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Background:
Incidentally discovered gallbladder cancer after routine laparoscopic cholecystectomy (LC) commonly requires a completion operation for proper oncologic resection. There are concerns that a LC prior to definitive resection may negatively affect perioperative morbidity and survival. We aim to compare perioperative outcomes and survival between patients undergoing a single, initial oncologic resection versus those whose gallbladder cancer is incidentally diagnosed after LC, therefore requiring staged, completion surgery.
Methods:
An observational, cohort study of patients undergoing resection of gallbladder cancer was conducted between 2003 and 2012. Twenty patients were evaluated based on the operative treatment required: single, initial oncologic resection (n=9) or staged, completion oncologic resection (n=11). Pre-operatively, all single surgery patients were suspected to have gallbladder cancer, while none of the staged operation patients were suspected to have gallbladder cancer. Nineteen patients received a radical cholecystectomy, segment IV, V liver resection, and porta hepatis lymphadenectomy. Univariate analysis of patient demographics, perioperative outcomes and overall survival were compared using SPSS analytical software v.20 and statistical significance was defined as p < 0.05.
Results:
Patient demographics were similar between the two groups. Post-operative staging was not statistically different and consisted of one unknown, two stage I, four stage II, one stage IIIA, eleven stage IIIB and two stage IV. Mean operative time for definitive R0 resection was 221.2 minutes for single and 248.0 minutes for staged surgery (p = 0.555). Median blood loss was greater in staged than single surgery (900mL versus 750mL, respectively) but was not significant (p = 0.23). Furthermore, the increased blood loss did not lead to a significantly greater number of units of blood transfused, mean of 1.75 units for staged versus 0.73 units for single surgery (p = 0.18). No 30-day post-operative complications occurred in patients receiving single surgery compared to three complications in the staged surgery group (p = 0.089). The single surgery group had one 30-day mortality. Although the 1-year survival rate for single surgery patients was 28.6% versus 57.1% in staged patients (p = 0.592), the 2-year survival rate was 14.3% for both groups (p = 0.999). Median survival for single surgery patients was 15.4 months versus 14.4 months for staged surgery patients (p = 0.255).
Conclusion:
Single versus staged resection of gallbladder cancer demonstrates no significant difference on perioperative morbidity or survival. Therefore, initial laparoscopic cholecystectomy does not appear to influence the outcomes of definitive oncologic resection for gallbladder cancer.