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Gholami S, Colby S, Horowitz DP, Guthrie KA, Ben-Josef E, El-Khoueiry AB, Blanke CD, Philip PA, Kachnic LA, Ahmad SA, Rocha FG. Adjuvant Chemoradiation in Patients with Lymph Node-Positive Biliary Tract Cancers: Secondary Analysis of a Single-Arm Clinical Trial (SWOG 0809). Ann Surg Oncol 2023; 30:1354-1363. [PMID: 36622529 PMCID: PMC10695673 DOI: 10.1245/s10434-022-12863-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/10/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND SWOG 0809 is the only prospective study of adjuvant chemotherapy followed by chemoradiation focusing on margin status in patients with extrahepatic cholangiocarcinoma (EHCC) and gallbladder cancer (GBCA); however, the effects of adjuvant therapy by nodal status have never been reported in this population. METHODS Patients with resected EHCC and GBCA, stage pT2-4, node-positive (N+) or margin-positive (R1) who completed four cycles of chemotherapy followed by radiotherapy were included. Cox regression was used to compare overall survival (OS), disease-free survival (DFS), local recurrence, and distant metastasis by nodal status. DFS rates were compared with historical data via a one-sample t-test. RESULTS Sixty-nine patients [EHCC, n = 46 (66%); GBCA, n = 23 (33%)] were evaluated, with a median age of 61.7 years and an R0 rate of 66.7% and R1 rate of 33.3%. EHCC versus GBCA was more likely to be N+ (73.9% vs. 47.8%, p = 0.03). Nodal status did not significantly impact OS (hazard ratio [HR] 1.98, 95% confidence interval [CI] 0.86-4.54, p = 0.11) or DFS (HR 1.63, 95% CI 0.77-3.44, p = 0.20). Two-year OS was 70.6% for node-negative (N0) disease and 60.9% for N+ disease, while 2-year DFS was 62.5% for N0 tumors and 49.8% for N+ tumors. N+ versus N0 tumors showed higher rates of distant failure (42.2% vs. 25.0%, p = 0.04). The 2-year DFS rate in N+ tumors was significantly higher than in historical controls (49.8% vs. 29.7%, p = 0.004). CONCLUSIONS Adjuvant therapy is associated with favorable outcome independent of nodal status and may impact local control in N+ patients. These data could serve as a benchmark for future adjuvant trials, including molecular-targeted agents.
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Affiliation(s)
- Sepideh Gholami
- Department of Surgery, University of California, Davis, CA, USA.
| | - Sarah Colby
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - David P Horowitz
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York City, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York City, NY, USA
| | - Katherine A Guthrie
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Edgar Ben-Josef
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony B El-Khoueiry
- Department of Clinical Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charles D Blanke
- SWOG Group Chair's Office, Oregon Health Sciences University, Knight Cancer Institute, Portland, OR, USA
| | - Philip A Philip
- Department of Oncology and Department of Pharmacology, School of Medicine, Wayne State University, Karmanos Cancer Center, Detroit, MI, USA
| | - Lisa A Kachnic
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York City, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York City, NY, USA
| | - Syed A Ahmad
- Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Flavio G Rocha
- Division of Surgical Oncology, Oregon Health Sciences University, Knight Cancer Institute, Portland, OR, USA
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Prieto-Ortiz RG, Borráez-Segura BA, Prieto-Ortiz JE, Guevara-Cruz ÓA. Cáncer de vesícula biliar, una visión actual. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El diagnóstico de cáncer de vesícula biliar se realiza generalmente de forma incidental durante el estudio de las piezas quirúrgicas o cuando la enfermedad está avanzada y se expresa por su diseminación. Muy pocas veces se diagnostica de forma preoperatoria. Corresponde a la neoplasia más común de las vías biliares y su incidencia varía de acuerdo a la región geográfica. La región andina en Latinoamérica presenta una de las mayores incidencias a nivel mundial.
