Port-Site Resection in the Surgical Management of Incidental Gallbladder Cancer: A Still Inconclusive Question: A Reply

Excerpt

We thank Liu et al. for their interest in our study and thoughtful comments. As demonstrated in electronic Supplementary Fig. 2 of the study by Maker et al.,1 multiple group analyses were carried out to help determine the role port-site excision may play in the management of gallbladder adenocarcinoma identified at laparoscopic cholecystectomy. In particular, in addition to patients with port sites resected being compared with all patients without port sites resected, additional analyses were only performed on patients after an R0 resection (Table 2; Fig. 1c). Overall survival (OS; p = 0.285) and recurrence-free survival (RFS; p = 0.47) were not different in these groups. Furthermore, we compared disease-specific survival (DSS), a more accurate reflection of the contribution of the malignancy to the patients’ OS, within the R0 resected group only, based on port-site status (Fig. 1a). Although the size of the port-site-positive group was now, expectedly, decreased (n = 6), there was no difference in DSS (p = 0.3). Therefore, in response to Lui and colleagues’ first contention that survival analysis was blurred by the R2 status of the resection, we refer to the provided multiple analyses to address the role played by completeness of resection in long-term outcomes. Similarly, in response to their comment that patients who underwent conversion to open surgery were not comparable with totally laparoscopic surgery, survival analyses were performed, including both laparoscopic converted to open patients and totally laparoscopic cholecystectomy patients, and found no difference in median OS, RFS, or DSS, regardless of port-site resection status. We refer Liu and colleagues to this description in the Discussion section of our article. …