Kasumova GG, et al. - This study aimed at determining whether simple cholecystectomy with adjuvant therapy could provide outcomes comparable to extended cholecystectomy. After resection of T2/T3 tumors, providing adjuvant therapy prolonged survival. Findings suggested the superiority of simple cholecystectomy with adjuvant therapy to extended resection alone in the short term. In select high-risk individuals, it could serve as a potential alternative to re-resection.

Methods

• Authors searched the national Cancer Data Base 2004 to 2014 for patients with pT2/T3 gallbladder adenocarcinoma who underwent resection.
• They defined adjuvant therapy as chemotherapy, with or without radiotherapy, within 90 days of surgery.
• Comparison of baseline characteristics and overall survival was performed using X² and Kaplan-Meier method, respectively.
• They used one-to-one propensity score matching for receipt of adjuvant therapy to assess potential selection bias.

Results

• Authors identified 6825 patients.
• Patients were predominantly (78.9%) diagnosed at the time of surgery or on pathology; 31.8% (2168) received adjuvant therapy.
• Simple cholecystectomy was performed on majority [88.8% (6060)] of patients.
• In this study, patients who received adjuvant therapy versus surgery alone were more likely to: be younger, privately insured, have no comorbidities, pT3 disease, positive lymph nodes, positive resection margins, and extended cholecystectomy.
• After matching, significantly longer median survival was observed for extended cholecystectomy with adjuvant therapy (23.3 months) than cholecystectomy with adjuvant therapy (16.4 months), which was significantly longer than either simple (12.4 months) or extended (10.7 months) cholecystectomy alone (all log-rank P<0.001).