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Hale J, Landrum KR, Agala C, Vidri RA, Gleeson E, LeCompte MT. Minimally invasive vs. open radical cholecystectomy for gallbladder cancer: 30-day NSQIP outcomes analysis. Surg Endosc 2025; 39:3873-3882. [PMID: 40346434 DOI: 10.1007/s00464-025-11755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Accepted: 04/20/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND Radical cholecystectomy (RC) is the standard procedure for gallbladder cancer (GBC) tumors stage TIb or higher. Advances in minimally invasive surgery (MIS) offer the potential for improved outcomes compared to the traditional open surgery. While small series have demonstrated the feasibility of an MIS approach, a detailed comparison of outcomes between the two approaches is lacking. METHODS The National Surgeon Quality Improvement Database (2010-2021) was queried to identify patients undergoing RC for GBC. Patients with T1b or higher disease were included. Thirty-day all-cause mortality and morbidity were evaluated. To assess associations between outcomes and covariates, we estimated risk ratios and risk differences using generalized linear models and adjusted the estimates using inverse propensity of treatment weights. RESULTS 1303 patients were identified (239 MIS, 1064 Open) with 178 excluded due to the need for biliary reconstruction. There was no difference in the primary outcomes of mortality or major morbidity between the groups with four deaths occurring overall and major morbidity rates of MIS = 2.26% and Open = 2.45% (p = 0.7924). Patients who underwent MIS had significantly fewer days in the hospital (3.00 vs.5.00, p < 0.001). After weighting, the MIS group had significantly fewer blood transfusions (2.12% vs. 6.73%, p = 0.009) and superficial surgical site infections (0.45% vs. 3.29%, p = 0.020). CONCLUSION Our findings contribute to the growing body of evidence supporting MIS for RC as a potential alternative to open resections.
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Affiliation(s)
- Joshua Hale
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Kelsey R Landrum
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27599, USA
| | - Chris Agala
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27599, USA
| | - Roberto A Vidri
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27599, USA
| | - Elizabeth Gleeson
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27599, USA
| | - Michael T LeCompte
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27599, USA.
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Muszynska C, Lundgren L, Jacobsson H, Sandström P, Andersson B. Preoperatively suspected gallbladder cancer improves survival compared with incidental gallbladder cancer in pT3 patients. Scand J Surg 2024; 113:314-323. [PMID: 39066517 DOI: 10.1177/14574969241263539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND The aim was to compare survival for incidental gallbladder cancer (IGBC), respectively, preoperatively suspected gallbladder cancer (GBC), subjected to surgery for different pathological tumour (pT) stages and in different treatment groups in a national cohort. METHODS Data were collected and crosslinked from two national quality registers, SweLiv (2009-2019) and GallRiks (2009-2016). Survival was estimated using Kaplan-Meier analysis. The log-rank test and Cox regression analyses were used to compare groups. RESULTS In total, 466 IGBC patients, including 225 who only underwent simple cholecystectomy (SC), and 477 GBC patients were included. Most patients were female, with small differences in mean age between groups. In all IGBC patients compared with GBC patients, an improved 5-year overall survival in pT3 GBC undergoing surgery (GBC 13% vs all IGBC 8%, p < 0.001), was seen. GBC was shown to be an independent predictor for improved survival in pT3 patients (hazard ratio (HR): 0.6; 95% confidence interval (CI): 0.4-0.8, p < 0.001). In addition, in GBC with curative reresection compared with IGBC SC and IGBC with curative resection, an improved 5-year overall survival in pT3 GBC was shown (GBC 20% vs all IGBC 10%, p < 0.001). GBC was an independent predictor for improved survival in pT3 patients with curative resection (HR: 0.4; 95% CI: 0.3-0.7, p < 0.001). CONCLUSIONS GBC was shown to be an independent predictor for improved survival in pT3 patients, and patients with GBC may benefit from one-stage resection. It is, therefore, reasonable to recommend that radiological suspicion of malignancy should be evaluated at a liver tumour centre to optimize patient outcomes.
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Affiliation(s)
- Carolina Muszynska
- Carolina Muszynska Department of Surgery Skåne University Hospital Department of Clinical Sciences Lund University Lund SE-221 85 Sweden
| | - Linda Lundgren
- Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden
- Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Helene Jacobsson
- Unit for Medical Statistics and Epidemiology, Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden
| | - Per Sandström
- Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden
- Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Bodil Andersson
- Department of Surgery, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden
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Chen LT, Vogel A, Hsu C, Chen MH, Fang W, Pangarsa EA, Sharma A, Ikeda M, Park JO, Tan CK, Regala E, Tai D, Tanasanvimon S, Charoentum C, Chee CE, Lui A, Sow J, Oh DY, Ueno M, Ramaswamy A, Jeo WS, Zhou J, Curigliano G, Yoshino T, Bai LY, Pentheroudakis G, Chiang NJ, Cervantes A, Chen JS, Ducreux M. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with biliary tract cancer. ESMO Open 2024; 9:103647. [PMID: 39232586 PMCID: PMC11410730 DOI: 10.1016/j.esmoop.2024.103647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 09/06/2024] Open
Abstract
The European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with biliary tract cancer (BTC), published in late 2022 were adapted in December 2023, according to established standard methodology, to produce the Pan-Asian adapted (PAGA) ESMO consensus guidelines for the management of Asian patients with BTC. The adapted guidelines presented in this manuscript represent the consensus opinions reached by a panel of Asian experts in the treatment of patients with BTC representing the oncological societies of China (CSCO), Indonesia (ISHMO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO), co-ordinated by ESMO and the Taiwan Oncology Society (TOS). The voting was based on scientific evidence and was independent of the current treatment practices, drug access restrictions and reimbursement decisions in the different regions of Asia. Drug access and reimbursement in the different regions of Asia are discussed separately in the manuscript. The aim is to provide guidance for the optimisation and harmonisation of the management of patients with BTC across the different countries and regions of Asia, drawing on the evidence provided by both Western and Asian trials, whilst respecting the differences in screening practices and molecular profiling, as well as age and stage at presentation. Attention is drawn to the disparity in the drug approvals and reimbursement strategies, between the different countries.
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Affiliation(s)
- L-T Chen
- Kaohsiung Medical University Hospital, Center for Cancer Research, Kaohsiung Medical University, Kaohsiung; National Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan.
| | - A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Hannover, Germany; Division of Gastroenterology and Hepatology, Toronto General Hospital, Medical Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - C Hsu
- Department of Oncology, National Taiwan University Hospital, Taipei; Department of Medical Oncology, National Taiwan University Cancer Center, Taipei
| | - M-H Chen
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - W Fang
- Department of Medical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - E A Pangarsa
- Haematology Medical Oncology Division, Department of Oncology, Faculty of Medicine, Diponegoro University/Dr. Kariadi Hospital, Semarang, Indonesia
| | - A Sharma
- Department of Medical Oncology, Max Institute of Cancer Care, Max Super Specialty Hospital, Saket, New Delhi, India
| | - M Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - J O Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - C K Tan
- Department of Oncology and Nuclear Medicine, Thomson Hospital Kota Damansara, Petaling Jaya, Selangor, Malaysia
| | - E Regala
- Clinical Division Building, University of Santo Tomas Hospital, Sampaloc, Manila, Philippines
| | - D Tai
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - S Tanasanvimon
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok
| | - C Charoentum
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - C E Chee
- Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - A Lui
- Department of Internal Medicine, Metro Davao Medical and Research Center, Davao City; Section of Medical Oncology, Department of Internal Medicine, Southern Philippines Medical Center, Davao City, The Philippines
| | - J Sow
- Department of Oncology, Curie Oncology Kuala Lumpur, Kuala Lumpur, Malaysia
| | - D-Y Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - M Ueno
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
| | - A Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Parel, Mumbai, India
| | - W S Jeo
- Division of Digestive Surgery, Department of General Surgery, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - J Zhou
- Department of Gastrointestinal Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - G Curigliano
- Istituto Europeo di Oncologia, Milano, IRCCS, Milano; Department of Oncology and Haematology, University of Milano, Milano, Italy
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - L-Y Bai
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | | | - N-J Chiang
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - A Cervantes
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia; CIBERONC. Instituto de Salud Carlos III, Madrid, Spain
| | - J-S Chen
- Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - M Ducreux
- INSERM U1279, Université Paris-Saclay, Villejuif; Department of Cancer Medicine, Gustave Roussy, Villejuif, France
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Li D, Xu L, Deng X, Sun Y, Zhang Z, Wang T, Wei R, Luo Y, Niu W, Yang Z. Laparoscopic versus open surgery in treating patients with gallbladder cancer: a systematic review and meta-analysis. Hepatobiliary Surg Nutr 2024; 13:444-459. [PMID: 38911190 PMCID: PMC11190509 DOI: 10.21037/hbsn-22-597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/27/2023] [Indexed: 06/25/2024]
Abstract
Background Concerns over the security of laparoscopic radical operation for gallbladder cancer (GBC) persist. This systematic review and meta-analysis attempted to compare the safety and efficacy of laparoscopic surgery (LS) versus open surgery (OS) in the treatment of GBC. Methods The PubMed, EMBASE, and Web of Science were searched from inception to July 18, 2022. Literature search, quality assessment, and data extraction were completed independently and in duplicate. Effect-size estimates expressed as weighted mean difference (WMD) or odds ratio (OR) with 95% confidence interval (CI) were derived under the random-effects model. Results A total of 27 independent studies including 2,868 participants were meta-analyzed. Significance was noted for intraoperative blood loss (WMD: -117.194, 95% CI: -170.188 to 64.201, P<0.001), harvested lymph nodes (WMD: -1.023, 95% CI: -1.776 to -0.269, P=0.008), postoperative hospital stay (WMD: -3.555, 95% CI: -4.509 to -2.601, P<0.001), postoperative morbidity (OR: 0.596, 95% CI: 0.407 to 0.871, P=0.008), overall survival rate at 2-year (OR: 1.524, 95% CI: 1.143 to 2.031, P=0.004), T2 survival at 1-year (OR: 1.799, 95% CI: 1.777 to 2.749, P<0.01) and 2-year (OR: 2.026, 95% CI: 1.392 to 2.949, P<0.001), as well as T3 survival at 1-year (OR: 2.669, 95% CI: 1.564 to 4.555, P<0.001) and 2-year (OR: 2.300, 95% CI: 1.308 to 4.046, P=0.004). Subgroup analyses revealed that ethnicity, incidental GBC, sample size, and follow-up period were possible sources of heterogeneity. There was a low probability of publication bias for all outcomes except postoperative morbidity. Conclusions Our findings indicated that LS statistically had better 2-year survival rates, less intraoperative bleeding, shorter hospitalization times, and lower rates of complications than OS. However, the superiority and even the safety of LS still remain an open question due to the impact of incidental GBC, unaccounted heterogeneity, publication bias, lymph node dissection, and port-site metastasis.
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Affiliation(s)
- Duo Li
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Li Xu
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiangling Deng
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Pediatrics, China-Japan Friendship Hospital, Beijing, China
| | - Yongliang Sun
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zihuan Zhang
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Tianxiao Wang
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
- Graduate School, Peking University Health Science Center, Beijing, China
| | - Ruili Wei
- Graduate School, Capital Medical University, Beijing, China
| | - Yingjixing Luo
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Wenquan Niu
- Center for Evidence-Based Medicine, Capital Institute of Pediatrics, Beijing, China
| | - Zhiying Yang
- Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- Department of General Surgery, China-Japan Friendship Hospital, Beijing, China
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5
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Olecki EJ, Mayhew M, Perez Holguin R, Wong WG, Stahl KA, Peng JS, Dixon ME, Gusani NJ. Gallbladder Cancer Incidentally Found at Cholecystectomy: Perioperative Risk Factors. J Gastrointest Cancer 2024; 55:723-732. [PMID: 38191950 DOI: 10.1007/s12029-023-00973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Risk factors of gallbladder cancer (GBC) are not well-defined resulting in greater than 60% of GBCs being diagnosed incidentally following cholecystectomy performed for presumed benign indications. As most localized GBCs require more extensive oncologic surgery beyond cholecystectomy, this study aims to examine factors associated with incidentally found GBC to improve preoperative and intraoperative diagnoses. METHODS The American College of Surgeons National Surgical Quality Improvement Program Database from 2007 to 2017 was used to identify cholecystectomies performed with and without a final diagnosis of GBC. Univariate and multivariable logistic regressions were used to compare demographic, intraoperative, and postoperative characteristics among those with and without a diagnosis of GBC. RESULTS The incidence of GBC was observed to be 0.11% (441/403,443). Preoperative factors associated with risk of GBC included age > 60 (OR 6.51, p < .001), female sex (OR 1.75, p < .001), history of weight loss (2.58, p < .001), and elevated preoperative alkaline phosphatase level (OR 1.67, p = .001). Open approach was associated with 7 times increased risk of GBC compared to laparoscopic approach (OR 7.33, p < .001). In addition to preoperative factors and surgical approach, longer mean operative times (127 min vs 70.7 min, p < .001) were significantly associated with increased risk of GBC compared to benign final pathology. CONCLUSION This study demonstrates that those with incidentally discovered GBC at cholecystectomy are unique from those undergoing cholecystectomy for benign indications. By identifying predictors of GBC, surgeons can choose high risk individuals for pre-operative oncologic evaluation and consider better tools for identifying GBC such as intraoperative frozen pathology.
