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Minimally invasive and open gallbladder cancer resections: 30- vs 90-day mortality
Naeem Goussous1, Motahar Hosseini1, Anne M Sill1
1Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
Background:
Minimally invasive surgery is increasingly used for gallbladder cancer resection. Postoperative mortality at 30 days is low, but 90-day mortality is underreported.
Methods:
Using National Cancer Database (1998-2012), all resection patients were included. Thirty- and 90-day mortality rates were compared.
Results:
A total of 36 067 patients were identified, 19 139 (53%) of whom underwent resection. Median age was 71 years and 70.7% were female. Ninety-day mortality following surgical resection was 2.3-fold higher than 30-mortality (17.1% vs 7.4%). There was a statistically significant increase in 30- and 90-day mortality with poorly differentiated tumors, presence of lymphovascular invasion, tumor stage, incomplete surgical resection and low-volume centers (P<0.001 for all). Even for the 1885 patients who underwent minimally invasive resection between 2010 and 2012, the 90-day mortality was 2.8-fold higher than the 30-day mortality (12.0% vs 4.3%).
Conclusions:
Ninety-day mortality following gallbladder cancer resection is significantly higher than 30-day mortality. Postoperative mortality is associated with tumor grade, lymphovascular invasion, tumor stage, type and completeness of surgical resection as well as type and volume of facility.
