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Minimally Invasive and Open Gallbladder Cancer Resections: 30- vs 90-Day Mortality
Naeem Goussous, Motahar Hosseini, Anne Sill, Steven Cunningham*
Saint Agnes Hospital and Cancer Institute, Ellicott City, MD
Introduction: Gallbladder cancer (GBCa) is an aggressive malignancy with a 5-year survival of approximately 5%. Minimally invasive surgery is increasingly used for GBCa resection, with low reported mortality. However, postoperative mortality following surgical resection may underreported, usually recorded as 30-day mortality.
Methods: The National Cancer Database was used to identify patients with GBCa between 1998-2012. Only patients who underwent surgical resection of the tumor were included. Clinical data were collected for all patients and in addition operative approach was recorded for patients with operative data available (2010-2012 only). The 30- and 90-day mortality rates and their 95% confidence intervals were compared. Data are presented as number of cases and (percentages). Significance was defined as a P-value <0.05.
Results: 36,067 cases of GBCa were identified. 19,139 patients (53%) of the cohort underwent surgical resection. Mean age was 69.9 years and 70.7% were females. 90-day mortality following surgical resection was 2.3 fold higher than 30-mortaltiy (17.1% (95%CI: 16.5-17.7%) vs 7.4% (95%CI: 7.0-7.8%). There was a statistically significant increase in 30- and 90-day mortality with poorly differentiated tumors, presence of lymphovascular invasion (LVI), tumor stage, incomplete surgical resection and low-volume centers (Table). For the 1,885 patients who underwent a laparoscopic or robotic resection between 2010-2012, the 90-day mortaltiy was 2.8 times higher than the 30-day mortality (12.0% (95%CI: 10.1-13.9%) vs 4.3% (95%CI: 3.1-5.5%).
Conclusion: 90-day mortality following GBCa resection is significantly higher when compared to 30-day mortality and, importantly, given recent reports of laparoscopic radical cholecystectomy with lymph node dissection for GBCa, this holds true for patients undergoing minimally invasive approach. Postoperative mortality is affected by tumor grade, LVI, tumor stage, type and completeness of surgical resection as well as type and volume of facility.
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