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Affiliation(s)
- Elizabeth J Olecki
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
| | - Mackenzie Mayhew
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy Perez Holguin
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - William G Wong
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Kelly A Stahl
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - June S Peng
- Program for Liver, Pancreas, & Foregut Tumors, Department of Surgery College of Medicine, The Pennsylvania State University, PA, USA
| | - Matthew E Dixon
- Division of Surgical Oncology, Department of Surgery, Rush Medical College, Chicago, IL, USA
| | - Niraj J Gusani
- Section of Surgical Oncology, Division of Surgery, Baptist MD Anderson Cancer Center, Jacksonville, FL, USA
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Naples R, Perlmutter BC, Lu H, Allende D, Tu C, Hitawala A, Chadalavada P, Padbidri V, Haddad A, Simon R, Walsh RM, Augustin T. Intramucosal Extent as a Marker for Advanced Disease and Survival in Gallbladder Adenocarcinoma. Am Surg 2024; 90:1133-1139. [PMID: 38174690 DOI: 10.1177/00031348231220581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Gallbladder cancer (GBC) is the most common biliary tract malignancy and has a poor prognosis. The clinical significance of focal vs diffuse GBC remains unclear. METHODS A retrospective review was conducted on all patients with non-metastatic GBC at a quaternary care center. Pathology was reviewed, and gallbladder cancer pattern was defined based on the extent of mucosal involvement; "diffuse" if the tumor was multicentric or "focal" if the tumor was only in a single location. Patients undergoing liver resection and portal lymphadenectomy were considered to have definitive surgery. The primary outcome was overall survival and assessed by Kaplan-Meier curves. RESULTS 63 patients met study criteria with 32 (50.7%) having diffuse cancer. No difference was observed in utilization of definitive surgery between the groups (14 [43.8%] with focal and 12 [38.7%] with diffuse, P = .88). Lymphovascular invasion (P = .04) and higher nodal stage (P = .04) were more common with diffuse GBC. Median overall survival was significantly improved in those with focal cancer (5.1 vs 1.2 years, P = .02). Although not statistically significant, this difference in overall survival persisted in patients who underwent definitive surgery (4.3 vs 2.4 years, P = .70). DISCUSSION Patients with diffuse involvement of the gallbladder mucosa likely represent a subset with aggressive biology and worse overall survival compared to focal disease. These findings may aid surgeons in subsequent surgical and medical decision-making for patients with GBC.
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Affiliation(s)
- Robert Naples
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Haiyan Lu
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Daniela Allende
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Chao Tu
- Department of Quantitative Health Sciences, Cleveland Clinic Learner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Asif Hitawala
- Department of Internal Medicine, Fairview Hospital, Cleveland, OH, USA
| | | | - Vinay Padbidri
- Department of Internal Medicine, Fairview Hospital, Cleveland, OH, USA
| | - Abdo Haddad
- Department of Hematology Oncology, Fairview Hospital, Cleveland, OH, USA
| | - Robert Simon
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - R Matthew Walsh
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Toms Augustin
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
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Chaturvedi A, Misra S, Chaudhary S, Gupta S, Prakash P, Kumar V, Akhtar N, Rajan S. Treatment Outcomes of Incidental Gallbladder Cancer - Results from a High-Volume Tertiary Care Centre in North India. Indian J Surg Oncol 2024; 15:204-211. [PMID: 38818010 PMCID: PMC11133270 DOI: 10.1007/s13193-024-01937-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/28/2024] [Indexed: 06/01/2024] Open
Abstract
Gallbladder cancer (GBC) is a lethal disease. Incidentally detected gallbladder cancer (IGBC) presents a unique opportunity for early management and better outcomes. We present the institutional experience of a high-volume tertiary care center in northern India. Retrospective analysis of a prospectively maintained database was performed and data of all IGBC patients between January 2014 to December 2021 was analyzed. There were 125 patients of IGBC among the 750 patients of GBC seen during the study period. Of these 125 patients, 72 (57.6%) patients were not eligible for surgery. Successful completion radical cholecystectomy (CRC) was possible in 37 (69.8%) of the 53 patients who underwent surgery. On univariate analysis, thickness of gallbladder wall 10 mm or more (p < 0.001, OR 19.0, 95% CI 4.58-78.76), pathological stage (p < 0.001, OR 5.8, 95% CI 2.45-14.98) and median delay of 16 weeks or more (p < 0.001, OR 17.0, 95% CI = 4.08-70.76), were associated with inoperability. However, on multivariate analysis only gallbladder wall thickness of 10 mm or more (p < 0.001, AOR 17.9, 95% CI 3.24-98.78) and median delay of 16 weeks or more (p < 0.001, AOR 32.33, 95% CI 6.05-172.66) remained significant. Median time to recurrence (TTR) and overall survival (OS) was not reached after a median follow up of 30 months in patients undergoing successful CRC. Successful outcomes of IGBC are dependent on several factors. Diligent workup of suspicious thickening before simple cholecystectomy for gallstone disease and timely referral of IGBC to tertiary care are the keystones for good outcomes.
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Affiliation(s)
- Arun Chaturvedi
- Department of Surgical Oncology, King George’s Medical University, Lucknow, 226003 India
| | - Sanjeev Misra
- Atal Bihari Vajpayee Medical University, Lucknow, 226010 India
| | | | - Sameer Gupta
- Department of Surgical Oncology, King George’s Medical University, Lucknow, 226003 India
| | - Puneet Prakash
- Department of Surgical Oncology, King George’s Medical University, Lucknow, 226003 India
| | - Vijay Kumar
- Department of Surgical Oncology, King George’s Medical University, Lucknow, 226003 India
| | - Naseem Akhtar
- Department of Surgical Oncology, King George’s Medical University, Lucknow, 226003 India
| | - Shiv Rajan
- Department of Surgical Oncology, King George’s Medical University, Lucknow, 226003 India
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Alaswad M, Otry AA, Alhosainy Z, Elkordy F, Sabbah BN, Arabi TZ, Abdulkader H, Ghanayem OF, Azzam AZ, Amin T. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy and intraoperative radiation therapy in the management of gallbladder cancer: a case report. Front Oncol 2024; 14:1361017. [PMID: 38634052 PMCID: PMC11021777 DOI: 10.3389/fonc.2024.1361017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Gallbladder cancer (GBC) is a rare and highly aggressive malignancy, often characterized by nonspecific clinical presentations and late diagnosis, which contribute to its poor prognosis. It is commonly detected at advanced stages, leading to low survival rates. Surgical resection is the primary treatment, with the extent of surgery depending on the T stage of the cancer. In advanced cases, surgery is only considered if it can potentially be curative. Despite various treatment approaches for advanced GBC, survival outcomes remain poor. In our case series, we introduce a novel treatment approach combining cytoreductive surgery, intraoperative radiation therapy, and hyperthermic intraperitoneal chemotherapy. Remarkably, we observed a 100% one-year survival rate, with one patient achieving eight years of disease-free survival without recurrence or metastasis. This aggressive treatment strategy did not lead to increased morbidity or mortality, suggesting its safety and feasibility. However, larger-scale studies are required to draw definitive conclusions.
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Affiliation(s)
- Marwan Alaswad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Ziad Alhosainy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fadwa Elkordy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | | | | | - Ayman Zaki Azzam
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek Amin
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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9
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Yang Y, Li H, Liu K, Zou L, Xiang S, Geng Y, Li X, Qiu S, Yang J, Cui X, Li L, Li Y, Li W, Yan S, Liu L, Wu X, Liu F, Wu W, Chen S, Liu Y. Acylcarnitines promote gallbladder cancer metastasis through lncBCL2L11-THOC5-JNK axis. J Transl Med 2024; 22:299. [PMID: 38519939 PMCID: PMC10958842 DOI: 10.1186/s12967-024-05091-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/13/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The progression of gallbladder cancer (GBC) is accompanied by abnormal fatty acid β-oxidation (FAO) metabolism. Different types of lipids perform various biological functions. This study aimed to determine the role of acyl carnitines in the molecular mechanisms of GBC progression. METHODS Distribution of lipids in GBC was described by LC-MS-based lipidomics. Cellular localization, expression level and full-length of lncBCL2L11 were detected using fluorescence in situ hybridization (FISH) assays, subcellular fractionation assay and 5' and 3' rapid amplification of the cDNA ends (RACE), respectively. In vitro and in vivo experiments were used to verify the biological function of lncBCL2L11 in GBC cells. Methylated RNA Immunoprecipitation (MeRIP) was performed to detect the methylation levels of lncBCL2L11. RNA pull-down assay and RNA immunoprecipitation (RIP) assay were used to identify lncBCL2L11 interacting proteins. Co-Immunoprecipitation (Co-IP) and Western blot assay were performed to validate the regulatory mechanism of lncBCL2L11 and THO complex. RESULTS Acylcarnitines were significantly up-regulated in GBC tissues. High serum triglycerides correlated to decreased survival in GBC patients and promoted tumor migration. LncBCL2L11 was identified in the joint analysis of highly metastatic cells and RNA sequencing data. LncBCl2L11 prevented the binding of THOC6 and THOC5 and causes the degradation of THOC5, thus promoting the accumulation of acylcarnitines in GBC cells, leading to the malignant progression of cancer cells. In addition, highly expressed acylcarnitines stabilized the expression of lncBCL2L11 through N6-methyladenosine methylation (m6A), forming a positive feedback regulation in tumor dissemination. CONCLUSIONS LncBCL2L11 is involved in gallbladder cancer metastasis through FAO metabolism. High lipid intake is associated with poor prognosis of GBC. Therefore, targeting lncBCL2L11 and its pathway-related proteins or reducing lipid intake may be significant for the treatment of GBC patients.
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Affiliation(s)
- Yang Yang
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Huaifeng Li
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Ke Liu
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Lu Zou
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Shanshan Xiang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Yajun Geng
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Xuechuan Li
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Shimei Qiu
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
- University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Jiahua Yang
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Xuya Cui
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Lin Li
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Yang Li
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Weijian Li
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Siyuan Yan
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Liguo Liu
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Xiangsong Wu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Fatao Liu
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| | - Wenguang Wu
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
| | - Shili Chen
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
| | - Yingbin Liu
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
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Parray AM, Singh A, Vats R, Reyaz M, Goel D. Decoding the Conundrum: Navigating Intra-operatively Encountered Suspicious Gallbladder Wall Thickening with Laparoscopic Transhepatic Needle Decompression and Beyond Cystic Plate Cholecystectomy. Ann Surg Oncol 2024; 31:1268-1270. [PMID: 37962742 DOI: 10.1245/s10434-023-14578-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Suspicious gallbladder wall thickening encountered during laparoscopic cholecystectomy poses challenges in its management. This study aims to address this problem by proposing a technique that involves laparoscopic transhepatic needle decompression and modified cystic plate cholecystectomy. METHODS In this report, we describe the case of a 36-year-old female with symptomatic gallstone disease and ultrasound findings of a well-distended gallbladder with a uniform wall thickness. Diagnostic laparoscopy revealed a distended, tense gallbladder with suspicious areas of thickness. Transhepatic aspiration was performed for gallbladder decompression, followed by modified cystic plate cholecystectomy with preservation of the thin rim of liver tissue over the cystic plate. The gallbladder was removed in a specimen bag, and final histopathology showed a hyalinized gallbladder wall with calcification and pyloric gland metaplasia, with liver tissue adhered to the gallbladder wall (Video). RESULTS The proposed technique aimed to minimize the risk of bile spillage and violation of oncological planes while maintaining surgical integrity. It offers a middle path between standard and extended cholecystectomy, reducing the chance of over- or under-treatment. This approach ensures patient safety, minimizes the need for conversion to open surgery, and preserves the tumour-tissue interface. CONCLUSION Intraoperatively encountered suspicious gallbladder wall thickening can be effectively managed with laparoscopic transhepatic needle decompression and modified cystic plate cholecystectomy.
