Extended Re-resection For Incidental Gallbladder Cancer:A Survival Analysis

Objective:This study was conducted to evaluate the prognosis of incidental gallbladder carcinoma(IGBC),with the focus on who can benefit from an extended re-surgery(RR)Methods:Retrieved multiple electronic databases by using related search terms on a computer,including Pub Med,Medline(EBSCO),Web of Science,EMBASE database,a comprehensive search of the literature published from January 01,1990 to nowadays about incidental gallbladder cancer,and browsed the related literature references,and then to manually search for possible related references,limited to the English language.Strict inclusion and exclusion criteria were established,and then the literature was screened and data extracted by two researchers.Kaplan-Meier curves were used to determine whether the extended re-surgery improves the survival of patients,and compared by the long-rank test.p values of <0.05 were considered significant.Results:A total of 26 articles include 359 patients were involved in our study.There were16 Tis patients,61 T1 a patients,59 T1 b patients,149 T2 patients,64 T3 patients,10 T4 patients among them.Finding 20 of 59 T1 b patients can benefit from radical re-surgery(P=0.02).There was a significant benefit for the 100 of 149 T2 patients who underwent a extended re-surgery.Median overall survival was 33 months with 1-,3-and 5-year survival of patients who presented for radical re-surgery was 91.8%,76.3%and 68.8% respectively,while 83.3%,39.9% and 29.5% for non-extended re-resection(NR)(simple cholecystectomy)respectively.(P < 0.001).In the meantime,34 of 64T3 patients can also benefit from extended re-resection(RR)with 1-and 2-year survival of 63.3% and 41.1% in RR,compared to 26.7% and 13.3% in NR.As for patients with Tis,T1 a and T4 tumors,there shows no difference whether a extended re-surgery was conducted.There was a significantly improvement of survival for T2 patients who underwent an extended re-resection.Conclusion:No benefit was found for 6 of the 61 T1 a patients who had a radical re-surgery,but T1 b,T2 and T3 patients who had a radical re-surgery experienced a significant benefit.For Tis and T1 a patients,there is no different whether an extended re-resection was conducted,simple cholecystectomy is curable.As to T1 b,T2 and T3 patients,a radical re-surgery is highly recommended,especially in patients with T2 stage tumors.Palliative surgery is profitable for T4 patients.