Métodos. Se realizó una revisión narrativa de la literatura, para presentar una información actualizada en lo referente a los factores de riesgo (incluyendo las alteraciones genéticas y moleculares), al diagnóstico y al tratamiento de esta patología. Basados en los datos actuales, presentamos algunas recomendaciones dirigidas al diagnóstico temprano, que permita un manejo más adecuado de nuestros pacientes.
Resultados. Se han implicado nuevos factores de riesgo relacionados con la etiología del cáncer de vesícula biliar, como la obesidad, factores genéticos y moleculares. A pesar de la disponibilidad de los métodos diagnósticos imagenológicos, no ha ocurrido una importante variación porcentual en cuanto al estadio al momento del diagnóstico.
Conclusiones. El manejo quirúrgico del cáncer de vesícula biliar está indicado en los estadios más tempranos de la enfermedad y es importante evaluar las opciones terapéuticas en pacientes con enfermedad avanzada. Se considera de suma importancia el estudio anatomopatológico de la pieza quirúrgica y la revisión del informe por parte del cirujano
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Burasakarn P, Thienhiran A, Hongjinda S, Fuengfoo P. The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis. Asian J Surg 2021; 45:33-38. [PMID: 34052085 DOI: 10.1016/j.asjsur.2021.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/04/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
Abstract
Extensive surgery is the mainstay treatment for gallbladder cancer and offers a long-term survival benefits to the patients. However, the optimal extent of surgery remains debatable. We aimed to perform a meta-analysis of hepatectomy and no hepatectomy approaches in patients with T2 gallbladder cancer. We searched the following electronic databases for systematic literature: PubMed, Google Scholar, and the Cochrane Library. We selected studies that compared patients with T2 gallbladder cancer who underwent hepatectomy with those who did not. While the long-term overall survival (OS) and disease-free survival (DFS) were the primary outcomes, perioperative morbidity and mortality were the secondary outcome. We analysed over 18 studies with 4,587 patients. Of the total patients, 1,683 and 1,303 patients underwent hepatectomy and no hepatectomy, respectively. The meta-analysis revealed no significant difference between the hepatectomy and no hepatectomy groups, in terms of the overall morbidity (risk ratio [RR] = 1.85, 95% confidence interval [CI] = 0.66-5.20) and 30-day mortality (RR = 0.9, 95% CI = 0.1-8.2). The results were comparable in terms of the OS (RR = 0.76, 95% CI = 0.57-1.01), (HR = 0.74, 95% CI = 0.49-1.12), and DFS (RR = 0.99, 95% CI = 0.88-1.11). In conclusion, the perioperative and long-term outcomes of hepatectomy and no hepatectomy approaches were comparable. Hepatectomy may not be required in T2 gall bladder cancer if the preoperative evaluation confirms the depth of the tumour in the perimuscular connective tissue and the intraoperative frozen sections confirm microscopic negative margins. Likewise, for those whom gall bladder cancer was diagnosed from the pathological report after simple cholecystectomy, further hepatectomy may not necessary.
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Affiliation(s)
- Pipit Burasakarn
- Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Anuparp Thienhiran
- Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Sermsak Hongjinda
- Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
| | - Pusit Fuengfoo
- Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand.
