Aggressive surgical management of gallbladder cancer: at what cost?

Abstract

Background: An aggressive operative approach to gallbladder cancer has been advocated because of improved long-term survival, but data on short-term outcomes are lacking. Therefore, the purpose of this study was to analyze the postoperative outcomes of patients undergoing operative management of gallbladder cancer.

Methods: Data from the American College of Surgeons-National Surgical Quality Improvement Program (2005-2009) were queried for patients with a diagnosis of gallbladder cancer. Outcomes included serious morbidity, overall morbidity, and mortality.

Results: For the 613 patients identified, the median age was 67 years, and 64% were female. A potentially curative operation was performed in 424 (69%) patients, including cholecystectomy alone (n =150, 35%), partial hepatectomy (n = 249, 59%), and extensive hepatectomy (n = 25, 6%). Overall morbidity rates for these procedures were 21%, 19%, and 28%, respectively. Mortality was greater (P < .001) in patients undergoing extensive hepatectomy (16%) compared with those undergoing cholecystectomy (7%) or partial hepatectomy (2%).

Conclusion: Partial hepatectomy is the most common procedure performed for gallbladder cancer and is a safe operation. A small minority of younger, healthier patients undergoes an extensive hepatectomy, but the mortality of this operation is greater. This analysis suggests that patients with gallbladder cancer should be managed at high-volume centers.