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

Cecilia G. Ethun, Lauren M. Postlewait, Nina Le, Timothy M. Pawlik, George Poultsides, Thuy Tran, Kamran Idrees, Chelsea A. Isom, Ryan C. Fields, Bradley A. Krasnick, Sharon M. Weber, Ahmed Salem, Robert C G Martin, Charles R. Scoggins, Perry Shen, Harveshp D. Mogal, Carl Schmidt, Eliza Beal, Ioannis Hatzaras, Rivfka ShenoyKenneth Cardona, Shishir K. Maithel

Research output: Contribution to journalArticlepeer-review

Abstract

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 449pts with GBC, 266 were incidentally discovered, of which 193(73%) underwent curative re-resection and had port-site data; 47pts(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.

Original languageEnglish (US)
JournalJournal of Surgical Oncology
DOIs
StateAccepted/In press - 2017

Keywords

  • Abdominal wall
  • Disease recurrence
  • Peritoneal carcinomatosis

ASJC Scopus subject areas

  • Surgery
  • Oncology

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