Assessing the Impact of Common Bile Duct Resection in the Surgical Management of Gallbladder Cancer

作者：Gani Faiz; Buettner Stefan; Margonis Georgios A; Ethun Cecilia G; Poultsides George; Thuy Tran; Idrees Kamran; Isom Chelsea A; Fields Ryan C; Krasnick Bradley; Weber Sharon M; Salem Ahmed; Martin Robert C G; Scoggins Charles; Shen Perry; Mogal Harveshp D; Schmidt Carl; Beal Eliza; Hatzaras Ioannis; Shenoy Rivfka; Maithel Shishir K; Pawlik Timothy M

来源：Journal of Surgical Oncology, 2016, 114(2): 176-180.

DOI：10.1002/jso.24283

• gallbladder cancer
• surgical resection
• common bile duct
• survival

Background: Although radical re-resection for gallbladder cancer (GBC) has been advocated, the optimal extent of re-resection remains unknown. The current study aimed to assess the impact of common bile duct (CBD) resection on survival among patients undergoing surgery for GBC.
Methods: Patients undergoing curative-intent surgery for GBC were identified using a multi-institutional cohort of patients. Multivariable Cox-proportional hazards regression was performed to identify risk factors for a poor overall survival (OS).
Results: Among the 449 patients identified, 26.9% underwent a concomitant CBD resection. The median number of lymph nodes harvested did not differ based on CBD resection (CBD, 4 [IQR: 2-9] vs. no CBD, 3 [IQR: 1-7], P = 0.108). While patients who underwent a CBD resection had a worse OS, after adjusting for potential confounders, CBD resection did not impact OS (HR = 1.40, 95% CI 0.87-2.27, P = 0.170). Rather, the presence of advanced disease (T3: HR = 3.11, 95% CI 1.22-7.96, P = 0.018; T4: HR = 7.24, 95% CI 1.70-30.85, P = 0.007) and the presence of disease at the surgical margin (HR = 2.58, 95% CI 1.26-5.31, P = 0.010) were predictive of a worse OS.
Conclusions: CBD resection did not yield a higher lymph node count and was not associated with an improved survival. Routine CBD excision in the re-resection of GBC is unwarranted and should only be performed selectively.

• 出版日期2016-8-1