Ann Hepatobiliary Pancreat Surg.  2023 Feb;27(1):70-75. 10.14701/ahbps.22-075.

Survival after extended resections for gallbladder cancer

Affiliations
  • 1Division of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad, Islamabad, Pakistan
  • 2Shifa Tameer-e-Millat University Islamabad, Islamabad, Pakistan
  • 3Division of Gastroenterology, Shifa International Hospital Islamabad, Islamabad, Pakistan
  • 4Division of Anesthesiology, Shifa International Hospital Islamabad, Islamabad, Pakistan

Abstract

Backgrounds/Aims
Locally advanced gallbladder cancer (GBC) is associated with survival limited to a few months. Extended resections (ER) are occasionally performed in this group and outcomes remain inconclusive. This study assessed outcomes after ER for locally advanced GBC.
Methods
Patients who underwent ER for GBC between 2011 and 2020 were reviewed. ER was defined as a major hepatectomy alone (n = 9), a pancreaticoduodenectomy (PD) with or without minor hepatectomy (n = 3), a major hepatectomy with PD (HPD) (n = 3) or vascular resection and reconstruction (n = 4). We assessed 30-day morbidity, mortality, and 2-year overall survival (OS).
Results
Among 19 patients, negative margins were achieved in 14 (73.6%). The 30-day mortality was 1/9 (11.1%) for a major hepatectomy, 0/3 (0%) for a minor HPD, 2/3 (66.7%) for a major HPD, and 1/4 (25.0%) for vascular resection. All short term survivors (< 6 months) (n=8) had preoperative jaundice and 6/8 (75.0%) underwent a major HPD or vascular resection. There were five (26.3%) long term survivors. The median OS in patients with and without preoperative jaundice was 4.1 months (0.7–11.1 months) and 13.7 months (12–30.4 months), respectively (p = 0.009) (2-year OS = 7% vs. 75%; p = 0.008). The median OS in patients who underwent a major hepatectomy alone or a minor HPD was 11.3 months (6.8–17.3 months) versus 1.4 months (0.3–4.1 months) (p = 0.02) in patients who underwent major HPD or vascular resection (2 year OS = 33% vs. not reached) (p = 0.010) respectively.
Conclusions
In selected patients with GBC, when ER is limited to a major hepatectomy alone, or a minor HPD, acceptable survival can be achieved.

Keyword

Gallbladder cancer; Hepatectomy; Pancreaticoduodenectomy; Outcomes

Figure

  • Fig. 1 Estimated 2-year overall survival after extended resection for gallbladder cancer based on the presence (n = 4) or absence (n = 15) of preoperative jaundice.

  • Fig. 2 Estimated 2-year overall survival with types of extended resection for gallbladder cancer (major HPD or vascular resection [n = 9] versus major hepatectomy alone or minor HPD [n = 10]). PD, pancreaticoduodenectomy; HPD, hepatectomy with PD.


