Detailed Abstract
[Poster Presentation 6 - Biliary & Pancreas (Biliary Disease/Surgery)]
[BP PP 6-S1] Optimal Timing of Reoperation for T2 Gallbladder Cancer Postoperatively Diagnosed after Cholecystectomy: a Multicenter Cohort Study
Sneh SHETH1, Anand Vijai NATESAN1, Vijayakumar K1, Rajiv MAHARAJ1, Raghunandhan YERRAGUNTLA1, V.P. NALANKILLI1, Senthilnathan PALANISAMY1, Chinnusamy PALANIVELU1
1Department of Liver Transplantation and Hepatobiliary Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India, India
Background : Although incidental diagnosis of gallbladder cancer (GBC) after cholecystectomy is increasing and further resection is necessary for GBC of T2 stage or higher, the optimal timing of reoperation is still debated.
Methods : We analyzed 148 patients who underwent reoperation for postoperatively diagnosed T2 GBC between November 2004 and October 2022 at five tertiary referral centers. Patient outcomes were compared according to time interval from the initial cholecystectomy to reoperation.
Results : The median time interval was 29 days. Patients were divided into three groups according to the time interval: group A (<4 weeks), group B (4-8 weeks), and group C (>8 weeks). Group A was associated with longer operation time (A: 225.3 ± 124.7 vs. B: 179.9 ± 86.3 vs. C 176.5 ± 63.8 minutes, P = 0.031), more intraoperative blood loss (A: 100 (100 - 300) vs. B: 100 (100 - 100) vs. C: 100 (50 - 100) cc, P = 0.029), and higher transfusion rates (A: 47.9% vs. B: 12.3% vs. C: 27.8%, P < 0.001). Five-year recurrence-free survival was lowest in group C (A: 64.0% vs. B: 83.6% vs. C: 58.9%, P = 0.016). In multivariable analysis, long time interval (hazard ratio (HR) 5.74, P = 0.002) and residual disease (HR 5.42, P < 0.001) were independent risk factors for recurrence.
Conclusions : The optimal timing of reoperation for incidentally found T2 GBC is between 4 to 8 weeks after initial cholecystectomy. Early reoperation is associated with worse intraoperative outcomes, and late reoperation shows higher risk of recurrence.
Methods : We analyzed 148 patients who underwent reoperation for postoperatively diagnosed T2 GBC between November 2004 and October 2022 at five tertiary referral centers. Patient outcomes were compared according to time interval from the initial cholecystectomy to reoperation.
Results : The median time interval was 29 days. Patients were divided into three groups according to the time interval: group A (<4 weeks), group B (4-8 weeks), and group C (>8 weeks). Group A was associated with longer operation time (A: 225.3 ± 124.7 vs. B: 179.9 ± 86.3 vs. C 176.5 ± 63.8 minutes, P = 0.031), more intraoperative blood loss (A: 100 (100 - 300) vs. B: 100 (100 - 100) vs. C: 100 (50 - 100) cc, P = 0.029), and higher transfusion rates (A: 47.9% vs. B: 12.3% vs. C: 27.8%, P < 0.001). Five-year recurrence-free survival was lowest in group C (A: 64.0% vs. B: 83.6% vs. C: 58.9%, P = 0.016). In multivariable analysis, long time interval (hazard ratio (HR) 5.74, P = 0.002) and residual disease (HR 5.42, P < 0.001) were independent risk factors for recurrence.
Conclusions : The optimal timing of reoperation for incidentally found T2 GBC is between 4 to 8 weeks after initial cholecystectomy. Early reoperation is associated with worse intraoperative outcomes, and late reoperation shows higher risk of recurrence.
SESSION
Poster Presentation 6
Zone G 3/21/2024 2:50 PM - 3:30 PM