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Kapoor R, Periasamy K, Gupta R, Yadav A, Khosla D. Real world clinical outcomes of adjuvant sequential chemoradiation in patients with gallbladder carcinomas with poor performance status. Radiat Oncol J 2020; 38:262-269. [PMID: 33389981 PMCID: PMC10652062 DOI: 10.3857/roj.2020.00626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/10/2020] [Accepted: 12/14/2020] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The purpose of the study is to analyze the overall survival, relapse-free survival, and relapse patterns of adjuvant sequential chemoradiation for gallbladder cancers after curative resection in patients with poor performance status. MATERIALS AND METHODS We retrospectively reviewed clinical records of gallbladder patients with pathologic stage T2-4 or node positivity treated with sequential chemoradiation at our institute between January 2015 and January 2019. Sequential chemoradiotherapy protocol consisted of six cycles of gemcitabine 1,000 mg/m2 and oxaliplatin 100 mg/m2 administered every 2 weekly and postoperative radiation therapy (45 Gy in 25 fractions over 5 weeks) by three-dimensional conformal technique. RESULTS A total of 36 patients were included. The median overall survival and relapse-free survival was 26 months (95% confidence interval [CI], 21.4-30.5) and 21 months (95% CI, 11.8-30.1), respectively. The 2-year overall and relapse-free survival rates were 55.1% (95% CI, 37.9%-72.3%) and 44.7% (95% CI, 27.5%-61.9%), respectively. Locoregional, systemic, and combined recurrence were noted in 2 (5.5%), 14 (38.8%), and 3 (8.3%) patients, respectively. On univariate analysis, tumour grading significantly influenced relapse free survival; nodal stage and overall stage demonstrated a statistically significant influence on overall survival (p < 0.05) with a trend towards significance for lymphovascular invasion. On multivariate analysis, no significant factors were found. Grade 3 and 4 haematological adverse events were observed only in 2 (5.5%) with chemotherapy. No grade 3 and 4 adverse events were observed due to radiation therapy. CONCLUSION Sequential chemoradiation is feasible and tolerable with acceptable efficacy in the adjuvant setting in patients unfit for concurrent chemoradiotherapy.
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Affiliation(s)
- Rakesh Kapoor
- Department of Radiotherapy, Homi Bhabha Cancer Hospital and Research Center, Mullanpur & Sangrur, India
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kannan Periasamy
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Yadav
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Divya Khosla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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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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Mao W, Deng F, Wang D, Gao L, Shi X. Treatment of advanced gallbladder cancer: A SEER-based study. Cancer Med 2019; 9:141-150. [PMID: 31721465 PMCID: PMC6943088 DOI: 10.1002/cam4.2679] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The treatment of advanced gallbladder cancer (GBC) remains controversial. Therefore, the purpose of this study was to explore treatment choices for advanced GBC. METHODS We identified four different treatments from the surveillance, epidemiology, and end results (SEER) database: surgery, chemotherapy (CT), surgery and chemotherapy (Surgery + CT), and no surgery/no chemotherapy (No surgery/No CT). Kaplan-Meier method and Cox proportional hazards regression method were used to determine the risk factors for overall survival (OS) and cancer-specific survival (CSS). In addition, patients in AJCC stages III and IV stage were matched with 1:1 propensity score matching (PSM) for diagnosis age, race, marital status, histological type, tumor grade, and treatment pattern to decrease the possibility of selection bias. RESULTS A total of 288 AJCC stage III patients and 4239 AJCC stage IV patients with advanced GBC were identified from the SEER database between 2004 and 2015. Treatment pattern was an independent risk factor for patients with advanced GBC. For all patient, AJCC stage III patients and AJCC stage IV patients, "Surgery + CT" treatment minimized the OS and CSS in advanced GBC patients. In addition, after the PSM analysis, the "Surgery + CT" treatment still significantly decreased patient OS and CSS. CONCLUSIONS "Surgery + CT" treatment can provide survival benefits for patients with advanced GBC. In addition, "Surgery + CT" treatment was not fully utilized and may further improve the survival rate of GBC patients.
