Anatomical hepatic resection versus wedge resection for gallbladder cancer: analysis of multi-center database

Abstract

Background: To compare anatomical hepatic resection (AHR) to wedge resection (WR) for gallbladder cancer. Methods: Hepatic resections for GBCA at 13 medical centers (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) were included. WR was defined as non-anatomical resection of 2-3 cm of the gallbladder fossa. AHR was defined as identifying and dividing the vasculobiliary pedicle for hepatic segments 4b and 5. Overall postoperative morbidity (OM), 90-day major (Clavien !3) morbidity (MM), mortality, and hospital length of stay (LOS) were compared using bivariate and multivariate analysis. Results: In 753 patients with GBCA, 341 (45%) underwent cholecystectomy only and 112 (15%) underwent hepatic resection. Four resection cases were excluded, because they involved extended right hepatectomy. Of the remaining 108 cases, 25 (23%) underwent AHR. OM, MM and mortality were 44%, 25% and 1.8% respectively. Patients undergoing AHR were more likely to have hepaticojejunostomy (28% vs. 6%, p < 0.001) and open surgery (76% vs. 53%, p = 0.041). There was an association of AHR with OM (60% vs. 40%, p = 0.082), but this difference was not statistically significant. There was no difference in mortality (4% vs. 1.2%, p = 0.363), MM (32% vs. 24%, p = 0.429), organ/ space infection (24% vs. 19%, p = 0.587), bile leak (12% vs. 10%, p = 0.869), and LOS (7.8 AE 4.7 vs. 6.7 AE 4.7 days, p = 0.307) between groups. Patients undergoing AHR and WR had comparable 5-year overall survival (43% vs. 46%, p = 0.113), disease-free survival (44% vs. 54%, p = 0.510) and disease-specific survival (59% vs. 51%, p = 0.657). Conclusion: AHR for GBCA is associated with more complex hepatic resection than WR without improved long-term oncologic outcomes. Further studies with larger sample size are needed to confirm these findings.

Management of gallbladder cancer in India

“…In another study by Pawlik et al (8) there was similar risk of disease-specific death among patients who underwent a major hepatic resection (e.g., formal segmentectomy of 4b and 5 or hemihepatectomy) and patients who underwent a hepatic wedge resection. Similar results were reported by other authors (9). It was shown that surgical margin status was the key determinant of overall outcome, and not the type of liver resection (10).…”