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Positive cystic duct margin at index cholecystectomy in incidental gallbladder cancer is an important negative prognosticator |
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| Institution: | 1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;2. Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Sotero del Rio Hospital, Santiago, Chile;3. Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile;1. Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland;2. Heart Center, Turku University Hospital, Turku, Finland;3. Department of Neurology, North Karelia Central Hospital, Joensuu, Finland;4. Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland;5. Clinical Research Center, Turku University Hospital and Department of Public Health, University of Turku, Turku, Finland;6. Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland;1. Université de Bordeaux, 351 Cours de la Liberation, 33400, Talence, France;2. Institut Bergonié, 229 cours de l’Argonne, 33076, Bordeaux, Department of Surgery, France;3. Institut Bergonié, 229 cours de l’Argonne, 33076, Bordeaux, Department of Biostatistics, France;4. Institut Bergonié, 229 cours de l’Argonne, 33076, Bordeaux, Department of Pathology, France |
| Abstract: | BackgroundPrognostic factors following index-cholecystectomy in patients with incidental gallbladder cancer (IGBC) are poorly understood. The aim of this study was to assess the value of the initial cystic duct margin status as a prognosticator factor and to aid in clinical decision making to move forward with curative intent oncologic extended resection (OER).MethodsThis retrospective study included patients with IGBC who underwent subsequent OER with curative intent at 2 centers (USA and Chile) between 1999 and 2016., Patients with and without evidence of residual cancer (RC) at OER were included. Pathologic features were examined, and predictors of overall survival (OS) were analyzed.ResultsThe study included 179 patients. Thirty-three patients (17%) had a positive cystic duct margin at the index cholecystectomy. Forty-two patients (23%) underwent resection of the common bile duct. OS was significantly worse in the patients with a positive cystic duct margin at index cholecystectomy (OS rates at 5 years, 34% vs 57%; p = 0.032). Following multivariate analysis, only a positive cystic duct margin at index cholecystectomy was predictive of worse OS in patients with no evidence of residual cancer (RC) at OER (hazard ratio, 1.7 95%CI 1.04–2.78; p = 0.034).ConclusionsA positive cystic duct margin at index-cholecystectomy is a strong independent predictor of worse OS even if no further cancer is found at OER. In patients with positive cystic duct margin and no RC at OER common bile duct resection leads to improved outcomes. |
| Keywords: | Gallbladder neoplasms Cystic duct margin Cholecystectomy Survival IGBC"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"incidental gallbladder cancer CDM"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"cystic duct margin OER"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"oncologic extended resection OS"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"overall survival RC"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"residual cancer IC"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"index cholecystectomy |
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