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Affiliation(s)
- Weipu Mao
- Department of General Surgery, The People's Hospital of Yingshang, Fuyang, China
| | - Fang Deng
- Department of Clinical Laboratory, The People's Hospital of Yingshang, Fuyang, China
| | - Dongyan Wang
- Department of Gastroenterology, Pudong New Area Gongli Hospital Affiliated to Naval Military Medical University, Shanghai, China
| | - Li Gao
- Department of Obstetrics and Gynecology, The People's Hospital of Yingshang, Fuyang, China
| | - Xiuquan Shi
- Department of General Surgery, The People's Hospital of Yingshang, Fuyang, China
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Cherkassky L, Jarnagin W. Selecting treatment sequence for patients with incidental gallbladder cancer: a neoadjuvant approach versus upfront surgery. Updates Surg 2019; 71:217-225. [PMID: 31254234 DOI: 10.1007/s13304-019-00670-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 02/07/2023]
Abstract
At MSKCC, over 50% of the patients presenting with gallbladder cancer have been diagnosed incidentally following elective cholecystectomy for presumed benign disease. While traditional management of incidental gallbladder cancer (IGBC) dictates re-resection with the ultimate goal of achieving cure, surgical decision-making must take into account that this malignancy is characterized by poor tumor biology with frequent distant recurrence. Since early and frequent distant recurrence is the most common cause of surgical failure, the surgical oncologist's goal should be to selectively re-resect only those patients most likely to benefit from an operation. The astute surgeon recognizes the high-risk patients who likely have micrometastatic disease at the time of diagnosis and alters the treatment sequence, delivering neoadjuvant chemotherapy. This strategy acts as a selection tool, as those progressing at distant sites during therapy are spared the morbidity and mortality of surgery and furthermore has the potential to treat micrometastatic disease. However, a chemotherapy first approach must be applied selectively since a poor response risks local progression to unresectability and a decrease in functional status that comes from the toxicities of dual agent chemotherapy that can impair surgical candidacy. To balance these risks and benefits, two other criteria for a neoadjuvant approach must be met: i) reliable identification of those patients who are at high risk of distant recurrence and who are, therefore, most likely to benefit from a systemic therapy first approach and ii) availability of effective chemotherapy options. In this review, we will outline the data and judgement we use to select a treatment sequence at our institution.
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Affiliation(s)
- Leonid Cherkassky
- Clinical Fellow in Complex General Surgical Oncology, Department of Surgical Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - William Jarnagin
- Leslie Blumgart Chair in Surgery, Department of Surgical Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Abstract
In this review, the authors present an updated description of gallbladder cancer in 2 sections based on presentation: disease that presents incidentally following laparoscopic cholecystectomy and malignancy that is suspected preoperatively. Elements pertaining to technical aspects of surgical resection provide the critical focus of this review and are discussed in the context of evidence-based literature on gallbladder cancer today.
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Affiliation(s)
- Motaz Qadan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Baig M, Guarino M, Petrelli N. Report on demographics of gall bladder cancer in Delaware and retrospective review of treatment strategies for gallbladder cancer in a large community cancer center. Surg Oncol 2016; 25:86-91. [DOI: 10.1016/j.suronc.2016.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/08/2016] [Accepted: 03/14/2016] [Indexed: 12/27/2022]
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Pandey D, Garg PK, Manjunath NML, Sharma J. Extra-Hepatic Bile Duct Resection: an Insight in the Management of Gallbladder Cancer. J Gastrointest Cancer 2016; 46:291-6. [PMID: 26049726 DOI: 10.1007/s12029-015-9737-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Involvement of extrahepatic bile duct in gallbladder cancer (GBC) is considered a sign of advanced disease; resection of extrahepatic bile duct in GBC has been a contentious issue considering the poor prognosis of the disease. METHODS This retrospective study was done in two tertiary teaching hospitals of North India. The case records of all the GBC patients who underwent radical cholecystectomy with extra-hepatic bile duct resection were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, indication of bile duct resection, postoperative complications and outcome were retrieved from the case records. Kaplan-Meier analysis was done to estimate median disease-free survival and overall survival. RESULTS There were 17 GBC patients who underwent radical cholecystectomy with resection of extrahepatic bile duct. Median age of the patients was 51 years (range 35-62); male to female ratio was 5:12. Six patients were diagnosed after histopathological examination of resected gallbladder specimen following cholecystectomy (incidental gallbladder cancer). All the patients had R'0' resection. The indication for extra-hepatic bile duct resection was direct infiltration of hepatoduodenal ligament in nine, positive cystic duct margin in two, densely adherent pericholedochal lymphnodes in one and associated ampullary growth in one patient. Kaplan-Meier analysis predicted median disease-free survival of 20 months and median overall survival of 26 months. CONCLUSION Extrahepatic bile duct resection to achieve R'0' resection in the management of advanced gallbladder cancer is safe with acceptable postoperative morbidity and has potential to improve survival.
