Time to gallbladder cancer reoperation linked to outcome

Last Updated: 2016-11-01

By David Douglas

NEW YORK (Reuters Health) - An interval of between four and eight weeks between initial cholecystectomy and resection of incidentally discovered gallbladder cancer is associated with optimal results, according to a new study.

"Relatively little data exist regarding the optimal management of incidental gallbladder cancer -- who do we reoperate on, when do we do it, and how much do we take when we do?" said Dr. Cecilia G. Ethun of Emory University, Atlanta.

"What we tried to address with this study is the 'when' question, and found that taking patients back for reoperation at 4 to 8 weeks after the initial cholecystectomy was the time period associated with the best survival," she told Reuters Health by email.

Dr. Ethun and colleagues, whose findings were published online October 26 in JAMA Surgery, analyzed data from 2000 to 2014 on 207 patients.

All patients had incidentally discovered gallbladder cancer and underwent reoperation. Overall, 25 patients had reoperation at less than four weeks, 91 at four to eight weeks and the remaining 91 after more than eight weeks.

Mean ages ranged from 64 to 66 years across groups, and other factors such as extent of resection, presence of residual disease and lymph node involvement were also similar.

Patients in the intermediate group had significantly longer median overall survival (40.4 months) than both the early group (17.4 months) and the late group (22.4 months).

In univariable Cox regression analysis, the shortest and longest intervals, and factors including presence of residual disease, lymph node involvement, advanced T stage and the extent of resection were associated with decreased overall survival.

On multivariable Cox regression analysis, compared to the intermediate group, mortality was significantly greater in the early group (hazard ratio, 2.63) and the late group (HR, 2.07). Mortality was also increased in those with R2 resection and advanced T stage.

Dr. Ethun said the reasons for the findings are still unclear.

"What we hope," she said, "is that our data will help surgeons who are suddenly faced with gallbladder cancer in a patient who was thought to have benign disease, and guide them in taking the appropriate next steps to manage this disease."

Dr. Vatche G. Agopian, co-author of an accompanying editorial, told Reuters Health by email, "The correct timing of reoperation following diagnosis of an incidentally discovered gallbladder adenocarcinoma is an important and yet unanswered question. While the study by Ethun and colleagues suggests that reoperation at the 4 to 8 week interval following diagnosis optimizes outcomes, this retrospective analysis may ignore unknown factors leading to variable times to reoperation that should soften the conclusions."

Dr. Agopian, of the David Geffen School of Medicine at UCLA in Los Angeles, concluded, "Prospective evaluation is necessary to confirm that reoperation in the prescribed time period is indeed responsible for improved outcomes."

SOURCE: http://bit.ly/2fcDWhF and http://bit.ly/2fq7ayr

JAMA Surg 2016.