Analysis of the Extent of Liver Oncological Extended Resection for Incidental Gallbladder Cancer: How Much Is Too Much?

Background. Liver resection is pivotal in treating incidental gallbladder cancer (IGBC). However, the adequate volume of liver resection remains controversial. Methods. A cross-sectional retrospective analysis was performed on resected IGBC patients between 1999 and 2018. Morbidity was evaluated according to the Clavien-Dindo classification. The theoretical volume of a 2-cm and 1.5-cm wedge liver resection was calculated (105 cm(3) and 77.5 cm(3), respectively) and used as reference. Overall survival (OS) was estimated using Kaplan-Meier and Cox regression analyses. Results. Among 111 patients re-resected for IGBC, 84 provided sufficient data to calculate liver resection volume. Patients with a resection volume >= 105 cm(3) had a higher rate of overall morbidity (P = 0.001) and length of stay (P = 0.012), with no difference in mortality. There was no significant difference in OS according to residual cancer or T-category. A resection volume >= 77.5 cm(3) was more frequent in T = 3 than in T1-2 patients (P = 0.026), and residual cancer was higher (P = 0.041) among patients with >= 77.5 cm(3) resected. Cox multivariate regression showed that residual cancer (HR = 11.47, P < 0.001), perineural/lymphovascular invasion (HR = 2.48, P = 0.021), and Clavien-Dindo >= IIIa morbidity (HR = 5.03, P = 0.003) predict worse OS, but not liver volume resection. Conclusion. There are no significant differences in OS based on resected liver volume of IGBC, when R0 is achieved. There is a significant difference in morbidity and length of stay when liver wedges are >= 105 cm(3), which is lost when analyzed by Clavien-Dindo >= IIIa. A 77.5-105 cm(3) resection is indicated in >= T3 patients, minimizing morbidity risk, while addressing concerns of overall survival.

Automated summary

In this retrospective analysis, the volume of liver resection in patients with incidental gallbladder cancer was found to be associated with overall morbidity and length of stay, but not overall survival. Resection volume of 105 cm3 or more was associated with higher morbidity and length of stay. However, there was no significant difference in overall survival based on the volume of liver resection.