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Affiliation(s)
- Durgatosh Pandey
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India, 110029,
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Jung W, Jang JY, Kang MJ, Chang YR, Shin YC, Chang J, Kim SW. Effects of Surgical Methods and Tumor Location on Survival and Recurrence Patterns after Curative Resection in Patients with T2 Gallbladder Cancer. Gut Liver 2016; 10:140-6. [PMID: 26347513 PMCID: PMC4694746 DOI: 10.5009/gnl15080] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/14/2015] [Accepted: 04/15/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/AIMS Extended cholecystectomy is generally recommended for patients with T2 gallbladder cancer. However, few studies have assessed the extent of resection relative to T2 gallbladder tumor location. This study analyzed the effects of surgical methods and tumor location on survival outcomes and tumor recurrence in patients with T2 gallbladder cancer. METHODS Clinicopathological characteristics, extent of resection, survival rates, and recurrence patterns were retrospectively analyzed in 88 patients with pathologically confirmed T2 gallbladder cancer. RESULTS The 5-year disease-free survival rate was 65.0%. Multivariate analysis showed that lymph node metastasis was the only independent risk factor for poor 5-year disease-free survival rate. Survival outcomes were not associated with tumor location. Survival tended to be better in patients who underwent extended cholecystectomy than in those who underwent simple cholecystectomy. Recurrence rate was not affected by surgical method or tumor location. Systemic recurrence was more frequent than local recurrence without distant recurrence. Gallbladder bed recurrence and liver recurrence were relatively rare, occurring only in patients with liver side tumors. CONCLUSIONS Extended cholecystectomy is the most appropriate treatment for T2 gallbladder cancer. However, simple cholecystectomy with regional lymph node dissection may be appropriate for patients with serosal side tumors.
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Affiliation(s)
- Woohyun Jung
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Mee Joo Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Ye Rim Chang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Yong Chan Shin
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Jihoon Chang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul,
Korea
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Mallick S, Benson R, Julka PK, Rath GK. Adjuvant chemoradiotherapy for squamous cell carcinoma of gallbladder. J Gastrointest Cancer 2015; 45 Suppl 1:237-40. [PMID: 25119385 DOI: 10.1007/s12029-014-9641-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Adjuvant radiotherapy in the treatment of gall bladder carcinoma: What is the current evidence. J Egypt Natl Canc Inst 2015; 28:1-6. [PMID: 26265290 DOI: 10.1016/j.jnci.2015.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/10/2015] [Accepted: 07/11/2015] [Indexed: 01/07/2023] Open
Abstract
Gall bladder carcinoma (GBC) is considered the fifth most common one of the most aggressive gastro intestinal tract malignancies. Owing to their large incidence randomised controlled trials have hardly been conducted to look into their optimum treatment. Over the years surgical resection has been considered the only curative treatment of these tumors. However, the outcome still remains guarded. The predominant pattern of failure is loco-regional followed by systemic. Hence, local adjuvant radiation has been used by different institutes with concurrent and adjuvant chemotherapy. The large retrospective series with their limitations showed improved survival in patients with regional spread or tumors infiltrating the liver when treated with adjuvant radiotherapy. In the present era with modern radiation techniques and target delineation radiation may further improve upon the impact without adding to the toxicity profile. Hence, radiation in gall bladder cancer needs a relook to optimize treatment outcome of such aggressive disease.