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Affiliation(s)
- Amir M Parray
- BLK Max Super Speciality Hospital, New Delhi, India.
| | - Anoop Singh
- BLK Max Super Speciality Hospital, New Delhi, India
| | | | | | - Deep Goel
- BLK Max Super Speciality Hospital, New Delhi, India
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11
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Crum AE, Sestito M, Garland-Kledzik M, Boone BA. Prophylactic Hyperthermic Intraperitoneal Chemotherapy for Patients at High Risk of Developing Gallbladder Cancer Peritoneal Metastases: Case Report and Rationale for a Prospective Clinical Trial. J Clin Med 2024; 13:768. [PMID: 38337462 PMCID: PMC10856521 DOI: 10.3390/jcm13030768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Gallbladder cancer is a devastating disease with a 5-year survival of only 18%. The majority of gallbladder cancers are discovered incidentally in patients undergoing cholecystectomy. During non-oncologic laparoscopic cholecystectomy for gallbladder disease, gallbladder perforation occurs in 29% of cases and spillage of gallstones occurs in 9% of cases. Patients with gallbladder cancer frequently develop peritoneal recurrence, particularly after intra-operative bile spillage during cholecystectomy for incidental gallbladder cancer. The high likelihood of spillage and peritoneal seeding during cholecystectomy for incidental gallbladder cancer suggests the need for prophylactic strategies to prevent peritoneal carcinomatosis. Hyperthermic intraperitoneal chemotherapy (HIPEC) has efficacy in gallbladder cancer patients with macroscopic peritoneal disease undergoing cytoreductive surgery and has been associated with a survival advantage in a multi-institutional retrospective case series. However, the utilization of HIPEC with a prophylactic intent against the development of peritoneal disease following resection of gallbladder cancer has not yet been prospectively studied. Here, we review the literature surrounding gallbladder cancer and HIPEC, report an institutional experience utilizing prophylactic HIPEC, and discuss a recently proposed prospective clinical trial evaluating the efficacy of prophylactic HIPEC in the prevention of gallbladder peritoneal metastasis.
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Affiliation(s)
- Alexander E. Crum
- School of Medicine, West Virginia University, Morgantown, WV 26506, USA;
| | - Michael Sestito
- Department of Surgery, West Virginia University, Morgantown, WV 26506, USA; (M.S.); (M.G.-K.)
| | - Mary Garland-Kledzik
- Department of Surgery, West Virginia University, Morgantown, WV 26506, USA; (M.S.); (M.G.-K.)
| | - Brian A. Boone
- Department of Surgery, West Virginia University, Morgantown, WV 26506, USA; (M.S.); (M.G.-K.)
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12
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Chen J, Han Y. Development and validation of an online dynamic prognostic nomogram for incidental gallbladder adenocarcinoma patients without distant metastasis after surgery: a population-based study. Front Med (Lausanne) 2023; 10:1175211. [PMID: 38020083 PMCID: PMC10667698 DOI: 10.3389/fmed.2023.1175211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Gallbladder cancer is the most common malignant tumor of the biliary system, most of which is adenocarcinoma. Our study explored developing and validating a nomogram to predict overall and cancer-specific survival probabilities internally and externally for incidental gallbladder adenocarcinoma patients without distant metastasis after surgery. Methods Patients screened and filtered in the Surveillance, Epidemiology, and End Results (SEER) database, whose years of diagnosis between 2010 and 2015 were collected as a derivation cohort, while those between 2016 and 2019 were a temporal validation cohort. Overall survival (OS) and cancer-specific survival (CSS) were chosen as the primary and secondary endpoints of the retrospective study cohort. Potential clinical variables were selected for a Cox regression model analysis by performing both-direction stepwise selection to confirm the final variables. The performance of final nomograms was evaluated by Harrell's C statistic and Brier score, with a graphical receptor operating characteristic (ROC) curve and calibration curve. Results Seven variables of age, race, tumor size, histologic grade, T stage, regional lymph nodes removed, and positive regional lymph nodes were finally determined for the OS nomogram; sex had also been added to the CSS nomogram. Novel dynamic nomograms were established to predict the prognosis of incidental gallbladder adenocarcinoma patients without distant metastasis after surgery. The ROC curve demonstrated good accuracy in predicting 1-, 3-, and 5-year OS and CSS in both derivation and validation cohorts. Correspondingly, the calibration curve presented perfect reliability between the death or cancer-specific death probability and observed death or cancer-specific death proportion in both derivation and validation cohorts. Conclusion Our study established novel dynamic nomograms based on seven and eight clinical variables separately to predict OS and CSS of incidental gallbladder adenocarcinoma patients without distant metastasis after surgery, which might assist doctors in advising and guiding therapeutic strategies for postoperative gallbladder adenocarcinoma patients in the future.
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Affiliation(s)
- Jie Chen
- Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Yehong Han
- Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
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13
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Malik H, Izwan S, Ng J, Teng R, Chan E, Damodaran Prabha R, Puhalla H. Incidence and management of gallbladder cancer in cholecystectomy specimens: a 5-year tertiary centre experience. ANZ J Surg 2023; 93:2481-2486. [PMID: 37338023 DOI: 10.1111/ans.18577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an uncommon, but highly aggressive cancer. Half of these cases are diagnosed pre-operatively, and the remaining cases are discovered incidentally on post-cholecystectomy specimens. There is a significant geographical variability in GBC incidence, with increasing age, female sex, and prolonged duration of cholelithiasis being risk factors for GBC. The primary aim was to define the overall local incidence of GBC incidental GBC and management of these cases. The secondary aim was to determine any pertinent risk factors in our case population. METHODS A retrospective observational study was performed on all the cholecystectomy specimens at the Gold Coast Hospital and Health Service from 1 January 2016 to 2 December 2021. Data was collected via the electronic medical record. The incidence and management of gallbladder cancers was calculated, and association with body mass index (BMI), smoking status, diabetes, inflammatory bowel disease (IBD) was identified. RESULTS 3904 cholecystectomy specimens were reviewed. GBC was identified in 0.46% of cholecystectomies. 50% of these cases were found incidentally. Abdominal pain was the most common presenting complaint (94.4%). GBC was associated with increased age and BMI and female sex. There was no association between smoking status, diabetes or IBD with an increased incidence of cancer. Tumour staging guided surgical and/or adjuvant chemotherapy. CONCLUSION GBC is rare. Patients with symptoms are associated with a poor prognosis. Incidental cancers are common, and negative margin resection based on the T stage of the cancer is the most reliable curative option.
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Affiliation(s)
- Hassan Malik
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sara Izwan
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Justin Ng
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Roy Teng
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Erick Chan
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Ramesh Damodaran Prabha
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Harald Puhalla
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
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14
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Gu S, Xu W, Wang L, Zhao H. Microcystin-leucine-arginine promotes the development of gallbladder carcinoma via regulating ELAC2. Biochem Biophys Res Commun 2023; 671:350-356. [PMID: 37329658 DOI: 10.1016/j.bbrc.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/10/2023] [Indexed: 06/19/2023]
Abstract
Gallbladder carcinoma (GBC) is the most prevalent cancer of the bile tract, with unexpected GBC accounting for almost half of all GBC cases in some tertiary medical centers. Although the involvement of microcystin-leucine-arginine (MC-LR) in the development of intrahepatic cholangiocarcinoma has been established, there is a paucity of data regarding its association with GBC. The present study aims to investigate whether MC-LR level in the gallbladder of patients is associated with GBC development and, if so, to characterize the underlying mechanism in GBC cells. Our clinical data revealed that MC-LR level was significantly increased in GBC patients compared to patients with gallbladder stones only (P = 0.009). Moreover, our findings demonstrated that MC-LR could promote the proliferation and metastasis of human GBC cell lines. Furthermore, ELAC2 was identified as a critical mRNA involved in GBC progression through RNA sequencing. Collectively, our study suggests that MC-LR might be involved in the development of GBC by modulating the expression of ELAC2.
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Affiliation(s)
- Shen Gu
- Translational Medicine Research Center, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 31006, China; Department of Clinical Pharmacy, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China.
| | - Wei Xu
- Department of Clinical Pharmacy, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China; College of Pharmaceutical Sciences, Hangzhou First People's Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
| | - Lei Wang
- Department of Hepatopancreatobiliary Surgery, Jiangnan University Medical Center, Wuxi, 214000, China.
| | - Hui Zhao
- Department of Hepatopancreatobiliary Surgery, Jiangnan University Medical Center, Wuxi, 214000, China.
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15
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Wu X, Li BL, Zheng CJ. Application of laparoscopic surgery in gallbladder carcinoma. World J Clin Cases 2023; 11:3694-3705. [PMID: 37383140 PMCID: PMC10294166 DOI: 10.12998/wjcc.v11.i16.3694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/04/2023] [Accepted: 04/19/2023] [Indexed: 06/02/2023] Open
Abstract
Gallbladder carcinoma (GC) is a rare type of cancer of the digestive system, with an incidence that varies by region. Surgery plays a primary role in the comprehensive treatment of GC and is the only known cure. Compared with traditional open surgery, laparoscopic surgery has the advantages of convenient operation and magnified field of view. Laparoscopic surgery has been successful in many fields, including gastrointestinal medicine and gynecology. The gallbladder was one of the first organs to be treated by laparoscopic surgery, and laparoscopic cholecystectomy has become the gold standard surgical treatment for benign gallbladder diseases. However, the safety and feasibility of laparoscopic surgery for patients with GC remain controversial. Over the past several decades, research has focused on laparoscopic surgery for GC. The disadvantages of laparoscopic surgery include a high incidence of gallbladder perforation, possible port site metastasis, and potential tumor seeding. The advantages of laparoscopic surgery include less intraoperative blood loss, shorter postoperative hospital stay, and fewer complications. Nevertheless, studies have provided contrasting conclusions over time. In general, recent research has tended to support laparoscopic surgery. However, the application of laparoscopic surgery in GC is still in the exploratory stage. Here, we provide an overview of previous studies, with the aim of introducing the application of laparoscopy in GC.
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Affiliation(s)
- Xin Wu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Bing-Lu Li
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Chao-Ji Zheng
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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16
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Yang J, Li E, Wang C, Luo S, Fu Z, Peng J, Liao W, Wu L. Robotic versus open extended cholecystectomy for T1a-T3 gallbladder cancer: A matched comparison. Front Surg 2022; 9:1039828. [PMID: 36420415 PMCID: PMC9676919 DOI: 10.3389/fsurg.2022.1039828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/17/2022] [Indexed: 11/14/2024] Open
Abstract
BACKGROUND The feasibility and safety of robotic extended cholecystectomy (REC) are still uncertain. This study was performed to compare the short- and long-term outcomes of REC with those of open extended cholecystectomy (OEC) for T1a-T3 gallbladder cancer. METHODS From January 2015 to April 2022, 28 patients underwent REC in our center. To minimize any confounding factors, a 1:2 propensity score-matching analysis was conducted based on the patients' demographics, liver function indicators, T stage, and symptoms. The data regarding demographics, perioperative outcomes, and long-term oncologic outcomes were reviewed. RESULTS The visual analogue scale score was significantly lower in the REC than OEC group immediately postoperatively (3.68 ± 2.09 vs. 4.73 ± 1.85, P = 0.008), on postoperative day 1 (2.96 ± 1.75 vs. 3.69 ± 1.41, P = 0.023), and on postoperative day 2 (2.36 ± 1.55 vs. 2.92 ± 1.21, P = 0.031). In addition, the REC group exhibited a shorter time to first ambulation (P = 0.043), a shorter time to drainage tube removal (P = 0.038), and a shorter postoperative stay (P = 0.037), but hospital costs were significantly higher in the REC group (P < 0.001). However, no statistically significant difference was found in the operation time (P = 0.134), intraoperative blood loss (P = 0.467), or incidence of postoperative morbidity (P = 0.227) or mortality (P = 0.289) between the REC and OEC groups. In regard to long-term outcomes, the 3-year disease-free survival rate was comparable between the OEC and REC groups (43.1% vs. 57.2%, P = 0.684), as was the 3-year overall survival rate (62.8% vs. 75.0%, P = 0.619). CONCLUSION REC can be an effective and safe alternative to OEC for selected patients with T1a-T3 gallbladder cancer with respect to short- and long-term outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Wenjun Liao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Linquan Wu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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17
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Miller Q, Dave N, Popnikolov N, Bruce SD, Mesa H. Prominent Pseudo-Angiovascular invasion by benign gallbladder epithelium and bile emboli in a patient with delayed cholecystectomy due to COVID-19 positive test. SURGICAL AND EXPERIMENTAL PATHOLOGY 2022. [PMCID: PMC9462894 DOI: 10.1186/s42047-022-00120-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Lymphovascular invasion is a hallmark of malignant neoplasms, however the presence of benign epithelium within vessels has been reported in benign processes, albeit infrequently. The proposed mechanism to explain this phenomenon entails mechanical displacement of benign epithelium into the vascular spaces during surgical manipulation or diagnostic interventions. We report a case of numerous benign epithelial vascular emboli in a cholecystectomy specimen. A 29-year-old male presented with acute calculous cholecystitis. Surgery was delayed for several weeks due to COVID-19 infection. Histologic examination of the gallbladder showed subacute cholecystitis, widespread vascular epithelial emboli with associated fibrin deposition and bile embolism supporting an in vivo process. The epithelial emboli were localized in small veins and arterioles with D2–40−/CD31+/CD34+ endothelium. The displaced epithelium showed benign cytologic features, was negative for p53 expression, and had a Ki-67 labelling index like the benign background mucosa, supporting a benign process. There was no evidence of dysplasia or malignancy in the specimen after thorough sampling. Persistent inflammation, mucosal ulceration, transmural mucosal herniation (Rokitansky-Aschoff sinuses), and protracted surgical manipulation secondary to adhesive disease are favored to be the underlying causes of this unusual histologic finding. Although we presume an uneventful outcome, clinical follow up was recommended. COVID-19 infection likely contributed to this phenomenon by causing a delay in the surgical management.
