Residual disease predicts outcomes after definitive resection for incidental gallbladder cancer Journal Article


Authors: Butte, J. M.; Kingham, T. P.; Gonen, M.; D'Angelica, M. I.; Allen, P. J.; Fong, Y.; DeMatteo, R. P.; Jarnagin, W. R.
Article Title: Residual disease predicts outcomes after definitive resection for incidental gallbladder cancer
Abstract: Background Residual disease (RD) at definitive resection of incidental gallbladder cancer (IGBCA) influences outcome, but its clinical relevance with respect to anatomic site is incompletely characterized. Study Design Consecutive patients with IGBCA undergoing re-exploration from 1998 to 2009 were identified; those submitted to a complete resection were analyzed. Demographics and tumor- and treatment-related variables were correlated with RD and survival. Cancer-specific survival was stratified by site of RD (local [gallbladder bed]; regional [bile duct, lymph nodes]; distant [discontiguous liver, port site, peritoneal]). Results Of the 135 patients submitted to re-exploration, RD was found in 82 (61%) overall and in 63 (54%) of 116 patients submitted to resection; the most common site was regional (n = 27, 43%). The T stage of the gallbladder specimen was the only independent predictor of RD (T1b = 35.7%, T2 = 48.3%, T3 = 70%, p = 0.015). The presence of RD at any site dramatically reduced median disease-free survival (DFS) (11.2 vs 93.4 months, p < 0.0001) and disease-specific survival (DSS) (25.2 months vs not reached, p < 0.0001) compared with no RD, respectively. Disease-specific survival did not differ according to RD location, with all anatomic sites being equally poor (p = 0.87). Residual disease at any site predicted DFS (hazard ratio [HR] 3.3, 95% CI 1.9 to 5.7, p = 0.0003) and DSS (HR 2.4, 95% CI 1.2 to 4.6, p = 0.01), independent of all other tumor-related variables. Conclusions Survival in patients with RD at local or regional sites was not significantly different than that seen in stage IV disease, with neither subgroup clearly benefiting from reoperation. Outcomes were poor in all patients with RD, regardless of location. © 2014 by the American College of Surgeons.
Keywords: adult; controlled study; treatment outcome; disease-free survival; major clinical study; cancer patient; disease free survival; cancer staging; minimal residual disease; cancer specific survival; reoperation; hazard ratio; cholecystectomy; gallbladder cancer; disease-specific survival; disease specific survival; residual disease; memorial sloan-kettering cancer center; mskcc; incidental gallbladder cancer; ajcc; american joint committee on cancer; hr; dss; human; male; female; priority journal; article; abbreviations and acronyms; dfs; gbca; igbca; rd
Journal Title: Journal of the American College of Surgeons
Volume: 219
Issue: 3
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 2014-09-01
Start Page: 416
End Page: 429
Language: English
DOI: 10.1016/j.jamcollsurg.2014.01.069
PROVIDER: scopus
PMCID: PMC4143454
PUBMED: 25087941
DOI/URL:
Notes: Export Date: 1 October 2014 -- Source: Scopus
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MSK Authors
  1. Ronald P DeMatteo
    634 DeMatteo
  2. Mithat Gonen
    824 Gonen
  3. Peter Allen
    493 Allen
  4. William R Jarnagin
    684 Jarnagin
  5. Yuman Fong
    769 Fong
  6. T Peter Kingham
    376 Kingham