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Ben-Josef E, Guthrie KA, El-Khoueiry AB, Corless CL, Zalupski MM, Lowy AM, Thomas CR, Alberts SR, Dawson LA, Micetich KC, Thomas MB, Siegel AB, Blanke CD. SWOG S0809: A Phase II Intergroup Trial of Adjuvant Capecitabine and Gemcitabine Followed by Radiotherapy and Concurrent Capecitabine in Extrahepatic Cholangiocarcinoma and Gallbladder Carcinoma. J Clin Oncol 2015; 33:2617-22. [PMID: 25964250 DOI: 10.1200/jco.2014.60.2219] [Citation(s) in RCA: 250] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The role of postoperative therapy in extrahepatic cholangiocarcinoma (EHCC) or gallbladder carcinoma (GBCA) is unknown. S0809 was designed to estimate 2-year survival (overall and after R0 or R1 resection), pattern of relapse, and toxicity in patients treated with this adjuvant regimen. PATIENTS AND METHODS Eligibility criteria included diagnosis of EHCC or GBCA after radical resection, stage pT2-4 or N+ or positive resection margins, M0, and performance status 0 to 1. Patients received four cycles of gemcitabine (1,000 mg/m(2) intravenously on days 1 and 8) and capecitabine (1,500 mg/m(2) per day on days 1 to 14) every 21 days followed by concurrent capecitabine (1,330 mg/m(2) per day) and radiotherapy (45 Gy to regional lymphatics; 54 to 59.4 Gy to tumor bed). With 80 evaluable patients, results would be promising if 2-year survival 95% CI were > 45% and R0 and R1 survival estimates were ≥ 65% and 45%, respectively. RESULTS A total of 79 eligible patients (R0, n = 54; R1, n = 25; EHCC, 68%; GBCA, 32%) were treated (86% completed). For all patients, 2-year survival was 65% (95% CI, 53% to 74%); it was 67% and 60% in R0 and R1 patients, respectively. Median overall survival was 35 months (R0, 34 months; R1, 35 months). Local, distant, and combined relapse occurred in 14, 24, and nine patients. Grade 3 and 4 adverse effects were observed in 52% and 11% of patients, respectively. The most common grade 3 to 4 adverse effects were neutropenia (44%), hand-foot syndrome (11%), diarrhea (8%), lymphopenia (8%), and leukopenia (6%). There was one death resulting from GI hemorrhage. CONCLUSION This combination was well tolerated, has promising efficacy, and provides clinicians with a well-supported regimen. Our trial establishes the feasibility of conducting national adjuvant trials in EHCC and GBCA and provides baseline data for planning future phase III trials.
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Affiliation(s)
- Edgar Ben-Josef
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY.
| | - Katherine A Guthrie
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Anthony B El-Khoueiry
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Christopher L Corless
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Mark M Zalupski
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Andrew M Lowy
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Charles R Thomas
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Steven R Alberts
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Laura A Dawson
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Kenneth C Micetich
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Melanie B Thomas
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Abby B Siegel
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
| | - Charles D Blanke
- Edgar Ben-Josef, University of Pennsylvania, Philadelphia, PA; Katherine A. Guthrie, Fred Hutchinson Cancer Research Center, Seattle, WA; Anthony B. El-Khoueiry, University of Southern California Norris Comprehensive Cancer Center, Los Angeles; Andrew M. Lowy, University of California San Diego Moores Cancer Center, La Jolla, CA; Christopher L. Corless, Oregon Health and Science University Knight Diagnostic Laboratories; Charles R. Thomas Jr and Charles D. Blanke, Oregon Health and Science University Knight Cancer Institute, Portland, OR; Mark M. Zalupski, University of Michigan, Ann Arbor, MI; Steven R. Alberts, Mayo Clinic, Rochester, MN; Laura A. Dawson, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada; Kenneth C. Micetich, Loyola University Medical Center, Maywood, IL; Melanie B. Thomas, Medical University of South Carolina, Charleston, SC; and Abby B. Siegel, Columbia University, New York, NY
