Abstract
To the Editor
We read with great interest the study by Muszynska et al. comparing survival outcomes between preoperatively suspected gallbladder cancer (GBC) and incidental GBC (IGBC). 1 Their use of the SweLiv and GallRiks registries provides a valuable data set, particularly highlighting the improved survival in pT3 patients with preoperatively suspected GBC. The study’s rigorous use of Kaplan–Meier and Cox regression analyses enhances its credibility by appropriately adjusting for key prognostic factors.
However, several important considerations should be addressed to maximize the study’s clinical impact. Notably, the study does not fully examine the role of adjuvant therapies, such as chemotherapy, which are known to improve survival in GBC, particularly in patients undergoing re-resection. 2 Including data on adjuvant therapies would provide a more holistic understanding of treatment outcomes, as multimodal approaches are often employed in advanced-stage cases.
Furthermore, the rationale for forgoing re-resection in IGBC patients warrants more exploration. Prior research suggests that decisions against re-resection are often influenced by factors such as advanced disease or comorbidities, which were not fully addressed in the study. 3 Clarifying these factors could help refine the survival comparisons by accounting for patient selection biases.
The study also overlooks the role of tumor location, which has been shown to significantly affect survival outcomes in GBC. For instance, Shindoh et al. demonstrated that hepatic-side involvement in T2 tumors is associated with worse prognosis. 4 A detailed analysis of tumor location would add further granularity to the study’s findings and could better explain variations in survival rates.
Finally, the exclusion of early postoperative mortality, as highlighted in previous studies, likely underestimates the true risks of surgery in these patients.5,6 Including such data would offer a more accurate reflection of surgical outcomes, especially given the aggressive nature of GBC.
In conclusion, Muszynska et al. provide valuable insights into GBC management, but addressing these factors—adjuvant therapies, tumor location, and early mortality—would enhance the clinical applicability of their findings.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
