title: Association of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall Survival: A Multi-Institution Analysis From the US Extrahepatic Biliary Malignancy Consortium.
abstract: The current recommendation is to perform re-resection for select patients with incidentally discovered gallbladder cancer. The optimal time interval for re-resection for both patient selection and long-term survival is not known.
  
  
  
  To assess the association of time interval from the initial cholecystectomy to reoperation with overall survival.
  
  
  
  This cohort study was conducted from January 1, 2000, to December 31, 2014 at 10 US academic institutions. A total of 207 patients with incidentally discovered gallbladder cancer who underwent reoperation and had available data on the date of their initial cholecystectomy were included.
  
  
  
  Time interval from the initial cholecystectomy to reoperation: group A: less than 4 weeks; group B: 4 to 8 weeks; and group C: greater than 8 weeks.
  
  
  
  Primary outcome was overall survival.
  
  
  
  Of 449 patients with gallbladder cancer, 207 cases (46%) were discovered incidentally and underwent reoperation at 3 different time intervals from the date of the original cholecystectomy: group A: less than 4 weeks (25 patients, 12%); B: 4 to 8 weeks (91 patients, 44%); C: more than 8 weeks (91 patients, 44%). The mean (SD) ages of patients in groups A, B, and C were 65 (9), 64 (11), and 66 (12) years, respectively. All groups were similar for baseline demographics, extent of resection, presence of residual disease, T stage, resection margin status, lymph node involvement, and postoperative complications. Patients who underwent reoperation between 4 and 8 weeks had the longest median overall survival (group B: 40.4 months) compared with those who underwent early (group A: 17.4 months) or late (group C: 22.4 months) reoperation (log-rank P = .03). Group A and C time intervals (vs group B), presence of residual disease, an R2 resection, advanced T stage, and lymph node involvement were associated with decreased overall survival on univariable Cox regression. Only group A (hazard ratio, 2.63; 95% CI, 1.25-5.54) and group C (hazard ratio, 2.07; 95% CI, 1.17-3.66) time intervals (vs group B), R2 resection (hazard ratio, 2.69; 95% CI, 1.27-5.69), and advanced Tstage (hazard ratio, 1.85; 95% CI, 1.11-3.08) persisted on multivariable Cox regression analysis.
  
  
  
  The optimal time interval for re-resection for incidentally discovered gallbladder cancer appears to be between 4 and 8 weeks after the initial cholecystectomy.
authors: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors: Cecilia G
authors: CG
authors: Ethun
authors: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors: Lauren M
authors: LM
authors: Postlewait
authors: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors: Nina
authors: N
authors: Le
authors: Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland3Deputy Editor, JAMA Surgery.
authors: Timothy M
authors: TM
authors: Pawlik
authors: Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Maryland.
authors: Stefan
authors: S
authors: Buettner
authors: Department of Surgery, Stanford University Medical Center, Stanford, California.
authors: George
authors: G
authors: Poultsides
authors: Department of Surgery, Stanford University Medical Center, Stanford, California.
authors: Thuy
authors: T
authors: Tran
authors: Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Kamran
authors: K
authors: Idrees
authors: Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Chelsea A
authors: CA
authors: Isom
authors: Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors: Ryan C
authors: RC
authors: Fields
authors: Department of Surgery, Washington University School of Medicine, St Louis, Missouri.
authors: Linda X
authors: LX
authors: Jin
authors: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison.
authors: Sharon M
authors: SM
authors: Weber
authors: Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison.
authors: Ahmed
authors: A
authors: Salem
authors: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
authors: Robert C G
authors: RC
authors: Martin
authors: Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky.
authors: Charles
authors: C
authors: Scoggins
authors: Department of Surgery, Wake Forest University, Winston-Salem, North Carolina.
authors: Perry
authors: P
authors: Shen
authors: Department of Surgery, Wake Forest University, Winston-Salem, North Carolina.
authors: Harveshp D
authors: HD
authors: Mogal
authors: Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus.
authors: Carl
authors: C
authors: Schmidt
authors: Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus.
authors: Eliza
authors: E
authors: Beal
authors: Department of Surgery, New York University, New York.
authors: Ioannis
authors: I
authors: Hatzaras
authors: Department of Surgery, New York University, New York.
authors: Rivfka
authors: R
authors: Shenoy
authors: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors: David A
authors: DA
authors: Kooby
authors: Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors: Shishir K
authors: SK
authors: Maithel
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery*; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012086:Reoperation; D015996:Survival Rate; D013997:Time Factors; D014481:United States