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18
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Alarabiyat M, Raza SS, Isaac J, Mirza D, Marudanayagam R, Roberts K, Abradelo M, Bartlett DC, Dasari BV, Sutcliffe RP, Chatzizacharias NA. Incidental gallbladder cancer diagnosis confers survival advantage irrespective of tumour stage and characteristics. World J Gastroenterol 2022; 28:1996-2007. [PMID: 35664962 PMCID: PMC9150056 DOI: 10.3748/wjg.v28.i18.1996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/22/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Incidental gallbladder cancer (IGBC) represents 50%-60% of gallbladder cancer cases. Data are conflicting on the role of IGBC diagnosis in oncological outcomes. Some studies suggest that IGBC diagnosis does not affect outcomes, while others that overall survival (OS) is longer in these cases compared to non-incidental diagnosis (NIGBC). Furthermore, some studies reported early tumour stages and histopathologic characteristics as possible confounders, while others not. AIM To investigate the role of IGBC diagnosis on patients' overall survival, especially after surgical treatment with curative intent. METHODS Retrospective analysis of all patient referrals with gallbladder cancer between 2008 and 2020 in a tertiary hepatobiliary centre. Statistical comparison of patient and tumour characteristics between IGBC and NIGBC subgroups was performed. Survival analysis for the whole cohort, surgical and non-surgical subgroups was done with the Kaplan-Meier method and the use of log rank test. Risk analysis was performed with univariable and multivariable Cox regression analysis. RESULTS The cohort included 261 patients with gallbladder cancer. 65% of cases had NIGBC and 35% had IGBC. A total of 90 patients received surgical treatment (66% of IGBC cases and 19% of NIGBC cases). NIGBC patients had more advanced T stage and required more extensive resections than IGBC ones. OS was longer in patients with IGBC in the whole cohort (29 vs 4 mo, P < 0.001), as well as in the non-surgical (14 vs 2 mo, P < 0.001) and surgical subgroups (29 vs 16.5 mo, P = 0.001). Disease free survival (DFS) after surgery was longer in patients with IGBC (21.5 mo vs 8.5 mo, P = 0.007). N stage and resection margin status were identified as independent predictors of OS and DFS. NIGBC diagnosis was identified as an independent predictor of OS. CONCLUSION IGBC diagnosis may confer a survival advantage independently of the pathological stage and tumour characteristics. Prospective studies are required to further investigate this, including detailed pathological analysis and molecular gene expression.
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Affiliation(s)
- Moath Alarabiyat
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Syed Soulat Raza
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - John Isaac
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Darius Mirza
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Ravi Marudanayagam
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Keith Roberts
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Manuel Abradelo
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - David C Bartlett
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Bobby V Dasari
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Robert P Sutcliffe
- HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
| | - Nikolaos A Chatzizacharias
- Department of HPB and Liver Transplantation, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2TH, United Kingdom
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Cho JK, Kim JR, Jang JY, Kim HG, Kim JM, Kwag SJ, Park JH, Kim JY, Ju YT, Jeong CY. Comparison of the Oncological Outcomes of Open versus Laparoscopic Surgery for T2 Gallbladder Cancer: A Propensity-Score-Matched Analysis. J Clin Med 2022; 11:jcm11092644. [PMID: 35566770 PMCID: PMC9099510 DOI: 10.3390/jcm11092644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023] Open
Abstract
Although laparoscopic treatment for T1 gallbladder cancer (GBC) has been described previously, the differences in oncologic outcomes between laparoscopic and conventional open surgery for T2 GBC have not been investigated. We aimed to assess the role of laparoscopic surgery using retrospectively collected data for 81 patients with T2 GBC who underwent surgical resection between January 2010 and December 2017. Eligible patients were classified into “laparoscopic” and “open” groups. Propensity-score matching was performed in a 1:1 ratio. The effects of surgery type on surgical and oncological outcomes were investigated. After propensity-score matching, 19 patients were included in the open and laparoscopic surgery groups. The median follow-up durations were 70 and 26 months in the open and laparoscopic groups, respectively. The operative time (316.8 ± 80.3 vs. 218.9 ± 145.0 min, p = 0.016) and length of postoperative hospital stay (14.4 ± 6.0 vs. 8.4 ± 5.9 days, p = 0.004) were significantly shorter in the laparoscopic group. The three-year overall (86.3% vs. 88.9%, p = 0.660) and disease-free (76.4% vs. 60.2%, p = 0.448) survival rates were similar between the groups. Propensity-score matching showed that laparoscopic surgery for T2 GBC yielded similar long-term oncological outcomes and favorable short-term outcomes in comparison with open surgery. Laparoscopic treatment should be considered in patients with T2 GBC.
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Affiliation(s)
- Jin-Kyu Cho
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Jae-Ri Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, 11, Samjeongja-ro, Changwon-si 51472, Korea; (J.-R.K.); (J.-Y.J.)
| | - Jae-Yool Jang
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, 11, Samjeongja-ro, Changwon-si 51472, Korea; (J.-R.K.); (J.-Y.J.)
| | - Han-Gil Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Jae-Myung Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Seung-Jin Kwag
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
- Correspondence: ; Tel.: +82-10-9360-8294
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Vega EA, Mellado S, Salehi O, Freeman R, Conrad C. Treatment of Resectable Gallbladder Cancer. Cancers (Basel) 2022; 14:1413. [PMID: 35326566 PMCID: PMC8945892 DOI: 10.3390/cancers14061413] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/18/2022] [Accepted: 03/06/2022] [Indexed: 02/04/2023] Open
Abstract
Gallbladder cancer (GBC) is the most common biliary tract cancer worldwide and its incidence has significant geographic variation. A unique combination of predisposing factors includes genetic predisposition, geographic distribution, female gender, chronic inflammation, and congenital developmental abnormalities. Today, incidental GBC is the most common presentation of resectable gallbladder cancer, and surgery (minimally invasive or open) remains the only curative treatment available. Encouragingly, there is an important emerging role for systemic treatment for patients who have R1 resection or present with stage III-IV. In this article, we describe the pathogenesis, surgical and systemic treatment, and prognosis.
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Affiliation(s)
- Eduardo A. Vega
- Department of Surgery, St. Elizabeth’s Medical Center, Boston University School of Medicine, Boston, MA 02135, USA; (E.A.V.); (O.S.); (R.F.)
| | | | - Omid Salehi
- Department of Surgery, St. Elizabeth’s Medical Center, Boston University School of Medicine, Boston, MA 02135, USA; (E.A.V.); (O.S.); (R.F.)
| | - Richard Freeman
- Department of Surgery, St. Elizabeth’s Medical Center, Boston University School of Medicine, Boston, MA 02135, USA; (E.A.V.); (O.S.); (R.F.)
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth’s Medical Center, Boston University School of Medicine, Boston, MA 02135, USA; (E.A.V.); (O.S.); (R.F.)
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21
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Nakanishi H, Miangul S, Oluwaremi TT, Sim BL, Hong SS, Than CA. Open versus laparoscopic surgery in the management of patients with gallbladder cancer: A systematic review and meta-analysis. Am J Surg 2022; 224:348-357. [DOI: 10.1016/j.amjsurg.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/06/2022] [Accepted: 03/01/2022] [Indexed: 02/07/2023]
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22
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Lv TR, Liu F, Hu HJ, Regmi P, Ma WJ, Yang Q, Jin YW, Li FY. The role of extra-hepatic bile duct resection in the surgical management of gallbladder carcinoma. A first meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:482-491. [PMID: 34955314 DOI: 10.1016/j.ejso.2021.11.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 10/06/2021] [Accepted: 11/26/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To systematically evaluate the clinicopathological and prognostic value of extra-hepatic bile duct resection (EHBDR) in the surgical management of patients with gallbladder carcinoma (GBC), especially in non-jaundiced patients. METHODS PubMed, EMBASE and the Cochrane Library were searched up to March 1st 2021 for comparative studies between bile duct resected and non-resected groups. RevMan5.3 and Stata 13.0 software were used for the statistical analyses. RESULTS EHBDR did not correlate with a better overall survival (OS) (P = 0.17) or disease-free survival (P = 0.27). No survival benefit was also observed in patients with T2N1 (P = 0.4), T3N0 (P = 0.14) disease and node-positive patients (P = 0.75), rather, EHBDR was even harmful for patients with T2N0 (P = 0.01) and node-negative disease (P = 0.02). Significantly higher incidences of recurrent disease (P = 0.0007), postoperative complications (P < 0.00001) and positive margins (P = 0.02) were detected in the bile duct-resected group. The duration of postoperative hospital stay between the two groups was comparable (P = 0.58). Selection bias was also detected in our analysis that a significantly higher proportion of advanced lesions with T3-4 or III-IV disease was observed in the bile duct-resected group (P < 0.00001). EHBDR only contributed to a greater lymph yield (P = 0.01). CONCLUSION EHBDR has no survival advantage for patients with GBC, especially for those with non-jaundiced disease. Considering the unfairness of comparing OS between jaundiced patients receiving EHBDR with non-jaundiced patients without EHBDR, we could only conclude that routine EHBDR in non-jaundiced patients is not recommended and future well-designed studies with more specific subgroup analyses are required for further validation.
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Affiliation(s)
- Tian-Run Lv
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Parbatraj Regmi
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Qing Yang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yan-Wen Jin
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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23
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Regmi P, Hu HJ, Chang-Hao Y, Liu F, Ma WJ, Ran CD, Wang JK, Paudyal A, Cheng NS, Li FY. Laparoscopic surgery for oncologic extended resection of T1b and T2 incidental gallbladder carcinoma at a high-volume center: a single-center experience in China. Surg Endosc 2021; 35:6505-6512. [PMID: 33174099 DOI: 10.1007/s00464-020-08146-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical treatment is still the most effective treatment for gallbladder cancer. For the patients with stage T1b and above, the current guidelines recommend the extended radical operation, and oncologic extended resection can benefit the survival of the patients. The laparoscopic approach is still in the early phase, and its safety and oncological outcomes are not well known. OBJECTIVE To evaluate the technical feasibility and oncological outcomes of laparoscopic surgery for oncologic extended resection of early-stage incidental gallbladder carcinoma. RESULTS This study included 18 male and 32 female patients. Twenty patients underwent laparoscopic oncologic extended resection and 30 patients underwent open oncologic extended resection. All of the patients had R0 resection. A laparoscopic approach was associated with less intraoperative blood loss (242 ± 108.5 vs 401 ± 130.3; p < 0.01) and shorter duration of postoperative hospital stay (6.2 ± 2.4 vs 8.6 ± 2.3; p < 0.01). There was no statistically significant difference between two groups for lymph nodes yield (5.4 ± 3.5 vs 5.8 ± 2.1; p > 0.05), incidence of lymphatic metastasis (15% vs 16.67%; p > 0.05), residual disease (20% vs 23.3%; p > 0.05), and postoperative morbidity (15% vs 20%; p > 0.05). During follow-up time of median 20.95 (12-29.5) months, no significant difference was found between the two groups for early tumor recurrence (10% vs 13.33%; p > 0.05) and disease-free survival (p > 0.05). CONCLUSION Laparoscopic surgery may offer similar intraoperative, perioperative, and short-term oncological outcomes as an open oncologic extended resection for incidental gallbladder carcinoma.
