NEW data shows that one-fifth of patients who underwent gallbladder cancer surgery at top-performing centres experienced post-operative complications within 90 days. The retrospective study aimed to evaluate the quality of gallbladder cancer surgery programmes at different centres through established benchmark values, with the objective of reducing mortality and improving outcomes.
Previous data showed that less than 10% of patients received a high-quality surgical gallbladder resection for cancer according to guidelines, and no benchmarks existed to determine what made a procedure ‘high-quality’. Eduardo Vega, Boston University School of Medicine, Massachusetts, USA, and colleagues, determined new benchmark values, which will serve as a reference for institutions to assess their performance.
The team analysed data on 906 adult patients with gallbladder cancer who underwent a surgical resection between 2000–2021. The benchmark group included 245 patients who did not have significant comorbidities, or did not need vascular and/or bile reconstruction, and underwent surgery at high-volume centres.
Researchers then established benchmark values for a number of parameters, such as estimated blood loss (350 mL or less), lymph nodes retrieved (four or more), R1 surgical margins perioperative blood rate (7% or less), length of post-operative hospital stay (8 days or less), complication rate (22% or less), operative time (332 minutes or less), and Grade IIIa or higher Clavien-Dindo complications (11% or less). Overall survival was significantly longer in the benchmark group compared with the non-benchmark group, but recurrence-free survival was similar in both groups.
“Although gallbladder cancer is believed to be a low-morbidity surgery, even highly experienced centres had a level of complications similar to those seen with more complex procedures,” stated Vega, who explained that the results were surprising. They concluded that a shift from volume to evidence and data to assess quality of procedures, as the results showed that high volume of procedures was not linked to high-quality surgery.
