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Optimizing Outcomes in Gallbladder Cancer: Identifying Predictors of Futile Up-Front Surgery in a Global Multi-center
Matteo Serenari1,2, Davide Berti2, Belen Rivera3
1Hepatobiliary Surgery and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy.
Annals of Surgical Oncology
|March 6, 2025
Summary
Identifying risk factors for futile surgery in gallbladder cancer (GBC) can reduce unnecessary interventions. A predictive model helps improve patient selection and outcomes for advanced GBC cases.
Area of Science:
- Oncology
- Surgical Oncology
- Cancer Prognostics
Background:
- Gallbladder cancer (GBC) presents a poor prognosis, especially in advanced stages.
- Surgery in advanced GBC offers limited survival benefits, necessitating evaluation of intervention futility.
Purpose of the Study:
- To identify risk factors associated with futile surgery (FS) in gallbladder cancer.
- To develop a predictive model for FS to aid in clinical decision-making.
Main Methods:
- Analysis of an international cohort of 788 patients undergoing upfront GBC surgery.
- Definition of FS as recurrence within 5 months or death within 90 days post-surgery.
- Development of a multivariate predictive model and an online calculator for FS probability.
Main Results:
- Futile surgery (FS) occurred in 13.6% of patients, with significantly shorter median survival (6.8 months vs. 57.4 months).
- Key risk factors for FS included advanced tumor stage (T3-T4), lymph node involvement, and multivisceral resection.
- Incidental GBC diagnosis was associated with a lower risk of FS (OR 0.41).
- The predictive model demonstrated strong discriminative ability (c-statistic: 0.749).
Conclusions:
- Optimizing patient selection is crucial for reducing futile surgeries in GBC.
- The developed predictive model serves as a valuable online tool to enhance surgical decision-making and improve patient outcomes by minimizing non-beneficial interventions.
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