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Affiliation(s)
- Parbatraj Regmi
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yin Chang-Hao
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Cong-Dun Ran
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jun-Ke Wang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Aliza Paudyal
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Nan-Sheng Cheng
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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24
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Chan BKY, Carrion-Alvarez L, Telfer R, Rehman AH, Bird N, Mann K, Jones RP, Malik HZ, Fenwick SW, Diaz-Nieto R. Surgical management of suspected gallbladder cancer: The role of intraoperative frozen section for diagnostic confirmation. J Surg Oncol 2021; 125:399-404. [PMID: 34689332 DOI: 10.1002/jso.26726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/24/2021] [Accepted: 10/12/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Preoperative diagnosis for suspected gallbladder cancers is challenging, with a risk of overtreating benign disease, for example, xanthogranulomatous cholecystitis, with radical cholecystectomies. We retrospectively evaluated the surgeon's intraoperative assessment alone, and with the addition of intraoperative frozen sections, for suspected gallbladder cancers from a tertiary hepatobiliary multidisciplinary team (MDT). METHODS MDT patients with complex gallbladder disease were included. Collated data included demographics, MDT discussion, operative details, and patient outcomes. RESULTS A total of 454 patients with complex gallbladder disease were reviewed, 48 (10.6%) were offered radical surgery for suspected cancer. Twenty-five underwent frozen section that led to radical surgery in 6 (25%). All frozen sections were congruent with final histopathology but doubled the operating time (p < 0.0001). Both the surgeon's subjective and additional frozen section's objective assessment, allowed for de-escalation of unnecessary radical surgery, comparing favourably to a 13.0% cancer diagnosis among radical surgery historically. CONCLUSIONS The MDT process was highly sensitive in identifying gallbladder cancers but lacked specificity. The surgeon's intraoperative assessment is paramount in suspected cancers, and deescalated unnecessary radical surgery. Intraoperative frozen section was a safe and viable adjunct at a cost of resources and operative time.
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Affiliation(s)
- Benjamin K Y Chan
- Department of Hepato-Biliary Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England.,Department of Clinical Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, England
| | - Lucia Carrion-Alvarez
- Department of Hepato-Biliary Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England.,Department of Hepato-Pancreato-Biliary Surgery, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Rebecca Telfer
- Department of Hepato-Biliary Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England
| | - Adeeb H Rehman
- Department of Hepato-Biliary Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England.,Department of Clinical Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, England
| | - Nicholas Bird
- Department of Hepato-Biliary Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England
| | - Kulbir Mann
- Department of Pancreato-Biliary Surgery, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England
| | - Robert P Jones
- Department of Hepato-Biliary Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England
| | - Hassan Z Malik
- Department of Hepato-Biliary Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England
| | - Stephen W Fenwick
- Department of Hepato-Biliary Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England
| | - Rafael Diaz-Nieto
- Department of Hepato-Biliary Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, England
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25
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Okumura K, Gogna S, Gachabayov M, Felsenreich DM, McGuirk M, Rojas A, Quintero L, Seshadri R, Gu K, Dong XD. Gallbladder cancer: Historical treatment and new management options. World J Gastrointest Oncol 2021; 13:1317-1335. [PMID: 34721769 PMCID: PMC8529935 DOI: 10.4251/wjgo.v13.i10.1317] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/19/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023] Open
Abstract
Gallbladder cancer is a rare, aggressive malignancy that has a poor overall prognosis. Effective treatment consists of early detection and surgical treatment. With the wide spread treatment of gallbladder disease with minimally invasive techniques, the rate of incidental gallbladder cancer has seen an equitable rise along with stage migration towards earlier disease. Although the treatment remains mostly surgical, newer modalities such as regional therapy as well as directed therapy based on molecular medicine has led to improved outcomes in patients with advanced disease. We aim to summarize the management of gallbladder cancer along with the newer developments in this formidable disease process.
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Affiliation(s)
- Kenji Okumura
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Shekhar Gogna
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Mahir Gachabayov
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | | | - Matthew McGuirk
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Aram Rojas
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Luis Quintero
- Department of Surgery, New York Medical College, Valhalla, NY 10595, United States
| | - Ramanathan Seshadri
- Division of Surgical Oncology, Nuvance Health, Norwalk, CT 06856, United States
| | - Katie Gu
- Division of Surgical Oncology, Nuvance Health, Norwalk, CT 06856, United States
| | - Xiang Da Dong
- Division of Surgical Oncology, Nuvance Health, Norwalk, CT 06856, United States
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26
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Chaudhari VA, Bhandare MS, Shrikhande SV. Incidental Gallbladder Cancer—Current Recommendations and Management Protocols. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02828-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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27
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Wu B, Shen Y, Chen X, Wang X, Zhong Z. Effect of lymphadenectomy on the prognosis for N0 gallbladder carcinoma patients: A study based on SEER database. Cancer Med 2021; 10:7136-7143. [PMID: 34519168 PMCID: PMC8525154 DOI: 10.1002/cam4.4250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background It remains unclear whether lymph node dissection is necessary for patients with N0 gallbladder carcinoma (GBC). The objective of this study was to evaluate the effect of lymphadenectomy on the prognosis for N0 GBC patients. The secondary objective was to establish a prognostic model of survival for N0 GBC patients being founded on the large samples. Methods Patient data were obtained from the database named SEER (Surveillance, Epidemiology, and End Results database) between 2010 and 2014. Analyses of Kaplan–Meier survival and multivariate Cox regression were performed in subgroups based on regional lymph nodes removal (LNR) to calculate the excess risk of cause‐specific death. A prognosis nomogram was constructed build on the results of a multivariate analysis to predict the specific survival time (CSS) rates of N0 GBC patients. Result A total of 1406 N0 GBC patients were included in this research. The majority of N0 GBC patients undergoing cancer‐directed surgery did not undergo LNR (64.5%). The results showed that LNR can improve the survival of N0 GBC patients, including those at the T1a and T1b stages, and a wider range of lymph node dissection (LNR2) compared to LNR1 was more conducive to the prognosis. Furthermore, multivariate regression analysis showed that LNR was an independent favorable prognostic factor of N0 GBC. Finally, a nomogram was constructed to accurately predict the prognosis of N0 gallbladder cancer patients. Conclusion This study demonstrated a significant survival benefit for extended lymph nodes removed in N0 GBC patients. These results recommend that an extended lymph node dissection strategy is needed for N0 GBC patients.
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Affiliation(s)
- Bin Wu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, P.R. China
| | - Yiyu Shen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, P.R. China
| | - Xujian Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, P.R. China
| | - Xiaoguang Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, P.R. China
| | - Zhengxiang Zhong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, P.R. China
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Perlmutter BC, Naples R, Hitawala A, McMichael J, Chadalavada P, Padbidri V, Haddad A, Simon R, Walsh RM, Augustin T. Factors that Minimize Curative Resection for Gallbladder Adenocarcinoma: an Analysis of Clinical Decision-Making and Survival. J Gastrointest Surg 2021; 25:2344-2352. [PMID: 33565014 DOI: 10.1007/s11605-021-04942-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/19/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gallbladder adenocarcinoma has a poor prognosis as it is often diagnosed incidentally, and patients have a high risk for residual and occult metastatic disease. Expert guidelines recommend definitive surgery for ≥T1b tumors; however, surgical management is inconsistent. This study evaluates the factors that affect the completion of radical resection with portal lymphadenectomy and its impact on survival. METHODS A retrospective review of patients who underwent surgery for gallbladder cancer from 2008 to 2017 at an academic institution was performed. Patients were analyzed based on whether they underwent definitive surgical resection. Patient factors and clinical decision-making were analyzed; overall survival was compared using Kaplan-Meier analysis. RESULTS Seventy-five patients with ≥T1b tumors were identified, of who 32 (42.7%) underwent definitive resection. Fifty-four (72%) patients had gallbladder cancer identified as an incidental diagnosis following laparoscopic cholecystectomy. Among patients who did not undergo definitive resection, the underlying factors were varied. Only 24 (55.8%) patients in the non-definitive resection group were seen by surgical oncology. Among patients who underwent re-operation for definitive resection, 12 (38.7%) were upstaged on final pathology. Of the 43 patients who did not undergo definitive resection, 4 (9.3%) had metastatic disease identified during attempted re-resection. Patients who underwent definitive resection had a significantly longer median overall survival compared to those who did not (4.3 v. 1.9 years, p = 0.02). CONCLUSIONS Patients undergoing definitive resection have a significantly improved survival, including as part of a re-operative strategy. Universal referral to a surgical specialist is a modifiable factor resulting in increased definitive resection rates.
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Affiliation(s)
| | - Robert Naples
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Asif Hitawala
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - John McMichael
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Vinay Padbidri
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Abdo Haddad
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Simon
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - R Matthew Walsh
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Toms Augustin
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA.
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Ando T, Sakata J, Nomura T, Takano K, Takizawa K, Miura K, Hirose Y, Kobayashi T, Ichikawa H, Hanyu T, Shimada Y, Nagahashi M, Kosugi SI, Wakai T. Anatomic location of residual disease after initial cholecystectomy independently determines outcomes after re-resection for incidental gallbladder cancer. Langenbecks Arch Surg 2021; 406:1521-1532. [PMID: 33839959 DOI: 10.1007/s00423-021-02165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to elucidate the impact of anatomic location of residual disease (RD) after initial cholecystectomy on survival following re-resection of incidental gallbladder cancer (IGBC). METHODS Patients with pT2 or pT3 gallbladder cancer (36 with IGBC and 171 with non-IGBC) who underwent resection were analyzed. Patients with IGBC were classified as follows according to the anatomic location of RD after initial cholecystectomy: no RD (group 1); RD in the gallbladder bed, stump of the cystic duct, and/or regional lymph nodes (group 2); and RD in the extrahepatic bile duct and/or distant sites (group 3). RESULTS Timing of resection (IGBC vs. non-IGBC) did not affect survival in either multivariate or propensity score matching analysis. RD was found in 16 (44.4%) of the 36 patients with IGBC; R0 resection following re-resection was achieved in 32 patients (88.9%). Overall survival (OS) following re-resection was worse in group 3 (n = 7; 5-year OS, 14.3%) than in group 2 (n = 9; 5-year OS, 55.6%) (p = 0.035) or in group 1 (n = 20; 5-year OS, 88.7%) (p < 0.001). There was no survival difference between groups 1 and 2 (p = 0.256). Anatomic location of RD was independently associated with OS (group 2, HR 2.425, p = 0.223; group 3, HR 9.627, p = 0.024). CONCLUSION The anatomic location of RD independently predicts survival following re-resection, which is effective for locoregional disease control in IGBC, similar to resection for non-IGBC. Not all patients with RD have poor survival following re-resection for IGBC.
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Affiliation(s)
- Takuya Ando
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Jun Sakata
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
| | - Tatsuya Nomura
- Department of Gastrointestinal Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata City, Niigata, 951-8566, Japan
| | - Kabuto Takano
- Department of Gastrointestinal Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata City, Niigata, 951-8566, Japan
| | - Kazuyasu Takizawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Kohei Miura
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Yuki Hirose
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Takashi Kobayashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Hiroshi Ichikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Takaaki Hanyu
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Masayuki Nagahashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Shin-Ichi Kosugi
- Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
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Lv TR, Hu HJ, Regmi P, Liu F, Li FY. The effect of preoperative jaundice in the surgical management of gallbladder carcinoma: An updated meta-analysis. ANZ J Surg 2021; 91:E455-E464. [PMID: 34224199 DOI: 10.1111/ans.17000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/27/2021] [Accepted: 05/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND An updated meta-analysis was performed on the significance of preoperative jaundice in the surgical management of gallbladder carcinoma (GBC). METHODS A thorough database searching was performed in PubMed, EMBASE, and the Cochrane library for comparative studies between jaundiced and non-jaundiced GBC patients. RevMan5.3 and Stata 13.0 software were used for statistical analysis. A total of nine measured outcomes were identified: resectability, R0 resection rate, concurrent bile duct resection, major hepatectomy, vital vascular reconstruction, combined adjacent organ resections, postoperative morbidities, mortalities, and overall survival (OS). RESULTS A total of eight studies were finally included. Newcastle- Ottawa Quality Assessment Scale was used for evaluating the quality of all included studies and the details were recorded in Table S1. Our pooled results revealed that preoperative jaundice was associated with a significantly lower resectability (p < 0.00001), a significantly lower R0 resection rate (p < 0.00001), a significantly higher concurrent bile duct resection rate (p < 0.00001), major hepatectomy rate (≥3 segments) (p < 0.00001), and vital vascular reconstruction rate (portal vein or hepatic artery) (p < 0.00001). Moreover, jaundiced patients experienced more postoperative morbidities (p < 0.00001), mortalities (p < 0.0001), and worse OS (p < 0.00001). However, jaundice was not related to combined adjacent organ resections (p = 0.58). CONCLUSION Preoperative jaundice in GBC patients seems to be contraindicated to curative resection and the optimal therapeutic strategies should be identified via multidisciplinary team rather than surgery alone. Candidates for curative surgery should be highly selected and experienced centers are preferred. More significant well-designed studies are required for further exploration.