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Dwivedi AND, Jain S, Dixit R. Gall bladder carcinoma: Aggressive malignancy with protean loco-regional and distant spread. World J Clin Cases 2015; 3:231-244. [PMID: 25789296 PMCID: PMC4360495 DOI: 10.12998/wjcc.v3.i3.231] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/25/2014] [Accepted: 12/17/2014] [Indexed: 02/05/2023] Open
Abstract
The most common malignancy of biliary tract is gallbladder cancer (GBC) which is the third most common cancer in gastrointestinal tract. It is a lethal disease for most patients in spite of growing awareness and improved diagnostic techniques. GBC has a very poor prognosis and the 5 year survival rate is < 10%. Although etiology of the carcinoma of the gallbladder is still obscure, various factors have been implicated, cholelithiasis being the most frequent. The incidence of GBC worldwide is based on the gender, geography and ethnicity which suggest that both genetic and environmental factors can cause GBC. The major route of spread of gallbladder cancer (GC) is loco-regional rather than distant. It spreads by lymphatic, vascular, neural, intraperitoneal, and intraductal routes. Sonography is usually the most common imaging test to evaluate symptoms of biliary tract disease including suspected GC. With recent advances in imaging modalities like multi-detector computed tomography (CT) scanners, magnetic resonance imaging-positron emission tomography/CT diagnosis of gallbladder cancer has improved. Studies have also targeted molecular and genetic pathways. Treatment options have included extended and radical surgeries and adjuvant chemotherapy. This review article deals in detail with important aspects of carcinoma gallbladder and its manifestations and challenges. Role of various imaging modalities in characterization and accurate staging has been discussed. The loco-regional spread of this aggressive malignancy is dealt explicitly.
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Kai K, Aishima S, Miyazaki K. Gallbladder cancer: Clinical and pathological approach. World J Clin Cases 2014; 2:515-521. [PMID: 25325061 PMCID: PMC4198403 DOI: 10.12998/wjcc.v2.i10.515] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/13/2014] [Accepted: 07/18/2014] [Indexed: 02/05/2023] Open
Abstract
Gallbladder cancer (GBC) shows a marked geographical variation in its incidence. Middle-aged and elderly women are more commonly affected. Risk factors for its development include the presence of gallstones, chronic infection and pancreaticobiliary maljunction. Controversy remains in regard to the theory of carcinogenesis from adenomyomatosis, porcelain gallbladder and adenoma of the gallbladder. The surgical strategy and prognosis after surgery for GBC differ strikingly according to T-stage. Discrimination of favorable cases, particularly T2 or T3 lesions, is useful for the selection of surgical strategies for individual patients. Although many candidate factors predicting disease progression, such as depth of subserosal invasion, horizontal tumor spread, tumor budding, dedifferentiation, Ki-67 labeling index, p53 nuclear expression, CD8+ tumor-infiltrating lymphocytes, mitotic counts, Laminin-5-gamma-2 chain, hypoxia-inducible factor-1a, cyclooxygenase-2 and the Hedgehog signaling pathway have been investigated, useful prognostic makers or factors have not been established. As GBC is often discovered incidentally after routine cholecystectomy and accurate preoperative diagnosis is difficult, close mutual cooperation between surgeons and pathologists is essential for developing a rational surgical strategy for GBC.
