BENCHMARK ANALYSIS: MULTI-INSTITUTIONAL COOPERATIVE COHORT FOR GALLBLADDER CANCER SURGERY
Eduardo A. Vega*1,2, Timothy E. Newhook1, Andrea Ruzzenente3, Masayuki Okuno1,4, Mario De Bellis3, Sebastian Mellado2,7, Elena Panettieri5, Agostino Maria De Rose5, Hiroto Nishino4, Yun Shin Chun1, Hop Tran Cao1, Ching-Wei D. Tzeng1, Xabier de Aretxabala6, Satoru Seo4, Felic Giulilante5, Alfredo Guglielmi3, Eduardo Vinuela8, Jean-Nicolas Vauthey1
1Surgical Oncology, MD Anderson Cancer Center, Houston, TX; 2Saint Elizabeth's Medical Center, Brighton, MA; 3Universita degli Studi di Verona Scuola di Medicina e Chirurgia, Verona, Veneto, Italy; 4Kyoto Daigaku Daigakuin Igaku Kenkyuka Igakubu, Kyoto, Kyoto, Japan; 5Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy; 6Clinica Alemana de Santiago SA, Vitacura, Metropolitan Region, Chile; 7Tufts University, Medford, MA; 8Pontificia Universidad Catolica de Chile, Santiago, Chile
Background: Quality of surgery plays a central role in the delivery of excellent oncologic care. Benchmark data represent the best achievable results. We aimed to define benchmark values for gallbladder cancer (GBC) surgery and serves as a reference for institutions worldwide.
Methods: This study analyzed consecutive patients with ?T1b GBC who underwent curative-intent surgery from 2000-2018 from 6 centers across 4 countries. Benchmark patients were those operated at high volume centers (?40 cases during the study period) without the need for vascular and/or bile duct reconstruction, or the presence of significant co-morbidities. Benchmark cutoff values were derived from the 75th or 25th percentile of the median values of all benchmark centers.
Results: From a total of 554 patients, 264 (47.7%) comprised the benchmark group and were predominantly women (71.6%) with a median age of 62 years (IQR 55–70). In the benchmark group, overall 90-day morbidity was 14.2%, with 14 (5.4%) patients experiencing major complications (CD grade >=IIIa). Median length of stay was 6 days (IQR 5-8). The benchmark cut-offs include number of lymph nodes retrieved (>=5), blood loss (<=338 mL), operative time (<=318 min) and R1 margin (<=7%). The postoperative variables included any complication (<=23%), and CD grade >=IIIa complication (<=13%).
Conclusion: Surgery for GBC remains associated with important morbidity. The availability of benchmark values may serve as key references for comparison in any future analyses regarding GBC patients, approaches, or centers.
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