Is there an association between time interval from the initial cholecystectomy to reoperation and overall survival?
In this multi-institutional cohort study of 207 patients who underwent reoperation for incidental gallbladder cancer, reoperation between 4 and 8 weeks after the initial cholecystectomy was associated with improved median overall survival (40.8 months) compared with reoperation less than 4 weeks (17.4 months) and greater than 8 weeks (22.4 months).
Reoperation between 4 and 8 weeks after the initial cholecystectomy appears to be the optimal time interval for re-resection in incidental gallbladder cancer.
The current recommendation is to perform re-resection for select patients with incidentally discovered gallbladder cancer. The optimal time interval for re-resection for both patient selection and long-term survival is not known.
To assess the association of time interval from the initial cholecystectomy to reoperation with overall survival.
Design, Setting, and Participants
This cohort study was conducted from January 1, 2000, to December 31, 2014 at 10 US academic institutions. A total of 207 patients with incidentally discovered gallbladder cancer who underwent reoperation and had available data on the date of their initial cholecystectomy were included.
Time interval from the initial cholecystectomy to reoperation: group A: less than 4 weeks; group B: 4 to 8 weeks; and group C: greater than 8 weeks.
Main Outcomes and Measures
Primary outcome was overall survival.
Of 449 patients with gallbladder cancer, 207 cases (46%) were discovered incidentally and underwent reoperation at 3 different time intervals from the date of the original cholecystectomy: group A: less than 4 weeks (25 patients, 12%); B: 4 to 8 weeks (91 patients, 44%); C: more than 8 weeks (91 patients, 44%). The mean (SD) ages of patients in groups A, B, and C were 65 (9), 64 (11), and 66 (12) years, respectively. All groups were similar for baseline demographics, extent of resection, presence of residual disease, T stage, resection margin status, lymph node involvement, and postoperative complications. Patients who underwent reoperation between 4 and 8 weeks had the longest median overall survival (group B: 40.4 months) compared with those who underwent early (group A: 17.4 months) or late (group C: 22.4 months) reoperation (log-rank P = .03). Group A and C time intervals (vs group B), presence of residual disease, an R2 resection, advanced T stage, and lymph node involvement were associated with decreased overall survival on univariable Cox regression. Only group A (hazard ratio, 2.63; 95% CI, 1.25-5.54) and group C (hazard ratio, 2.07; 95% CI, 1.17-3.66) time intervals (vs group B), R2 resection (hazard ratio, 2.69; 95% CI, 1.27-5.69), and advanced Tstage (hazard ratio, 1.85; 95% CI, 1.11-3.08) persisted on multivariable Cox regression analysis.
Conclusions and Relevance
The optimal time interval for re-resection for incidentally discovered gallbladder cancer appears to be between 4 and 8 weeks after the initial cholecystectomy.
Ethun CG, Postlewait LM, Le N, Pawlik TM, Buettner S, Poultsides G, Tran T, Idrees K, Isom CA, Fields RC, Jin LX, Weber SM, Salem A, Martin RCG, Scoggins C, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Shenoy R, Kooby DA, Maithel SK. Association of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall SurvivalA Multi-Institution Analysis From the US Extrahepatic Biliary Malignancy Consortium. JAMA Surg. Published online October 26, 2016. doi:10.1001/jamasurg.2016.3642