Assessing the Impact of Common Bile Duct Resection in the Surgical Management of Gallbladder Cancer

• Type of Material: Article
• Authors: Faiz Gani, Johns Hopkins Hospital; Stephen Buettner, Johns HJohns Hopkins Hospital; Gergios A. Margonis, Johns Hopkins Hospital; Cecelia G. Ethun, Emory University; George Poultsides, Stanford University; Thuy Tran, Stanford University; Kamran Idrees, Vanderbilt University; Chelsea A. Isom, Vanderbilt University; Ryan C. Fields, Washington University; Bradley Krasnick, Washington University; Sharon M. Weber, University of Wisconsin; Ahmed Salem, University of Wisconsin; Robert C.G. Martin, University of Louisville; Charles Scoggins, University of Louisville; Perry Shen, Wake Forest University; Harveshp D. Mogal, Wake Forest University; Carl Schmidt, Ohio State University; Eliza Beal, Ohio State University; Ioannis Hatzaras, New York University; Rivfka Shenoy, Emory University; Shishir Maithel, Johns Hopkins Hospital; Timothy M. Pawlik
• Language: English
• Date: 2016-08-01
• Publisher: Wiley
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Wiley Periodicals, Inc.This is the peer reviewed version of the following article,which has been published in final form. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
• Final Published Version (URL): http://dx.doi.org/10.1002/jso.24283
• Title of Journal or Parent Work: Journal of Surgical Oncology
• ISSN: 0022-4790
• Volume: 114
• Issue: 2
• Start Page: 176
• End Page: 180
• Keywords: Surgery; Classification; Carcinoma; Finding Residual disease; Japanese society; Stage; Re-resection; survival; surgical resection; common bile duct; Science & Technology; Life Sciences & Biomedicine; Radical surgery; Oncology; gallbladder cancer
• Research Categories: Biology, Biostatistics; Health Sciences, Oncology

Abstract

Background: Although radical re-resection for gallbladder cancer (GBC) has been advocated, the optimal extent of re-resection remains unknown. The current study aimed to assess the impact of common bile duct (CBD) resection on survival among patients undergoing surgery for GBC. Methods: Patients undergoing curative-intent surgery for GBC were identified using a multi-institutional cohort of patients. Multivariable Cox-proportional hazards regression was performed to identify risk factors for a poor overall survival (OS). Results: Among the 449 patients identified, 26.9% underwent a concomitant CBD resection. The median number of lymph nodes harvested did not differ based on CBD resection (CBD, 4 [IQR: 2–9] vs. no CBD, 3 [IQR: 1–7], P = 0.108). While patients who underwent a CBD resection had a worse OS, after adjusting for potential confounders, CBD resection did not impact OS (HR = 1.40, 95%CI 0.87–2.27, P = 0.170). Rather, the presence of advanced disease (T3: HR = 3.11, 95%CI 1.22–7.96, P = 0.018; T4: HR = 7.24, 95%CI 1.70–30.85, P = 0.007) and the presence of disease at the surgical margin (HR = 2.58, 95%CI 1.26–5.31, P = 0.010) were predictive of a worse OS. Conclusions: CBD resection did not yield a higher lymph node count and was not associated with an improved survival. Routine CBD excision in the re-resection of GBC is unwarranted and should only be performed selectively.