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18.11.2019 | Hepatobiliary Tumors Open Access

Re-resection in Incidental Gallbladder Cancer: Survival and the Incidence of Residual Disease

Annals of Surgical Oncology
MD, PhD Elise A. J. de Savornin Lohman, PhD Lydia G. van der Geest, MSc Tessa J. J. de Bitter, MD, PhD Iris D. Nagtegaal, MD, PhD Cornelis J. H. M. van Laarhoven, MD, PhD Peter van den Boezem, MD, PhD Chella S. van der Post, MD, PhD Philip R. de Reuver
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The online version of this article (https://​doi.​org/​10.​1245/​s10434-019-08074-4) contains supplementary material, which is available to authorized users.

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Re-resection for incidental gallbladder cancer (iGBC) is associated with improved survival but little is known about residual disease (RD) and prognostic factors. In this study, survival after re-resection, RD, and prognostic factors are analyzed.


Patients with iGBC were identified from the Netherlands Cancer Registry, and pathology reports of re-resected patients were reviewed. Survival and prognostic factors were analyzed.


Overall, 463 patients were included; 24% (n = 110) underwent re-resection after a median interval of 66 days. RD was present in 35% of patients and was most frequently found in the lymph nodes (23%). R0 resection was achieved in 93 patients (92%). Median overall survival (OS) of patients without re-resection was 13.7 (95% confidence interval [CI] 11.6–15.6), compared with 52.6 months (95% CI 36.3–68.8) in re-resected patients (p < 0.001). After re-resection, median OS was superior in patients without RD versus patients with RD (not reached vs. 23.1 months; p < 0.001). In patients who underwent re-resection, RD in the liver (hazard ratio [HR] 5.54; p < 0.001) and lymph nodes (HR 2.35; p = 0.005) were the only significant prognostic factors in multivariable analysis. Predictive factors for the presence of RD were pT3 stage (HR 25.3; p = 0.003) and pN1 stage (HR 23.0; p = 0.022).


Re-resection for iGBC is associated with improved survival but remains infrequently used and is often performed after the optimal timing interval. RD is the only significant prognostic factor for survival after re-resection and can be predicted by pT and pN stages.

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