anatomic location of residual disease after initial cholecystectomy independently determines outcomes after re-resection for incidental gallbladder cancer

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Abstract

Purpose

This study aimed to elucidate the impact of anatomic location of residual disease (RD) after initial cholecystectomy on survival following re-resection of incidental gallbladder cancer (IGBC).

Methods

Patients with pT2 or pT3 gallbladder cancer (36 with IGBC and 171 with non-IGBC) who underwent resection were analyzed. Patients with IGBC were classified as follows according to the anatomic location of RD after initial cholecystectomy: no RD (group 1); RD in the gallbladder bed, stump of the cystic duct, and/or regional lymph nodes (group 2); and RD in the extrahepatic bile duct and/or distant sites (group 3).

Results

Timing of resection (IGBC vs. non-IGBC) did not affect survival in either multivariate or propensity score matching analysis. RD was found in 16 (44.4%) of the 36 patients with IGBC; R0 resection following re-resection was achieved in 32 patients (88.9%). Overall survival (OS) following re-resection was worse in group 3 (n = 7; 5-year OS, 14.3%) than in group 2 (n = 9; 5-year OS, 55.6%) (p = 0.035) or in group 1 (n = 20; 5-year OS, 88.7%) (p < 0.001). There was no survival difference between groups 1 and 2 (p = 0.256). Anatomic location of RD was independently associated with OS (group 2, HR 2.425, p = 0.223; group 3, HR 9.627, p = 0.024).

Conclusion

The anatomic location of RD independently predicts survival following re-resection, which is effective for locoregional disease control in IGBC, similar to resection for non-IGBC. Not all patients with RD have poor survival following re-resection for IGBC.

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Author information

Authors and Affiliations

  1. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan

    Takuya Ando, Jun Sakata, Kazuyasu Takizawa, Kohei Miura, Yuki Hirose, Takashi Kobayashi, Hiroshi Ichikawa, Takaaki Hanyu, Yoshifumi Shimada, Masayuki Nagahashi & Toshifumi Wakai

  2. Department of Gastrointestinal Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata City, Niigata, 951-8566, Japan

    Tatsuya Nomura & Kabuto Takano

  3. Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan

    Shin-Ichi Kosugi

Authors
  1. Takuya Ando
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  2. Jun Sakata
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  3. Tatsuya Nomura
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  4. Kabuto Takano
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  6. Kohei Miura
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  10. Takaaki Hanyu
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  11. Yoshifumi Shimada
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  14. Toshifumi Wakai
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Contributions

Study conception and design: Ando T and Sakata J; acquisition of data: Ando T, Sakata J, Hirose Y, Takano K, Takizawa K, and Miura K; analysis and interpretation of data: Ando T, Sakata J, Kobayashi T, Ichikawa H, Hanyu T, Shimada Y, and Nagahashi M; drafting of manuscript: Ando T and Sakata J; critical revision of manuscript: Nomura T, Miura K, Takizawa K, Kobayashi T, Ichikawa H, Shimada Y, Nagahashi M, Kosugi SI, and Wakai T

Corresponding author

Correspondence to Jun Sakata.

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Ethical approval

This study was approved by the institutional review boards of Niigata University and Niigata Cancer Center Hospital. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration.

Informed consent

The need for informed consent was waived due to the retrospective observational nature of the study.

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The authors declare no competing interests.

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Ando, T., Sakata, J., Nomura, T. et al. Anatomic location of residual disease after initial cholecystectomy independently determines outcomes after re-resection for incidental gallbladder cancer. Langenbecks Arch Surg 406, 1521–1532 (2021). https://doi.org/10.1007/s00423-021-02165-1

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