Development of Benchmark Values for Evaluating Outcomes in Patients Undergoing Gallbladder Cancer Surgery in China: A Multicenter Retrospective Cohort Study.
Abstract
Background
Surgery is the only potentially curative treatment for gallbladder cancer (GBC); however, existing surgical benchmarks are derived mainly from Western populations and exclude some complex clinical presentations, limiting regional comparisons.
Methods
This multicenter retrospective cohort study evaluated patients undergoing curative-intent GBC resection for GBC at 9 high-volume centers in China between August 2018 and December 2023, with ≥1 year of follow-up. Benchmark patients were defined as those without major comorbidities, with an American Society of Anesthesiologists class I-II, body mass index <35kg/m², no chronic cardiovascular, pulmonary, or renal disease, no history of diabetes mellitus, and no anticoagulant use. Benchmark cutoff values were defined as the 25th percentile for favorable outcomes and the 75th percentile for unfavorable outcomes across participating centers.
Results
Of 1,063 patients screened, 513 met the study eligibility criteria, of whom 445 (86.7%) met the benchmark patient criteria. Eighteen core benchmark endpoints were established and classified into Surgical Quality/Safety and Long-term Outcome domains. Key surgical quality/safety benchmarks included overall postoperative complication rate ≤75.7%, severe complication (Clavien-Dindo grade III-V) rate ≤13.8%, grade B/C post-hepatectomy liver failure rate ≤4.4%, grade B/C bile leakage rate ≤7.1%, and 90-day mortality ≤6.0%. Key long-term outcome benchmarks included median recurrence-free survival ≥14.3 months, and median overall survival ≥25.3 months.
Conclusions
This study establishes standardized benchmarks for surgical quality/safety and long-term outcomes after curative-intent GBC resection using data from benchmark patients treated at nine high-volume centers in China. SYNOPSIS This multicenter retrospective cohort study of patients treated in nine high-volume centers in China provides benchmark values for perioperative, oncological, and survival outcomes in gallbladder cancer surgery.