Biological determinism and the stage-dependent role of surgical approach in gallbladder cancer: A 20-year cohort study and meta-analysis.
Yan-Yu Qiu, Sen Yang, Meng-Qing Sun et al.
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In 30 seconds
This retrospective cohort study of 416 patients who underwent gallbladder cancer surgery at a national tertiary centre from 2003 to 2022, combined with a systematic review and meta-analysis of surgical approach in incidental gallbladder cancer (IGBC), examined survival determinants and operative strategy. Most cohort patients had stage III–IV disease (68%), and 44.0% had an R0 resection. Tumour biology strongly shaped prognosis; R0 resection was associated with better overall and disease-free survival (HR 0.27 and 0.23, respectively). The meta-analysis found a stage-dependent survival benefit for primary laparoscopy in IGBC, particularly for T2 tumours.
Key findings
- The cohort had an R0 resection rate of 44.0%; perioperative morbidity was 12.7% and 30-day mortality was 0.7%.
- IGBC was associated with lower recurrence than conventional GBC (20.0% vs. 34.7%, P = 0.044) and longer median OS (56.5 vs. 32.0 months).
- R0 resection was associated with improved OS (HR 0.27) and DFS (HR 0.23) in multivariable analysis.
- Meta-analysis found a stage-dependent survival benefit for primary laparoscopic surgery in IGBC, particularly for T2 tumours.
Why it matters
The findings underscore the challenge of treating a cancer commonly diagnosed at advanced stages and the importance of complete oncologic resection when feasible. They also suggest that surgical approach may matter differently by stage in incidental disease, supporting careful selection rather than assuming one approach is optimal for all patients.
What to keep in mind
The cohort was retrospective and drawn from a single national tertiary centre; the abstract does not report the meta-analysis size or pooled effect estimate.