Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2021 Jun;28(6):2949-2957. doi: 10.1245/s10434-021-09607-6. Epub 2021 Feb 10.
Gallbladder cancer has a high mortality rate and an increasing incidence. The current National Comprehensive Cancer Network (NCCN) guidelines recommend resection for all T1b and higher-stage cancers. This study aimed to evaluate re-resection rates and the associated survival impact for patients with gallbladder cancer.
Patients with gallbladder adenocarcinoma who underwent resection were identified from the National Cancer Database (2004-2015). Re-resection was defined as definitive surgery within 180 days after the first operation. Propensity scores were created for the odds of a patient having a re-resection. Patients were matched 1:2. Survival analyses were performed using the Kaplan-Meier and Cox proportional hazard methods.
The study identified 6175 patients, and 466 of these patients (7.6%) underwent re-resection. Re-resection was associated with younger median age (65 vs 72 years; p < 0.0001), private insurance (41.6% vs 27.1%; p < 0.0001), academic centers (50.4% vs 29.7%; p < 0.0001), and treatment location in the Northeast (22.8% vs 20.4%; p = 0.0011). Compared with no re-resection, re-resection was associated with pT stage (pT2: 47.6% vs 42.8%; p = 0.0139) and pN stage (pN1-2: 28.1% vs 20.7%; p < 0.0001), negative margins on final pathology (90.1% vs 72.6%; p < 0.0001), and receipt of chemotherapy (53.7% vs 35.8%; p < 0.0001). The patients who underwent re-resection demonstrated significantly longer overall survival (OS) than the patients who did not undergo re-resection (median OS, 44.0 vs 23.0 months; p < 0.0001). After propensity score-matching, re-resection remained associated with superior survival (median OS, 44.0 vs 31.0 months; p = 0.0004).
Re-resection for gallbladder cancer is associated with improved survival but remains underused, particularly for early-stage disease.
胆囊癌死亡率高，发病率呈上升趋势。目前，国家综合癌症网络（NCCN）指南建议对所有 T1b 期及更高分期的癌症进行切除术。本研究旨在评估胆囊癌患者再次切除术的再切除率及相关生存影响。
从国家癌症数据库（2004-2015 年）中确定接受胆囊腺癌切除术的患者。再次切除术定义为第一次手术后 180 天内的确定性手术。为患者再次接受手术的可能性创建倾向评分。患者按 1:2 进行匹配。使用 Kaplan-Meier 和 Cox 比例风险方法进行生存分析。
本研究共纳入 6175 例患者，其中 466 例（7.6%）患者接受了再次切除术。再次切除术与更年轻的中位年龄（65 岁比 72 岁；p<0.0001）、私人保险（41.6%比 27.1%；p<0.0001）、学术中心（50.4%比 29.7%；p<0.0001）和东北部治疗地点（22.8%比 20.4%；p=0.0011）相关。与无再次切除术相比，再次切除术与 pT 分期（pT2：47.6%比 42.8%；p=0.0139）和 pN 分期（pN1-2：28.1%比 20.7%；p<0.0001）、最终病理切缘阴性（90.1%比 72.6%；p<0.0001）和接受化疗（53.7%比 35.8%；p<0.0001）相关。再次接受切除术的患者总生存期（OS）明显长于未再次接受切除术的患者（中位 OS，44.0 个月比 23.0 个月；p<0.0001）。在进行倾向评分匹配后，再次切除术仍与生存获益相关（中位 OS，44.0 个月比 31.0 个月；p=0.0004）。
胆囊癌再次切除术与生存改善相关，但仍未得到充分应用，特别是在早期疾病中。
