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Routine port‐site excision in incidentally discovered gallbladder cancer is not associated with improved survival: A multi‐institution analysis from the US Extrahepatic Biliary Malignancy Consortium
Author(s) -
Ethun Cecilia G.,
Postlewait Lauren M.,
Le Nina,
Pawlik Timothy M.,
Poultsides George,
Tran Thuy,
Idrees Kamran,
Isom Chelsea A.,
Fields Ryan C.,
Krasnick Bradley A.,
Weber Sharon M.,
Salem Ahmed,
Martin Robert C. G.,
Scoggins Charles R.,
Shen Perry,
Mogal Harveshp D.,
Schmidt Carl,
Beal Eliza,
Hatzaras Ioannis,
Shenoy Rivfka,
Cardona Kenneth,
Maithel Shishir K.
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24591
Subject(s) - medicine , gallbladder cancer , malignancy , surgery , stage (stratigraphy) , port (circuit theory) , demographics , gallbladder , cancer , survival analysis , gastroenterology , paleontology , demography , sociology , electrical engineering , biology , engineering
BACKGROUND Current data on the utility of port‐site excision (PSE) during re‐resection for incidentally discovered gallbladder cancer (IGBC) in the US are conflicting and limited to single‐institution series. METHODS All patients with IGBC who underwent curative re‐resection at 10 institutions from 2000 to 2015 were included. Patients with and without PSE were compared. Primary outcome was overall survival (OS). RESULTS Of 449 pts with GBC, 266 were incidentally discovered, of which 193(73%) underwent curative re‐resection and had port‐site data; 47 pts(24%) underwent PSE, 146(76%) did not. The PSE rate remained similar over time (2000‐2004: 33%; 2005‐2009: 22%; 2010‐2015:22%; P = 0.36). Both groups had similar demographics, operative procedures, and post‐operative complications. There was no difference in T‐stage (T1: 9 vs. 11%; T2: 52 vs. 52%; T3: 39 vs. 38%; P = 0.96) or LN involvement (36 vs. 41%; P = 0.7) between groups. A 3‐year OS was similar between PSE and no PSE groups (65 vs. 43%; P = 0.07). On univariable analysis, residual disease at re‐resection (HR = 2.1, 95% CI 1.4‐3.3; P = 0.001), high tumor grade, and advanced T‐stage were associated with decreased OS. Only grade and T‐stage, but not PSE, persisted on multivariable analysis. Distant disease recurrence‐rate was identical between PSE and no PSE groups (80 vs. 81%; P = 1.0). CONCLUSION Port‐site excision during re‐resection for IGBC is not associated with improved overall survival and has the same distant disease recurrence compared to no port‐site excision. Routine port‐site excision is not recommended.