DOI QR코드

DOI QR Code

Survival after extended resections for gallbladder cancer

  • Abu Bakar Hafeez Bhatti (Division of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad) ;
  • Faisal Saud Dar (Division of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad) ;
  • Shahzad Riyaz (Shifa Tameer-e-Millat University Islamabad) ;
  • Nusrat Yar Khan (Division of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad) ;
  • Najla Rahman Qureshi (Division of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Shifa International Hospital Islamabad) ;
  • Nasir Ayub Khan (Division of Anesthesiology, Shifa International Hospital Islamabad)
  • Received : 2022.08.30
  • Accepted : 2022.10.31
  • Published : 2023.02.28

Abstract

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

Keywords

References

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