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Affiliation(s)
- Tian-Run Lv
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Parbatraj Regmi
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, China
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Resectional surgery in gallbladder cancer with jaundice-how to improve the outcome? Langenbecks Arch Surg 2021; 406:791-800. [PMID: 33619629 DOI: 10.1007/s00423-020-02075-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the surgical outcomes of patients with gallbladder cancer (GBC) with jaundice due to as-yet unelucidated prognostic factors. METHODS A total of 348 GBC patients underwent resection at our institute between 1985 and 2016. Of these, 67 had jaundice (serum total bilirubin ≥ 2 mg/dL). Preoperative biliary drainage was performed, with portal vein embolization as required. All patients underwent radical surgery. We retrospectively evaluated the outcomes, performed multivariate analysis for overall survival, and compared our findings to those reported in the literature. RESULTS The 5-year survival rate of M0 (no distant metastasis) GBC patients with jaundice, who underwent resectional surgery, was 21.9%, versus 68.3% in those without jaundice (p < 0.05). Since 2000, surgical mortality in GBC patients with jaundice has decreased from 12 to 6.8%. Patients with jaundice had more advanced disease and underwent major hepatectomies and vascular resections; however, preoperative jaundice alone was not a prognostic factor. Multivariate analysis of jaundiced patients revealed that percutaneous biliary drainage (PTBD) (vis-à-vis endoscopic drainage [EBD], hazard ratio [HR] 2.82), postoperative morbidity (Clavien-Dindo classification ≥ 3, HR 2.31), and distant metastasis (HR 1.85) were predictors of poor long-term survival. The 5-year survival and peritoneal recurrence rates in M0 patients with jaundice were 16% and 44%, respectively, for patients with PTBD and 39% (p < 0.05) and 13% (p = 0.07) for those with EBD. CONCLUSION M0 GBC patients with jaundice should undergo surgery if R0 resection is possible. Preoperative EBD may be superior to PTBD in M0 GBC patients with jaundice, although further studies are needed.
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Papageorge MV, de Geus SWL, Woods AP, Ng SC, Drake FT, Cassidy MR, McAneny DB, Tseng JF, Sachs TE. Undertreatment of Gallbladder Cancer: A Nationwide Analysis. Ann Surg Oncol 2021; 28:2949-2957. [PMID: 33566241 DOI: 10.1245/s10434-021-09607-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/23/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gallbladder cancer has a high mortality rate and an increasing incidence. The current National Comprehensive Cancer Network (NCCN) guidelines recommend resection for all T1b and higher-stage cancers. This study aimed to evaluate re-resection rates and the associated survival impact for patients with gallbladder cancer. METHODS Patients with gallbladder adenocarcinoma who underwent resection were identified from the National Cancer Database (2004-2015). Re-resection was defined as definitive surgery within 180 days after the first operation. Propensity scores were created for the odds of a patient having a re-resection. Patients were matched 1:2. Survival analyses were performed using the Kaplan-Meier and Cox proportional hazard methods. RESULTS The study identified 6175 patients, and 466 of these patients (7.6%) underwent re-resection. Re-resection was associated with younger median age (65 vs 72 years; p < 0.0001), private insurance (41.6% vs 27.1%; p < 0.0001), academic centers (50.4% vs 29.7%; p < 0.0001), and treatment location in the Northeast (22.8% vs 20.4%; p = 0.0011). Compared with no re-resection, re-resection was associated with pT stage (pT2: 47.6% vs 42.8%; p = 0.0139) and pN stage (pN1-2: 28.1% vs 20.7%; p < 0.0001), negative margins on final pathology (90.1% vs 72.6%; p < 0.0001), and receipt of chemotherapy (53.7% vs 35.8%; p < 0.0001). The patients who underwent re-resection demonstrated significantly longer overall survival (OS) than the patients who did not undergo re-resection (median OS, 44.0 vs 23.0 months; p < 0.0001). After propensity score-matching, re-resection remained associated with superior survival (median OS, 44.0 vs 31.0 months; p = 0.0004). CONCLUSIONS Re-resection for gallbladder cancer is associated with improved survival but remains underused, particularly for early-stage disease.
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Affiliation(s)
- Marianna V Papageorge
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Susanna W L de Geus
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Alison P Woods
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.,Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sing Chau Ng
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Frederick T Drake
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Michael R Cassidy
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - David B McAneny
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
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Chen M, Cao J, Xiang Y, Ma X, Bai Y, Lai Q, Tong C, Ma Z, Topatana W, Hu J, Li S, Juengpanich S, Yu H, Cai X. Hepatectomy strategy for T2 gallbladder cancer between segment IVb and V resection and wedge resection: A propensity score-matched study. Surgery 2021; 169:1304-1311. [PMID: 33551070 DOI: 10.1016/j.surg.2020.12.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liver resection is recommended for T2 gallbladder cancer, but the optimal hepatectomy strategy remains controversial. We aimed to assess the safety and effectiveness of segment IVb and V resection versus wedge resection in patients with T2 gallbladder cancer. METHODS This is a retrospective multicenter propensity score-matched study in China. Overall survival, disease-free survival, perioperative complications, and hospital length of stay were used to evaluate safety and effectiveness. RESULTS There are a total of 512 patients. 112 of 117 patients undergoing segment IVb and V resection were matched to 112 patients undergoing wedge resection. After matching, segment IVb and V resection demonstrated no statistical difference in overall survival (hazard ratio, 0.970 [0.639-1.474]; P = .886), but significance in disease-free survival (hazard ratio, 0.708 [0.506-0.991]; P = .040). Patients with incidental gallbladder cancer (hazard ratio, 0.390 [0.180-0.846]; P = .019), stage T2b (hazard ratio, 0.515 [0.302-0.878]; P = .016), and negative lymph nodes status (hazard ratio, 0.627 [0.406-0.991]; P = .043) were associated with improved disease-free survival after segment IVb and V resection, but not in wedge resection. However, perioperative complications occurred more frequently after segment IVb and V resection (28.5% vs 9.1%, P < .001) along with the longer hospital length of stay (17.3 vs 10.2 days, P < .001). Notably, patients with jaundice (odds ratio, 4.053 [1.361-12.23]; P = .013), undergoing laparoscopic resection (odds ratio, 2.387 [1.059-4.484]; P = .028) or surgeon performing per the first 10 segment IVb and V resections (odds ratio, 2.697 [1.035-6.998]; P = .041), were the independent risk factors for perioperative complications in the segment IVb and V resection group. CONCLUSION T2 gallbladder cancer patients undergoing segment IVb and V resection rather than wedge resection have an improved disease-free survival, especially for incidental gallbladder cancer or hepatic-sided (T2b) gallbladder cancer. However, high rates of perioperative complications and longer hospital length of stay after segment IVb and V resection indicated that surgeons must rely on their own surgical skills and the patient profile to decide the optimal hepatectomy strategy.
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Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou, Zhejiang Province, China; Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China. https://twitter.com/MingyuChen6
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yukai Xiang
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiaochen Ma
- Department of Hepatobiliary Cancer, Liver Cancer Research Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yang Bai
- Department of General Surgery, Jinhua Center Hospital of Zhejiang University, Jinhua, Zhejiang Province, China; Department of General Surgery, The Second Affiliated Hospital of Zhejiang Medical University, Hangzhou, Zhejiang Province, China
| | - Qihong Lai
- Department of General Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Chenhao Tong
- Department of General Surgery, Shaoxing People's Hospital of Zhejiang University, Shaoxing, Zhejiang Province, China
| | - Zuyi Ma
- Department of General Surgery, Guangdong Academy of Medical Sciences & Guangdong Provincial People's Hospital, Guangdong Province, China; Shantou University of Medical College, Shantou, China
| | - Win Topatana
- Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jiahao Hu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Shijie Li
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Sarun Juengpanich
- Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Hong Yu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou, Zhejiang Province, China; Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
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Kim WJ, Lim TW, Park PJ, Choi SB, Kim WB. Safety and feasibility of pure laparoscopic extended cholecystectomy: comparison with the open technique in a propensity analysis at a single center. Surg Endosc 2021; 35:6166-6172. [PMID: 33409594 DOI: 10.1007/s00464-020-08112-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to validate the safety and feasibility of pure laparoscopic extended cholecystectomy (LEC) by comparing the outcome with that of open extended cholecystectomy (OEC). Moreover, on the basis of our experience, we also aimed to investigate the learning curve of pure LEC. METHODS This single-center study enrolled patients who were diagnosed primary gallbladder cancer with pathologically confirmed and underwent R0 resection with curative intent between January 2016 and December 2019. A total of 31 patients who underwent OEC and 17 patients who underwent LEC were selected. Propensity score matching analysis was performed in a 1:1 ratio using the nearest-neighbor matching method, and clinical information was retrospectively collected from medical records and analyzed. RESULTS The postoperative hospital stay was statistically shorter in the LEC group (7 days) than in the OEC group (12 days). The overall surgical complication rate did not differ between the two groups. The 1- and 3-year disease-free survival rates were 82.4% and 82.4% in the OEC group and 94.2% and 71.5% in the LEC group, respectively (P = 0.94). Considering the correlation between the number of cumulative cases and the operation time and between the number of cumulative cases and the number of retrieved lymph nodes in the LEC group, as the cases were accumulated, both the operation time and the number of retrieved lymph nodes had a statistically significant correlation with the number of cases. CONCLUSIONS LEC showed a significant advantage in terms of achieving shorter postoperative hospital stay and similar results to OEC with respect to overall complications and pathological outcomes. The present results confirm that laparoscopy can be considered a safe treatment for primary gallbladder cancer in selected patients.
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Affiliation(s)
- Wan-Joon Kim
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Tae-Wan Lim
- Division of Transplantation Vascular Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Pyoung-Jae Park
- Division of Transplantation Vascular Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Sae-Byeol Choi
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea
| | - Wan-Bae Kim
- Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, Korea University Guro Hospital, Korea University Medical College, Seoul, Korea.
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Hsu KF, Wang RT, Chen JY, Yu JC, Chen TW, Hsieh CB, Chan DC. Unusual cause of abdominal pain in a young adult: The clinical pitfalls of adenocarcinoma of the gallbladder with liver invasion. JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/jmedsci.jmedsci_243_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jha V, Sharma P, Mandal KA. Incidental gallbladder carcinoma: Utility of histopathological evaluation of routine cholecystectomy specimens. South Asian J Cancer 2020; 7:21-23. [PMID: 29600228 PMCID: PMC5865089 DOI: 10.4103/2278-330x.226802] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Incidental gallbladder carcinoma (IGBC) is rare cancer diagnosed during or after cholecystectomy done for benign gallbladder disease. The concern whether routine histopathological examination is needed for all cholecystectomy specimens still remains debatable. Materials and Methods Twenty patients diagnosed with IGBC over a period of 2 years were retrospectively reviewed. Clinical details including clinical presentation, preoperative ultrasound (USG) findings, and macroscopic features were retrieved. Diagnosis of IGBC was confirmed on microscopic examination, and staging was done using the tumor node metastasis staging system. Results Of the 4800 cholecystectomy specimens retrieved, diagnosis of IGBC was rendered in twenty cases (0.41%). Mean patient age was 50.65 years with a female preponderance. Preoperative USG detected an increase in wall thickness in six cases (30%) in contrast to gross examination which revealed the same in 55% (11/20) cases. Mucosal ulceration was observed in two cases (10%) of IGBC and seven cases (35%) did not reveal any preoperative or macroscopic findings suggestive of malignancy. Associated cholelithiasis was observed in 14 cases. Final diagnosis of IGBC was made on histomorphological assessment with tumor cells infiltrating the lamina propria in three cases (pT1b), muscularis propria in 15 cases (pT1b), and serosa in the remaining 2 cases (pT2). Conclusion IGBC is a clinical masquerader which often evades the eye of a radiologist and comes as pathological surprise. Histopathological examination of cholecystectomy specimens remains the gold standard for the detection of this occult, yet notorious malignancy and assessment of the depth of invasion in IGBC guide further management.
