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Comparison of oncological outcomes after open and laparoscopic re-resection of incidental gallbladder cancer
Indexado
WoS WOS:000504113200001
DOI 10.1002/BJS.11379
Año 2020
Tipo artículo de investigación

Citas Totales

Autores Afiliación Chile

Instituciones Chile

% Participación
Internacional

Autores
Afiliación Extranjera

Instituciones
Extranjeras


Abstract



Background The safety and oncological efficacy of laparoscopic re-resection of incidental gallbladder cancer have not been studied. This study aimed to compare laparoscopic with open re-resection of incidentally discovered gallbladder cancer while minimizing selection bias. Methods This was a multicentre retrospective observational cohort study of patients with incidental gallbladder cancer who underwent re-resection with curative intent at four centres between 2000 and 2017. Overall survival (OS) and recurrence-free survival (RFS) were analysed by intention to treat. Inverse probability of surgery treatment weighting using propensity scoring was undertaken. Results A total of 255 patients underwent re-resection (190 open, 65 laparoscopic). Nineteen laparoscopic procedures were converted to open operation. Surgery before 2011 was the only factor associated with conversion. Duration of hospital stay was shorter after laparoscopic re-resection (median 4 versus 6 days; P < 0 center dot 001). Three-year OS rates for laparoscopic and open re-resection were 87 and 62 per cent respectively (P = 0 center dot 502). Independent predictors of worse OS were residual cancer found at re-resection (hazard ratio (HR) 1 center dot 91, 95 per cent c.i. 1 center dot 17 to 3 center dot 11), blood loss of at least 500 ml (HR 1 center dot 83, 1 center dot 23 to 2 center dot 74) and at least four positive nodes (HR 3 center dot 11, 1 center dot 46 to 6 center dot 65). In competing-risks analysis, the RFS incidence was higher for laparoscopic re-resection (P = 0 center dot 038), but OS did not differ between groups. Independent predictors of worse RFS were one to three positive nodes (HR 2 center dot 16, 1 center dot 29 to 3 center dot 60), at least four positive nodes (HR 4 center dot 39, 1 center dot 96 to 9 center dot 82) and residual cancer (HR 2 center dot 42, 1 center dot 46 to 4 center dot 00). Conclusion Laparoscopic re-resection for selected patients with incidental gallbladder cancer is oncologically non-inferior to an open approach. Dissemination of advanced laparoscopic skills and timely referral of patients with incidental gallbladder cancer to specialized centres may allow more patients to benefit from this operation.

Revista



Revista ISSN
British Journal Of Surgery 0007-1323

Métricas Externas



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Disciplinas de Investigación



WOS
Surgery
Scopus
Sin Disciplinas
SciELO
Sin Disciplinas

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Publicaciones WoS (Ediciones: ISSHP, ISTP, AHCI, SSCI, SCI), Scopus, SciELO Chile.

Colaboración Institucional



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Autores - Afiliación



Ord. Autor Género Institución - País
1 Vega, E. A. - Univ Texas MD Anderson Canc Ctr - Estados Unidos
2 DE-ARETXABALA-URQUIZA, XABIER ANDER Hombre Clínica Alemana - Chile
3 Qiao, W. - Univ Texas MD Anderson Canc Ctr - Estados Unidos
4 Newhook, T. E. - Univ Texas MD Anderson Canc Ctr - Estados Unidos
5 Okuno, M. - Univ Texas MD Anderson Canc Ctr - Estados Unidos
6 Castillo, F. - Clínica Alemana - Chile
7 Sanhueza, M. - Hospital Dr Sotero del Rio - Chile
Pontificia Universidad Católica de Chile - Chile
Pontificia Univ Catolica Chile - Chile
8 Diaz, CHRISTIAN JAVIER Hombre Hospital Dr Sotero del Rio - Chile
Pontificia Universidad Católica de Chile - Chile
Pontificia Univ Catolica Chile - Chile
9 Cavada Chacon, Gabriel C. H. Hombre Universidad del Desarrollo - Chile
Univ Desarrollo - Chile
10 JARUFE-CASSIS, NICOLAS PATRICIO Hombre Pontificia Universidad Católica de Chile - Chile
Pontificia Univ Catolica Chile - Chile
11 MUNOZ-CERON, CLAUDIO ANTONIO Hombre Pontificia Universidad Católica de Chile - Chile
Pontificia Univ Catolica Chile - Chile
12 Rencoret, G. - Clínica Alemana - Chile
13 VIVANCO-LACALLE, MARCELO ALEJANDRO Hombre Clínica Alemana - Chile
14 Joechle, K. - Univ Texas MD Anderson Canc Ctr - Estados Unidos
15 Tzeng, C. -W. D. - Univ Texas MD Anderson Canc Ctr - Estados Unidos
16 Vauthey, J. -N. - Univ Texas MD Anderson Canc Ctr - Estados Unidos
17 VINUELA-FAWAZ, EDUARDO ANDRES Hombre Hospital Dr Sotero del Rio - Chile
Pontificia Universidad Católica de Chile - Chile
Pontificia Univ Catolica Chile - Chile
18 Conrad, C. - Univ Texas MD Anderson Canc Ctr - Estados Unidos

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Financiamiento



Fuente
National Cancer Institute

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Agradecimientos



Agradecimiento
The authors thank S. Deming for editorial support, and A. Castillo and F. Oppliger for assistance with project planning and data accrual. This study was supported by the National Cancer Institute (award number P30CA016672), which supports the MD Anderson Cancer Center Clinical Trials Support Resource.

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