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08.05.2017 | Original Article | Ausgabe 8/2017

Journal of Gastrointestinal Surgery 8/2017

Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies

Zeitschrift:
Journal of Gastrointestinal Surgery > Ausgabe 8/2017
Autoren:
John M. Creasy, Debra A. Goldman, Mithat Gonen, Vikas Dudeja, Gokce Askan, Olca Basturk, Vinod P. Balachandran, Peter J. Allen, Ronald P. DeMatteo, Michael I. D’Angelica, William R. Jarnagin, T. Peter Kingham

Abstract

Introduction

Re-operation is advised for patients with T1b or greater incidental gallbladder cancer (GBCA). The presence of residual disease (RD) impacts resectability, chemotherapy, and survival. This study created a preoperative model to predict RD at re-operation.

Methods

Patients with re-operation for incidental GBCA from 1992–2015 were included. The relationship between pathology data from initial cholecystectomy and RD at re-operation was assessed with logistic regression and classification and regression tree (CART) analysis.

Results

Two hundred fifty-four patients were included and 188 underwent definitive re-resection (74.0%). Distant RD was identified in 69 (27.2%) patients and locoregional only RD in 82 (32.3%). On multivariate analysis, T3 (OR 22.7, 95% CI 5.5–94.4) and poorly differentiated tumors (OR 4.3, 95% CI 1.4–13.3) were associated with RD (p < 0.001–0.012). AUC of multivariate model was 0.78 (95% CI 0.72–0.83). CART analysis split patients into groups based on percentage with RD: 87% RD with T3, 67% RD with T1b/T2 and poorly differentiated, and 35% RD with T1b/T2 and well/moderate differentiated tumors.

Conclusion

Based on T stage and grade from cholecystectomy, this study developed a model for predicting RD at re-operation in incidental GBCA. This model delineates patient groups with variable percentages of RD and could be used to stratify high-risk patients for prospective trials.

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