Comparison of the Oncological Outcomes of Open versus Laparoscopic Surgery for T2 Gallbladder Cancer: A Propensity-Score-Matched Analysis

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.

Gallbladder cancer and liver transplantation

Gallbladder cancer is the fifth most common malignancy of the gastrointestinal tract. Gallbladder cancer is found incidentally at the time of cholecystectomy in 0.35% of patients. Two previous isolated case reports of incidentally found gallbladder cancer in hepatectomy specimens following liver transplantation (LT) showed no adverse outcomes. We reviewed the outcome of four patients. Three patients had end-stage liver disease secondary to primary sclerosing cholangitis and one patient had cryptogenic cirrhosis. Gallbladder cancer was removed at cholecystectomy in one patient 11 months prior to transplant. One patient had suspected gallbladder cancer prior to LT by ultrasound and CT imaging, as well as a rising CA 19-9. The other two patients had incidentally identified gallbladder cancer. Median follow-up was 30 months. There has been no evidence of recurrence and patient survival was 100%. Early gallbladder cancer is not a contraindication for LT, however further follow-up is needed.

Expression of UDP-N-acetyl-alpha-D-galactosamine-polypeptide N-acetylgalactosaminyltransferase isozyme 3 in the subserosal layer correlates with postsurgical survival of pathological tumor stage 2 carcinoma of the gallbladder

PURPOSE AND EXPERIMENTAL DESIGN

Little is known about the molecular events leading to the development and progression of pathological tumor stage 2 (pT(2)) gallbladder carcinoma. An alteration in the site of O-glycosylation may be associated with malignant behavior of carcinoma cells by modulation of the biological properties of the target mucin. The UDP-N-acetyl-alpha-D-galactosamine-polypeptide N-acetylgalactosaminyltransferase isozyme 3 (GalNAc-T3) has the epithelial gland-specific expression and catalyzes mucin-type O-glycosylation. In this study, immunohistochemistry was performed to determine the expression level of GalNAc-T3 in 34 cases of pT(2) gallbladder carcinoma to determine the correlation of the GalNAc-T3 expression level with mode of recurrence and postsurgical survival.

RESULTS

The expression levels of GalNAc-T3 protein and mRNA were increased in gallbladder carcinomas compared with the levels in adjacent noncancerous tissues and in intact gallbladders. Immunostaining of GalNAc-T3 was recognized in the cancerous epithelia, and the subcellular localization was classified into granular and diffuse types. In the 34 cases of pT(2) carcinoma, the localization of GalNAc-T3 was granular type in 50% and diffuse type in 50% of the cases at the deepest invading sites in the subserosal layer. Postsurgical recurrence was significantly more frequent in cases showing diffuse-type localization of GalNAc-T3 at the deepest invading sites (65%) than in those showing granular-type localization (23%; P < 0.05). Postsurgical survival was significantly poorer in cases showing diffuse-type localization than in those showing granular-type localization (P = 0.033)

CONCLUSIONS

In pT(2) gallbladder carcinoma, the presence of diffuse-type localization of GalNAc-T3 in the subserosal layer is correlated with aggressiveness of the disease. This phenotype may serve as a unique biological feature associated with the malignant behavior.

Clinicopathological features and management of gallbladder cancer in Pakistan: a prospective study of 233 cases

BACKGROUND AND AIMS

Gallbladder cancer is common in Pakistan and has an extremely poor prognosis. Treatment is primarily surgical. Chemotherapy is frequently used in patients with advanced disease. This study was performed to evaluate and compare the clinicopathological features and management of gallbladder cancer in Pakistani patients, with particular emphasis on factors that influence survival.

METHODS

Two hundred and thirty-three patients with histologically proven gallbladder cancer were studied. Information was prospectively collected on demographic features, clinical and laboratory findings at the time of presentation, influence of therapy, and survival. Data were analyzed to evaluate variables that influenced survival. Kaplan-Meier analysis was used to calculate survival.

RESULTS

Most patients were women (77%). Mean age was 55 years (+/-11 years). Fourteen per cent of females were nulliparous. Twenty-six per cent had five or more children. Only 4% of patients had a documented history of typhoid fever. The majority (69%) had a history of symptomatic gallbladder disease. The commonest presenting symptom was pain (89%), followed by nausea and vomiting (52%), weight loss (42%), and jaundice (33%). One-quarter of patients had a palpable abdominal mass. Most had abnormal hepatic function tests and 58% had elevated carcinoma embryonic antigen levels. Stage (P < 0.001), jaundice (P = 0.01) and palpable mass (P = 0.02) were statistically significant variables. However, on multivariate analysis, tumor node metastases (TNM) stage was the only factor influencing survival. Median survival of the patients was 44 months for patients with stage I disease, 23 months for stage II, 17 months for stage III and 6 months for stage IV.

CONCLUSION

These data are comparable with those reported from other developing countries. Most patients presented at an advanced stage of disease and had an extremely poor prognosis. Systemic therapy did not provide any survival benefit. The TNM stage remains the most important factor influencing survival.

Current perspectives in gallbladder carcinoma

Carcinoma gallbladder (CaGB) is not a common malignancy in a large number of countries in the world, except Chile, Japan, some parts of India, and a few other regions. Lacunae exist even today in terms of understanding of its epidemiology, aetiopathogenesis, and in the early pick up of malignanacy, as well as in choosing the most appropriate treatment option for a given case. While Japanese surgeons have advocated radical resections for CaGB and have shown good outcome resulting in long- term survival, others have not felt convinced about the desirability of undertaking such morbid surgical procedures in all patients. Also, radical resections have not always resulted in a tumor-free state and a cure in a large percentage of cases. Under the circumstances, the clinician's mind is often confused as to the most beneficial option for that patient once curative resection is not possible. Palliation of the jaundice and/or gastric outlet obstruction relieves the symptoms but does not prolong survival. The role of adjuvant chemotherapy with or without cytoreductive surgery has not been fully explored in CaGB. The present review quotes experience that seems to support the above contention. However, a number of well-designed multicentric trials are required to confirm the above philosophy of treatment for the benefit of patients suffering from CaGB.