Reference

1. Lazcano-Ponce EC, Miquel JF, Muñoz N, Herrero R, Ferrecio C, Wistuba II, et al. 2001; Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin. 51:349–364. DOI: 10.3322/canjclin.51.6.349. PMID: 11760569.
Article
2. Stinton LM, Shaffer EA. 2012; Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 6:172–187. DOI: 10.5009/gnl.2012.6.2.172. PMID: 22570746. PMCID: PMC3343155.
Article
3. Sharma A, Sharma KL, Gupta A, Yadav A, Kumar A. 2017; Gallbladder cancer epidemiology, pathogenesis and molecular genetics: recent update. World J Gastroenterol. 23:3978–3998. DOI: 10.3748/wjg.v23.i22.3978. PMID: 28652652. PMCID: PMC5473118.
Article
4. Zhu AX, Hong TS, Hezel AF, Kooby DA. 2010; Current management of gallbladder carcinoma. Oncologist. 15:168–181. DOI: 10.1634/theoncologist.2009-0302. PMID: 20147507. PMCID: PMC3227945.
Article
5. Yamamoto Y, Sugiura T, Ashida R, Okamura Y, Ito T, Uesaka K. 2017; Indications for major hepatectomy and combined procedures for advanced gallbladder cancer. Br J Surg. 104:257–266. DOI: 10.1002/bjs.10401. PMID: 27864927.
Article
6. Chen C, Geng Z, Shen H, Song H, Zhao Y, Zhang G, et al. 2016; Long-term outcomes and prognostic factors in advanced gallbladder cancer: focus on the advanced T stage. PLoS One. 11:e0166361. DOI: 10.1371/journal.pone.0166361. PMID: 27846279. PMCID: PMC5112857.
Article
7. Kuipers H, de Savornin Lohman EAJ, van Dooren M, Braat AE, Daams F, van Dam R, et al. 2021; Extended resections for advanced gallbladder cancer: results from a nationwide cohort study. Ann Surg Oncol. 28:835–843. DOI: 10.1245/s10434-020-08858-z. PMID: 32696306. PMCID: PMC7801314.
Article
8. Sakamoto Y, Nara S, Kishi Y, Esaki M, Shimada K, Kokudo N, et al. 2013; Is extended hemihepatectomy plus pancreaticoduodenectomy justified for advanced bile duct cancer and gallbladder cancer? Surgery. 153:794–800. DOI: 10.1016/j.surg.2012.11.024. PMID: 23415082.
Article
9. D'Angelica M, Dalal KM, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR. 2009; Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncol. 16:806–816. DOI: 10.1245/s10434-008-0189-3. PMID: 18985272.
10. Cai ZQ, Guo P, Si SB, Geng ZM, Chen C, Cong LL. 2017; Analysis of prognostic factors for survival after surgery for gallbladder cancer based on a Bayesian network. Sci Rep. 7:293. DOI: 10.1038/s41598-017-00491-3. PMID: 28331235. PMCID: PMC5428511.
Article
11. Amin MB, Edge SB, Greene FL, Byrd DR, Brookland RK, Washington MK, et al. 2017. AJCC cancer staging manual. 8th ed. Springer;Cham:
12. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. 2009; The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 250:187–196. DOI: 10.1097/SLA.0b013e3181b13ca2. PMID: 19638912.
13. Witjes CD, van den Akker SA, Visser O, Karim-Kos HE, de Vries E, Ijzermans JN, et al. 2012; Gallbladder cancer in the Netherlands: incidence, treatment and survival patterns since 1989. Dig Surg. 29:92–98. DOI: 10.1159/000336217. PMID: 22441693.
Article
14. Hawkins WG, DeMatteo RP, Jarnagin WR, Ben-Porat L, Blumgart LH, Fong Y. 2004; Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer. Ann Surg Oncol. 11:310–315. DOI: 10.1245/ASO.2004.03.011. PMID: 14993027.
Article
15. Yang XW, Yuan JM, Chen JY, Yang J, Gao QG, Yan XZ, et al. 2014; The prognostic importance of jaundice in surgical resection with curative intent for gallbladder cancer. BMC Cancer. 14:652. DOI: 10.1186/1471-2407-14-652. PMID: 25187159. PMCID: PMC4164789.
Article
16. Dasari BVM, Ionescu MI, Pawlik TM, Hodson J, Sutcliffe RP, Roberts KJ, et al. 2018; Outcomes of surgical resection of gallbladder cancer in patients presenting with jaundice: a systematic review and meta-analysis. J Surg Oncol. 118:477–485. DOI: 10.1002/jso.25186. PMID: 30259519.
Article
17. Regimbeau JM, Fuks D, Bachellier P, Le Treut YP, Pruvot FR, Navarro F, et al. 2011; Prognostic value of jaundice in patients with gallbladder cancer by the AFC-GBC-2009 study group. Eur J Surg Oncol. 37:505–512. DOI: 10.1016/j.ejso.2011.03.135. PMID: 21514090.
Article
18. Miura F, Asano T, Amano H, Toyota N, Wada K, Kato K, et al. 2010; New prognostic factor influencing long-term survival of patients with advanced gallbladder carcinoma. Surgery. 148:271–277. DOI: 10.1016/j.surg.2010.04.022. PMID: 20570306.
Article
19. Kaneoka Y, Yamaguchi A, Isogai M. 2007; Hepatopancreatoduodenectomy: its suitability for bile duct cancer versus gallbladder cancer. J Hepatobiliary Pancreat Surg. 14:142–148. DOI: 10.1007/s00534-006-1108-2. PMID: 17384904.
Article
20. Hakeem AR, Papoulas M, Menon KV. 2019; The role of neoadjuvant chemotherapy or chemoradiotherapy for advanced gallbladder cancer - a systematic review. Eur J Surg Oncol. 45:83–91. DOI: 10.1016/j.ejso.2018.08.020. PMID: 30287098.
Article
21. Primrose JN, Fox RP, Palmer DH, Malik HZ, Prasad R, Mirza D, et al. 2019; Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol. 20:663–673. Erratum in: Lancet Oncol 2019;20:e242.
Article
22. Kim TH, Woo SM, Lee WJ, Oh ES, Youn SH, Moon SH, et al. 2019; Benefit of adjuvant chemoradiotherapy in resected gallbladder carcinoma. Sci Rep. 9:11770. DOI: 10.1038/s41598-019-48099-z. PMID: 31409811. PMCID: PMC6692378.
Article
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