Operative management and outcomes of gallbladder cancer in Australia: a multi-institutional, retrospective, observational cohort analysis.

BACKGROUND

Data on optimal extent of resection for various stages of gallbladder cancer are lacking. This study aims to evaluate disease-free (DFS) and overall survival (OS) after simple (SC) versus radical cholecystectomy (RC) for gallbladder cancer in the Australian context, and assesses factors associated with post-operative morbidity.

METHODS

Multi-centre, retrospective cohort analysis including all gallbladder cancer patients who underwent resection across six Australian institutions between January 2010 and January 2020.

RESULTS

Of 63 patients included, 31 underwent SC and 32 had RC. Liver and other organ resection correlated with prolonged median DFS (41.9 vs. 13.1 months, HR 0.492 [95% CI 0.245-0.987], P = 0.042) and OS on univariate analysis of all patients (55.8% survived five years follow-up at study conclusion vs. median 18.4 months, HR 0.66 [95% CI 0.446-0.972], P = 0.036) but failed to demonstrate effect on multivariable analysis (OS HR 0.31 [95% CI 0.09-1.04], P = 0.057). RC was associated with a higher 30-day complication rate (n = 21 [65.6%] vs. n = 15 [48.4%], P = 0.310) compared to SC, although not statistically significant. There was no significant difference in the major morbidity rate (Clavien-Dindo ≥ Grade III) observed after SC (n = 7 [22.6%]) compared with RC (n = 6 [18.7%], P = 0.754). Neoadjuvant therapy was not utilized and adjuvant treatment used infrequently.

CONCLUSION

Extended gallbladder cancer resection was associated with prolonged OS and DFS but also considerable post-operative morbidity. Further studies are warranted to determine the optimal extent of surgical resection by stage of gallbladder cancer.