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Affiliation(s)
- Vidya Jha
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Preeti Sharma
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - K Ashish Mandal
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Ramachandran A, Srivastava DN, Madhusudhan KS. Gallbladder cancer revisited: the evolving role of a radiologist. Br J Radiol 2020; 94:20200726. [PMID: 33090880 DOI: 10.1259/bjr.20200726] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Gallbladder cancer is the most common malignancy of the biliary tract. It is also the most aggressive biliary tumor with the shortest median survival duration. Complete surgical resection, the only potentially curative treatment, can be accomplished only in those patients who are diagnosed at an early stage of the disease. Majority (90%) of the patients present at an advanced stage and the management involves a multidisciplinary approach. The role of imaging in gallbladder cancer cannot be overemphasized. Imaging is crucial not only in detecting, staging, and planning management but also in guiding radiological interventions. This article discusses the role of a radiologist in the diagnosis and management of gallbladder cancer.
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Affiliation(s)
- Anupama Ramachandran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
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Histopathologic Features of 1000 Cholecystectomy Specimens. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.103522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: One of the most common gastrointestinal surgeries is cholecystectomy. Gallstones are the major causes of cholecystectomy and induce various histopathologic changes. Gallbladder carcinoma is rare with poor prognosis. Metaplasic changes in gallbladder epithelium are considered precancerous lesions. Objectives: This study aimed at revealing the spectrum of histopathological patterns of gallbladder diseases in cholecystectomy specimens. Methods: A total of 1004 gallbladder H & E stained slides of cholecystectomy specimens over one year were studied. Histopathological evaluation was done by 6 pathologists in terms of variables. Results: In our study, the male: female ratio was 1:2.1. The age of patients varied from 17 to 96 years with a mean age of 49.1 years. The mean age of patients with gallstones was 47.52 years and was more common in women. Cholesterol, pigmented, and mixed stones were reported in 58.36%, 39.03%, and 2.6% of gallstones, respectively. The most common histological morphology was chronic calculous cholecystitis (61.18%). The incidence of metaplasia and invasive carcinoma was 19.55% and 0.2%, respectively. Conclusions: In this study, histopathological analysis of gallbladder diseases in the cholecystectomy specimens revealed that chronic calculous cholecystitis was the most common histologic finding. Gallstones were found more commonly in women and cholesterol stone was the predominant type. Pyloric metaplasia was the most frequent type of metaplasia. The rate of invasive carcinoma is compatible with those reported in the literature. Routine histopathological analysis of the cholecystectomy specimens will help to detect incidental carcinoma and precursors of malignancy.
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Kamada Y, Hori T, Yamamoto H, Harada H, Yamamoto M, Yamada M, Yazawa T, Tani M, Sato A, Tani R, Aoyama R, Sasaki Y, Zaima M. Surgical treatment of gallbladder cancer: An eight-year experience in a single center. World J Hepatol 2020; 12:641-660. [PMID: 33033570 PMCID: PMC7522563 DOI: 10.4254/wjh.v12.i9.641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/10/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gallbladder cancer (GBC) is the most common biliary malignancy and has the worst prognosis, but aggressive surgeries [e.g., resection of the extrahepatic bile duct (EHBD), major hepatectomy and lymph node (LN) dissection] may improve long-term survival. GBC may be suspected preoperatively, identified intraoperatively, or discovered incidentally on histopathology. AIM To present our data together with a discussion of the therapeutic strategies for GBC. METHODS We retrospectively investigated nineteen GBC patients who underwent surgical treatment. RESULTS Nearly all symptomatic patients had poor outcomes, while suspicious or incidental GBCs at early stages showed excellent outcomes without the need for two-stage surgery. Lymph nodes around the cystic duct were reliable sentinel nodes in suspicious/incidental GBCs. Intentional LN dissection and EHBD resection prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic LNs or invasion of the nerve plexus. All patients with positive surgical margins (e.g., the biliary cut surface) showed poor outcomes. Hepatectomies were performed in sixteen patients, nearly all of which were minor hepatectomies. Metastases were observed in the left-sided liver but not in the caudate lobe. We may need to reconsider the indications for major hepatectomy, minimizing its use except when it is required to accomplish negative bile duct margins. Only a few patients received neoadjuvant or adjuvant chemoradiation. There were significant differences in overall and disease-free survival between patients with stages ≤ IIB and ≥ IIIA disease. The median overall survival and disease-free survival were 1.66 and 0.79 years, respectively. CONCLUSION Outcomes for GBC patients remain unacceptable, and improved therapeutic strategies, including neoadjuvant chemotherapy, optimal surgery and adjuvant chemotherapy, should be considered for patients with advanced GBCs.
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Affiliation(s)
- Yasuyuki Kamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan.
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Hideki Harada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Michihiro Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masahiro Yamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Takefumi Yazawa
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masaki Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Asahi Sato
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ryotaro Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ryuhei Aoyama
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Yudai Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
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Yang XW, Chen JY, Wen ZJ, Li YL, Wang FY, Li L, Yang J, Yang PH, Zhang BH, Shen F. Effect of preoperative jaundice on long-term prognosis of gallbladder carcinoma with radical resection. World J Surg Oncol 2020; 18:239. [PMID: 32891147 PMCID: PMC7487893 DOI: 10.1186/s12957-020-02015-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
Purposes This study was designed to evaluate the effect of preoperative jaundice on long-term prognosis of gallbladder carcinoma (GBC) after radical resection (R0). Methods A total of 267 GBC patients who underwent R0 resection from January 2004 to December 2014 were enrolled, including 54 patients with preoperative jaundice and 213 patients without jaundice. The clinicopathological parameters between the two groups were compared, and the correlation between preoperative jaundice and the long-term prognosis was furtherly analyzed. Results Unilateral and multivariate analyses of 267 GBC patients showed that the depth of tumor invasion (pT stage), lymphatic metastasis, and hepatic invasion were independent prognostic factors. The univariate and multivariate analysis of 54 GBC patients with preoperative jaundice showed that only pT stage was an independent factor for prognosis. Furthermore, the intraoperative blood transfusion and pT stage were significant different between long-term survival (survive for more than 3 years) and those who died within 3 years (P < 0.05). Conclusion Preoperative jaundice was not the independent factor resulting in the poor long-term prognosis of gallbladder carcinoma after R0 resection. The pT stage was the only long-term prognostic factor in all GBC patients regardless of preoperative jaundice.
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Affiliation(s)
- Xin-Wei Yang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China
| | - Jun-Yi Chen
- Department of General Surgery, The Fourth People's Hospital of Shanghai, North Sichuang Road 1878, Shanghai, 200081, Shanghai, China
| | - Zhi-Jian Wen
- Department of General Surgery, No.73 Army Hospital of PLA, Xiamen University, Xiamen, China
| | - Yu-Long Li
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China
| | - Fei-Yu Wang
- Department of General Surgery, Jiangdu People's Hospital of Yangzhou City, Jiangsu Province, No. 9 Dongfanghong East Road, Yangzhou, China
| | - Liang Li
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China
| | - Jue Yang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China
| | - Ping-Hua Yang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China
| | - Bao-Hua Zhang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China.
| | - Feng Shen
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Changhai Road 225, Shanghai, 200438, China.
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Yang Y, Tu Z, Cai H, Hu B, Ye C, Tu J. A predictive nomogram for lymph node metastasis of incidental gallbladder cancer: a SEER population-based study. BMC Cancer 2020; 20:828. [PMID: 32867722 PMCID: PMC7461264 DOI: 10.1186/s12885-020-07341-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Existing imaging techniques have a low ability to detect lymph node metastasis (LNM) of gallbladder cancer (GBC). Gallbladder removal by laparoscopic cholecystectomy can provide pathological information regarding the tumor itself for incidental gallbladder cancer (IGBC). The purpose of this study was to identify the risk factors associated with LNM of IGBC and to establish a nomogram to improve the ability to predict the risk of LNM for IGBC. METHODS A total of 796 patients diagnosed with stage T1/2 GBC between 2004 and 2015 who underwent surgery and lymph node evaluation were enrolled in this study. We randomly divided the dataset into a training set (70%) and a validation set (30%). A logistic regression model was used to construct the nomogram in the training set and then was verified in the validation set. Nomogram performance was quantified with respect to discrimination and calibration. RESULTS The rates of LNM in T1a, T1b and T2 patients were 7, 11.1 and 44.3%, respectively. Tumor diameter, T stage, and tumor differentiation were independent factors affecting LNM. The C-index and AUC of the training set were 0.718 (95% CI, 0.676-0.760) and 0.702 (95% CI, 0.659-0.702), respectively, demonstrating good prediction performance. The calibration curves showed perfect agreement between the nomogram predictions and actual observations. Decision curve analysis showed that the LNM nomogram was clinically useful when the risk was decided at a possibility threshold of 2-63%. The C-index and AUC of the validation set were 0.73 (95% CI: 0.665-0.795) and 0.692 (95% CI: 0.625-0.759), respectively. CONCLUSION The nomogram established in this study has good prediction ability. For patients with IGBC requiring re-resection, the model can effectively predict the risk of LNM and make up for the inaccuracy of imaging.
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Affiliation(s)
- Yingnan Yang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China
| | - Zhuolong Tu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China
| | - Huajie Cai
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China
| | - Bingren Hu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China
| | - Chentao Ye
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China
| | - Jinfu Tu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China.
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Dominguez DA, Aversa JG, Hagerty BL, Diggs LP, Raoof M, Davis JL, Hernandez JM, Blakely AM. Prognostic impact of lymphovascular invasion in pT1-T3 gallbladder adenocarcinoma. J Surg Oncol 2020; 122:1401-1408. [PMID: 32783204 DOI: 10.1002/jso.26160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Most gallbladder cancers are diagnosed after cholecystectomy for presumed benign disease, and nodal staging to inform subsequent treatment is therefore often lacking. We evaluated the association of lymphovascular invasion (LVI) with regional lymph node involvement in gallbladder adenocarcinoma and its impact on survival. METHODS The National Cancer Database was queried to identify patients with resected gallbladder adenocarcinoma and with available staging and LVI status. Patients with pT4 and M1 disease were excluded. Univariable and multivariable regression identified factors associated with positive lymph nodes. Cox proportional hazards model was used to evaluate overall survival (OS). RESULTS Of 1649 patients with available LVI status, 1142 (69.7%) had at least one positive lymph node and 765 (46.4%) had LVI. On multivariable regression, presence of LVI was the strongest predictor of positive lymph nodes (odds ratio, 3.69; P < .001). The positive predictive value of LVI for positive lymph nodes in pT2 and pT3 tumors was 80.1% and 90.5%, respectively. LVI was independently associated with decreased OS (hazard ratio, 1.21; P = .001), as were node-positive disease and increasing T stage. CONCLUSION In patients with gallbladder adenocarcinoma, LVI is independently associated with regional lymph node metastases and abbreviated OS. LVI status may help risk-stratify patients following initial cholecystectomy and inform subsequent treatment.
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Affiliation(s)
- Dana A Dominguez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.,Department of General Surgery, UCSF East Bay, Oakland, California
| | - John G Aversa
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Brendan L Hagerty
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Laurence P Diggs
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mustafa Raoof
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Jeremy L Davis
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jonathan M Hernandez
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrew M Blakely
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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Gamboa AC, Maithel SK. The Landmark Series: Gallbladder Cancer. Ann Surg Oncol 2020; 27:2846-2858. [PMID: 32474816 DOI: 10.1245/s10434-020-08654-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Indexed: 12/13/2022]
Abstract
Given the rarity of gallbladder carcinoma, level I evidence to guide the multimodal treatment of this disease is lacking. Since 2010, four randomized phase III clinical trials including ABC-02, PRODIGE-12/ACCORD-18, BILCAP, and BCAT, and a single-arm phase II trial (SWOG0809) have been reported on the use of adjuvant strategies for biliary malignancies. These trials have led to the recommendation that patients with resected biliary tract cancer should be offered adjuvant capecitabine chemotherapy and those with R1 margins could be considered for chemoradiotherapy. Because there is no level I evidence to guide neoadjuvant therapy or surgical management, current consensus is based on strong retrospective data. The following review summarizes available trials and highlights the best available evidence that form the basis of consensus statements for the multimodal management of gallbladder carcinoma.
