Analysis of neoadjuvant therapy effect on 30-day postoperative outcomes in gallbladder cancer

Nicole Martin, MD, MPH; Areg Grigorian, MD; Francesca A. Kimelman, MD, MPH; Zeljka Jutric, MD; Stephen Stopenski, MD; David K. Imagawa, MD, PhD; Ron F. Wolf, MD; Shimul Shah, MD, MHCM; Jeffry Nahmias, MD, MHPE

Surgery Open Science (Sep 2024)

Analysis of neoadjuvant therapy effect on 30-day postoperative outcomes in gallbladder cancer

Nicole Martin, MD, MPH,
Areg Grigorian, MD,
Francesca A. Kimelman, MD, MPH,
Zeljka Jutric, MD,
Stephen Stopenski, MD,
David K. Imagawa, MD, PhD,
Ron F. Wolf, MD,
Shimul Shah, MD, MHCM,
Jeffry Nahmias, MD, MHPE

Affiliations

Nicole Martin, MD, MPH: University of California, Irvine, Department of Surgery, 101 The City Dr S, Orange, CA, USA
Areg Grigorian, MD: University of California, Irvine, Department of Surgery, 101 The City Dr S, Orange, CA, USA
Francesca A. Kimelman, MD, MPH: University of California, Irvine, Department of Surgery, 101 The City Dr S, Orange, CA, USA; Corresponding author at: Department of Surgery, University of California, Irvine Medical Center, 3800 W Chapman Ave, Suite 6200, Orange, CA 92868-3298, USA.
Zeljka Jutric, MD: University of California, Irvine, Department of Surgery, 101 The City Dr S, Orange, CA, USA
Stephen Stopenski, MD: University of California, Irvine, Department of Surgery, 101 The City Dr S, Orange, CA, USA
David K. Imagawa, MD, PhD: University of California, Irvine, Department of Surgery, 101 The City Dr S, Orange, CA, USA
Ron F. Wolf, MD: University of California, Irvine, Department of Surgery, 101 The City Dr S, Orange, CA, USA
Shimul Shah, MD, MHCM: University of Cincinnati, Department of Surgery, 231 Albert Sabin Way, Cincinnati, OH, USA
Jeffry Nahmias, MD, MHPE: University of California, Irvine, Department of Surgery, 101 The City Dr S, Orange, CA, USA

Journal volume & issue: Vol. 21
pp. 17 – 21

Abstract

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Background: The role of neoadjuvant therapy (NAT) in gallbladder cancer (GBC) is not well established. We sought to evaluate the effect of NAT on postoperative outcomes following surgical resection of GBC. We hypothesized that patients receiving NAT would have similar rates of 30-day mortality, readmission, and postoperative complications (e.g. bile leakage and liver failure) compared to those who did not receive NAT. Methods: The 2014–2017 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Procedure-Targeted Hepatectomy database was queried for patients that underwent surgery for GBC. Propensity scores were calculated to match patients in a 1:2 ratio based on age, comorbidities, functional status, and tumor staging. Results: A total of 37 patients undergoing NAT were matched to 74 patients without NAT. There was no difference in any matched characteristics. Compared to the NAT group, the no NAT cohort had similar rates of postoperative bile leakage (NAT 13.5 % vs. no NAT 10.8 %, p = 0.31), postoperative liver failure (5.4 %, vs. 8.1 %, p = 0.60), 30-day readmission (10.8 % vs. 10.8 %, p = 1.00), and 30-day mortality (10.8 % vs. 2.7 %, p = 0.075). All 30-day complications were similar except for a higher rate of postoperative blood transfusion (NAT 32.4 % vs. no NAT 10.8 %, p = 0.005). Conclusion: In patients undergoing surgical resection for GBC, those with and without NAT had similar rates of readmission and 30-day mortality, however NAT was associated with an increased risk for transfusion. Despite use of a large national database, this study may be underpowered to adequately assess the effect of NAT on perioperative GBC outcomes and thus warrants further investigation.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

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