Minimally invasive and open gallbladder cancer resections: 30- vs 90-day mortality
Naeem Goussous, Motahar Hosseini, Anne M Sill and Steven C Cunningham
Baltimore, USA
Author Affiliations: Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA (Goussous N, Hosseini M, Sill AM and Cunningham SC)
Corresponding Author: Steven C Cunningham, MD, FACS, Director of Pancreatic and Hepatobiliary Surgery, Director of Research, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore, MD 21229, USA (Tel: +410-368-8815; Fax: +410-719-0094; Email: Steven.Cunningham@stagnes.org)
Abstract：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.
2017, Vol. 16 