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Affiliation(s)
- Adriana C Gamboa
- Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, GA, USA
| | - Shishir K Maithel
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
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Effect of lymphadenectomy in curative gallbladder cancer treatment: a systematic review and meta-analysis. Langenbecks Arch Surg 2020; 405:573-584. [PMID: 32458141 DOI: 10.1007/s00423-020-01878-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Only a small fraction of resectable gallbladder cancer (GBC) patients receive a thorough lymphadenectomy. The aim of this systematic review and meta-analysis was to investigate the effect of lymphadenectomy on survival in GBC surgery. METHODS On May 19, 2019, MEDLINE, EMBASE, and the Cochrane Library were searched for English or German articles published since 2002. Studies assessing the effect of lymphadenectomy on survival in GBC surgery were included. Fixed effect and random effects models were used to summarise the hazard ratio (HR). RESULTS Of the 530 identified articles, 18 observational studies (27,570 patients, 10 population-based, 8 cohort studies) were reviewed. In the meta-analysis, lymphadenectomy did not show a significant benefit for T1a tumours (n = 495; HR, 1.37; 95%CI, 0.65-2.86; P = 0.41). Lymphadenectomy showed a significant survival benefit in T1b (n = 1618; HR, 0.69; 95%CI, 0.50-0.94; P = 0.02) and T2 (n = 6204; HR, 0.68; 95%CI, 0.56-0.83; P < 0.01) tumours. Lymphadenectomy improved survival in the 2 studies assessing T3 tumours (n = 1961). A conclusive analysis was not possible for T4 tumours due to a low case load. Among patients undergoing lymphadenectomy, improved survival was observed in patients with a higher number of resected lymph nodes (HR, 0.57; 95%CI, 0.45-0.71; P < 0.01). CONCLUSIONS Regional lymphadenectomy improves survival in T1b to T3 GBC. A minimum of 6 retrieved lymph nodes are necessary for adequate staging, indicating a thorough lymphadenectomy. Patients with T1a tumours should be evaluated for lymphadenectomy, especially if lymph node metastases are suspected.
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Incidental Carcinoma after Cholecystectomy for Benign Disease of the Gallbladder: A Meta-Analysis. J Clin Med 2020; 9:jcm9051484. [PMID: 32423156 PMCID: PMC7290945 DOI: 10.3390/jcm9051484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
This study aimed to determine the incidence and the prognosis of incidental carcinoma of the gallbladder (IGBC) after cholecystectomy through a meta-analysis. This meta-analysis included 51 studies and 436,636 patients with cholecystectomy. The incidence rate of IGBC after cholecystectomy was 0.6% (95% confidence interval (CI) 0.5%-0.8%). The incidence rate of recent studies was not significantly different from those of past studies. The mean age and female ratio of the IGBC subgroup were not significantly different from those of the overall patient group. The estimated rates of IGBC were 13.0%, 34.1%, 39.7%, 22.7%, and 12.5% in the pTis, pT1, pT2, pT3, and pT4 stages, respectively. Patients with IGBC had a favorable overall survival rate compared to patients with non-IGBC (hazard ratio (HR) 0.574, 95% CI 0.445-0.739). However, there was no significant difference of disease-free survival between the IGBC and non-IGBC subgroups (HR 0.931, 95% CI 0.618-1.402). IGBC was found in 0.6% of patients with cholecystectomy. The prognosis of patients with IGBC was favorable compared to those with non-IGBC. In the pathologic examination after cholecystectomy for benign diseases, a sufficient examination for histology should be guaranteed to detect IGBC.
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Abstract
Managing patients with incidental gallbladder cancer requires stratifying patients risk for recurrence and an appreciation for the recurrence patterns characterizing this malignancy. Although standard management includes reresection to remove sites at risk of harboring residual disease and to achieve negative resection margin status, the decision to perform surgery is tempered by an early and frequent distant recurrence, the most common cause of surgical failure. High-risk patients may benefit from neoadjuvant chemotherapy before reresection. The goal of curative-intent reresection is achieving R0 margin status and optimal staging while limiting morbidity and mortality.
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Prognostic Impact of Lymph Node Excision in T1 and T2 Gallbladder Cancer: a Population-Based and Propensity Score-Matched SEER Analysis. J Gastrointest Surg 2020; 24:633-642. [PMID: 30887297 DOI: 10.1007/s11605-019-04175-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/20/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study was to assess the effect of lymphadenectomy on survival in T1/T2 gallbladder cancer (GBC). METHODS In this retrospective cohort study, patients undergoing surgery for T1/T2 GBC from 2004 to 2014 were identified in the Surveillance, Epidemiology, and End Results database. The effect of lymph node excision (LNE) on survival was assessed using Cox regression and propensity score methods. RESULTS A total of 2112 patients were identified: 11.4% had T1a, 18.5% T1b, and 70.1% had T2 tumors. Mean follow-up was 31.3 months. In 48.8% of patients, LNE was performed with a mean of 3.6 ± 4.3 nodes retrieved. Cancer-specific 5-year survival for T1 and T2 stages combined was 49.6% (95% confidence interval (CI), 45.9-53.6%) without LNE compared to 56.2% (95% CI, 52.4-60.4%) if LNE was performed (hazard ratio (HR), 0.75; 95%CI, 0.64-0.86, P < 0.001). Propensity score analyses for both stages combined confirmed this survival benefit with an HR of 0.67 (95% CI, 0.55-0.80) for the LNE group (P < 0.001). Stratified for tumor stages, LNE had no significant effect on cancer-specific survival in T1a (HR, 1.80 (95% CI, 0.76-4.26), P = 0.185) or T1b tumors (HR, 0.95 (95% CI, 0.57-1.58), P = 0.844), whereas it persistently revealed an advantage for patients with T2 tumors (HR 0.68 (95% CI, 0.55-0.83, P < 0.001). No correlation between the number of retrieved lymph nodes and the N+ rate was found (P = 0.134). CONCLUSIONS LNE is associated with improved survival in T2 GBC. No significant survival benefit was observed in T1a and T1b tumors. The retrieval of even a few lymph nodes reliably predicts the nodal status, which might assist in patient selection for re-resection in T1 GBC.
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Yuza K, Sakata J, Prasoon P, Hirose Y, Ohashi T, Toge K, Miura K, Nagahashi M, Kobayashi T, Wakai T. Long-term outcomes of surgical resection for T1b gallbladder cancer: an institutional evaluation. BMC Cancer 2020; 20:20. [PMID: 31907021 PMCID: PMC6945689 DOI: 10.1186/s12885-019-6507-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 12/30/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is no comprehensive agreement concerning the overall performance of radical resection for T1b gallbladder cancer (GBC). This research focused on addressing whether T1b GBC may spread loco-regionally and whether radical resection is necessary. METHODS A retrospective analysis was conducted of 1032 patients with GBC who underwent surgical resection at our centre and its affiliated institutions between January 1982 and December 2018. A total of 47 patients with T1b GBC, 29 (62%) of whom underwent simple cholecystectomy and 18 (38%) of whom underwent radical resection with regional lymph node dissection, were enrolled in the study. RESULTS GBC was diagnosed pre-operatively in 16 patients (34%), whereas 31 patients (66%) had incidental GBC. There was no blood venous or perineural invasion in any patient on histology evaluation, except for lymphatic vessel invasion in a single patient. There were no metastases in any analysed lymph nodes. The open surgical approach was more prevalent among the 18 patients who underwent radical resection (open in all 18 patients) than among the 29 patients who underwent simple cholecystectomy (open in 21; laparoscopic in 8) (P = 0.017). The cumulative 10- and 20-year overall survival rates were 65 and 25%, respectively. The outcome following simple cholecystectomy (10-year overall survival rate of 66%) was akin to that following radical resection (64%, P = 0.618). The cumulative 10- and 20-year disease-specific survival rates were 93 and 93%, respectively. The outcome following simple cholecystectomy (10-year disease-specific survival rate of 100%) was equivalent to that following radical resection (that of 86%, P = 0.151). While age (> 70 years, hazard ratio 5.285, P = 0.003) and gender (female, hazard ratio 0.272, P = 0.007) had a strong effect on patient overall survival, surgical procedure (simple cholecystectomy vs. radical resection) and surgical approach (open vs. laparoscopic) did not. CONCLUSIONS Most T1b GBCs represent local disease. As pre-operative diagnosis, including tumour penetration of T1b GBC, is difficult, the decision of radical resection is justified. Additional radical resection is not required following simple cholecystectomy provided that the penetration depth is restricted towards the muscular layer and that surgical margins are uninvolved.
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Affiliation(s)
- Kizuki Yuza
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Jun Sakata
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Pankaj Prasoon
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Yuki Hirose
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Taku Ohashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Koji Toge
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Kohei Miura
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Masayuki Nagahashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Takashi Kobayashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata City, 951-8510, Japan.
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Maruyama S, Kawaida H, Hosomura N, Amemiya H, Saito R, Shimizu H, Furuya S, Akaike H, Kawaguchi Y, Sudo M, Inoue S, Kono H, Ichikawa D. Indications for extrahepatic bile duct resection due to perineural invasion in patients with gallbladder cancer. World J Surg Oncol 2019; 17:200. [PMID: 31785615 PMCID: PMC6885324 DOI: 10.1186/s12957-019-1735-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023] Open
Abstract
Background The indications for extrahepatic bile duct (EHBD) resection remain a major controversy in the surgical management of patients with gallbladder cancer. On the other hand, perineural invasion (PNI) was reported as an important factor in patients with gallbladder cancer because gallbladder cancer cells frequently spread to the tissues surrounding the EHBD via perineural routes. We assessed the correlation of PNI with clinicopathological factors in patients with gallbladder cancer to elucidate EHBD resection indications specifically in patients with PNI. Methods This retrospective study assessed the PNI status of 50 patients with gallbladder cancer who underwent curative resection and examined the correlation between the presence of PNI and clinicopathological factors. Results Thirteen patients (26%) were PNI positive. PNI was significantly correlated with male sex, proximal-type tumor, lymphatic and vascular invasion, and advanced T stage. Multivariate analysis found that PNI positivity (p < 0.001), lymphatic invasion (p = 0.007), and nodal stage (p < 0.001) were independent prognostic factors. PNI was never observed in patients with stage T1 cancer. Conversely, PNI was detected rarely in distal-type tumors, all of whom developed various types of recurrences. Conclusions These results clearly demonstrated the prognostic impact of PNI in patients with gallbladder cancer. We suggest that EHBD resection in combination with cholecystectomy may not be useful for distal-type tumors from a perspective of PNI.
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Affiliation(s)
- Suguru Maruyama
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Hiromichi Kawaida
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Naohiro Hosomura
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Hidetake Amemiya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Ryo Saito
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Hiroki Shimizu
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Shinji Furuya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Hidenori Akaike
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Makoto Sudo
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Shingo Inoue
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Hiroshi Kono
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
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Kim BH, Kim SH, Song IS, Chun GS. The appropriate surgical strategy for T1b gallbladder cancer incidentally diagnosed after a simple cholecystectomy. Ann Hepatobiliary Pancreat Surg 2019; 23:327-333. [PMID: 31824997 PMCID: PMC6893052 DOI: 10.14701/ahbps.2019.23.4.327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/14/2019] [Accepted: 07/25/2019] [Indexed: 02/07/2023] Open
Abstract
Backgrounds/Aims The appropriate surgical treatment was investigated for T1b gallbladder (GB) cancer through a retrospective analysis of the clinical outcomes of patients with incidental T1 GB cancer. Methods Patients with T1 GB cancer who were incidentally diagnosed while undergoing a simple cholecystectomy at Chungnam University Hospital from January 2004 to December 2017 were enrolled. Overall, 39 patients with T1 GB cancer, 17 patients with T1a, and 22 patients with T1b were included. We retrospectively analyzed the patients' clinical and pathologic findings and follow-up results. Results Among the 6490 patients who underwent cholecystectomy during the study period, 165 patients were diagnosed with GB cancer (T1=42 [25.5%]). The risk factor associated with recurrence and cancer-related death in patients with T1 GB cancer was lymphovascular invasion (recurrence, p=0.028; death, p=0.004). In the T1b group, the 5-year disease-free survival (DFS) rate showed a statistical difference between patients with and without lymphovascular invasion (45.7% vs. 83.6%, p=0.048). There was no statistically significant difference in 5-year DFS and overall survival rate between simple cholecystectomy and extended cholecystectomy in T1b GB cancer with lymphovasular invasion (p=0.054 and p=0.091, respectively). Conclusions In incidental T1b GB cancer, extended cholecystectomy was not superior to simple cholecystectomy in terms of the 5-year DFS rate and nor in overall survival rate or recurrence rate, even when lymphovascular invasion was identified after simple cholecystectomy. Therefore, simple cholecystectomy may be recommended as a primary surgical strategy for T1b GB cancer.
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Affiliation(s)
- Byoung-Hyoung Kim
- Department of Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seok-Hwan Kim
- Department of Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - In-Sang Song
- Department of Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Gwang-Sik Chun
- Department of Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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