Comparison of oncological outcomes after open and laparoscopic re-resection of incidental gallbladder cancer
Author
dc.contributor.author
Vega, E. A.
Author
dc.contributor.author
De Aretxabala, X
Author
dc.contributor.author
Qiao, W.
Author
dc.contributor.author
Newhook, T. E.
Author
dc.contributor.author
Okuno, M.
Author
dc.contributor.author
Castillo, E.
Author
dc.contributor.author
Sanhueza, M.
Author
dc.contributor.author
Díaz, C.
Author
dc.contributor.author
Cavada, G.
Author
dc.contributor.author
Jarufe, N.
Author
dc.contributor.author
Muñoz, C.
Author
dc.contributor.author
Rencoret, G.
Author
dc.contributor.author
Vivanco, M.
Author
dc.contributor.author
Joechle, K.
Author
dc.contributor.author
Tzeng, C. -W. D.
Author
dc.contributor.author
Vauthey, J. -N.
Author
dc.contributor.author
Viñuela, E.
Author
dc.contributor.author
Conrad, C.
Admission date
dc.date.accessioned
2020-05-14T15:12:42Z
Available date
dc.date.available
2020-05-14T15:12:42Z
Publication date
dc.date.issued
2020
Cita de ítem
dc.identifier.citation
BJS 2020; 107: 289–300
es_ES
Identifier
dc.identifier.other
10.1002/bjs.11379
Identifier
dc.identifier.uri
https://repositorio.uchile.cl/handle/2250/174729
Abstract
dc.description.abstract
Background: The safety and oncological efficacy of laparoscopic re-resection of incidental gallbladder cancer have not been studied. This study aimed to compare laparoscopic with open re-resection of incidentally discovered gallbladder cancer while minimizing selection bias.
Methods: This was a multicentre retrospective observational cohort study of patients with incidental gallbladder cancer who underwent re-resection with curative intent at four centres between 2000 and 2017. Overall survival (OS) and recurrence-free survival (RFS) were analysed by intention to treat. Inverse probability of surgery treatment weighting using propensity scoring was undertaken.
Results: A total of 255 patients underwent re-resection (190 open, 65 laparoscopic). Nineteen laparoscopic procedures were converted to open operation. Surgery before 2011 was the only factor associated with conversion. Duration of hospital stay was shorter after laparoscopic re-resection (median 4 versus 6 days; P < 0.001). Three-year OS rates for laparoscopic and open re-resection were 87 and 62 per cent respectively (P = 0.502). Independent predictors of worse OS were residual cancer found at re-resection (hazard ratio (HR) 1.91, 95 per cent c.i. 1.17 to 3.11), blood loss of at least 500ml (HR 1.83, 1.23 to 2.74) and at least four positive nodes (HR 3.11, 1.46 to 6.65). In competing-risks analysis, the RFS incidence was higher for laparoscopic re-resection (P = 0.03 8), but OS did not differ between groups. Independent predictors of worse RFS were one to three positive nodes (HR 2.16, 1.29 to 3.60), at least four positive nodes (HR 4.39, 1.96 to 9.82) and residual cancer (HR 2.42, 1.46 to 4.00).
Conclusion: Laparoscopic re-resection for selected patients with incidental gallbladder cancer is oncologically non-inferior to an open approach. Dissemination of advanced laparoscopic skills and timely referral of patients with incidental gallbladder cancer to specialized centres may allow more patients to benefit from this operation.
es_ES
Patrocinador
dc.description.sponsorship
United States Department of Health & Human Services