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17
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Kim J, Ryu JK, Kim C, Paeng JC, Kim YT. Is there any role of positron emission tomography computed tomography for predicting resectability of gallbladder cancer? J Korean Med Sci 2014; 29:680-4. [PMID: 24851025 PMCID: PMC4024955 DOI: 10.3346/jkms.2014.29.5.680] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 03/11/2014] [Indexed: 12/27/2022] Open
Abstract
The role of integrated (18)F-2-fluoro-2-deoxy-D-glucose positron emission tomography computed tomography (PET-CT) is uncertain in gallbladder cancer. The aim of this study was to show the role of PET-CT in gallbladder cancer patients. Fifty-three patients with gallbladder cancer underwent preoperative computed tomography (CT) and PET-CT scans. Their medical records were retrospectively reviewed. Twenty-six patients underwent resection. Based on the final outcomes, PET-CT was in good agreement (0.61 to 0.80) with resectability whereas CT was in acceptable agreement (0.41 to 0.60) with resectability. When the diagnostic accuracy of the predictions for resectability was calculated with the ROC curve, the accuracy of PET-CT was higher than that of CT in patients who underwent surgical resection (P=0.03), however, there was no difference with all patients (P=0.12). CT and PET-CT had a discrepancy in assessing curative resection in nine patients. These consisted of two false negative and four false positive CT results (11.3%) and three false negative PET-CT results (5.1%). PET-CT was in good agreement with the final outcomes compared to CT. As a complementary role of PEC-CT to CT, PET-CT tended to show better prediction about resectability than CT, especially due to unexpected distant metastasis.
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Affiliation(s)
- Jaihwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chulhan Kim
- Department of Nuclear Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Tae Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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18
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Affiliation(s)
- Anu Behari
- Department of Surgical Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raibareli Road, Lucknow 226014, Uttar Pradesh, India
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19
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Gwark SC, Hwang S, Kim KH, Lee YJ, Park KM, Ahn CS, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Lee SG. Extent of resection for T2N0 gallbladder carcinoma regarding concurrent extrahepatic bile duct resection. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:142-6. [PMID: 26388925 PMCID: PMC4574996 DOI: 10.14701/kjhbps.2012.16.4.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 10/01/2012] [Accepted: 10/15/2012] [Indexed: 12/12/2022]
Abstract
Backgrounds/Aims Gallbladder carcinoma (GBCa) T2 lesions are considered to be advanced tumors showing diverse features in tumor extent. When this T2 lesion does not involve the cystic duct and there is no evidence of lymph node metastasis, we have to consider what is the most reasonable extent of resection - that is, whether to perform concurrent extra-hepatic bile duct resection (EHBD) resection or not. This study intends to evaluate the adequacy of EHBD resection in patients undergoing resection for T2N0 GBCa. Methods From our institutional database of GBCa, 48 cases of T2N0 GBCa who underwent R0 resection during November 1995 and August 2008 were selected. Patients who underwent prior laparoscopic cholecystectomy were excluded. Their medical records were reviewed retrospectively. Results Their mean age was 63.2±83.3 years and females were 25. The mean serum CA19-9 level was 37.3±89.3 ng/ml. The extents of liver resection were wedge resection (n=36) and segment 4a+5 resection (n=12). Concurrent EHBD resection was performed in 16 (33.3%) patients. No fatal surgical complication occurred. The majority of tumor pathology was adenocarcinoma (n=42), with additional unusual types as papillary (n=3), saromatoid (n=1), signet ring cell (n=1) and adenosquamous (n=1) cancers. The overall survival rate was 87.1% at 1 year, 69.5% at 3 years and 61.7% at 5 years. After exclusion of mortalities not related to cancer, the overall patient survival rate was 89.6% at 1 year, 72.9% at 3 years and 64.7% at 5 years, with 3-year survival rates of 72% in the EHBD resection group and 69.2% in the non-resection group (p=0.661). Conclusions The results of this study indicate that concurrent EHBD resection did not improve patient survival when R0 resection was achieved in patients with T2N0 GBCa. Therefore, routine EHBD resection may not be indicated for T2N0 GBCa unless the tumor is close to the cystic duct.
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Affiliation(s)
- Sung-Chan Gwark
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Joo Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang-Min Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok-Bog Moon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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20
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Boutros C, Gary M, Baldwin K, Somasundar P. Gallbladder cancer: past, present and an uncertain future. Surg Oncol 2012; 21:e183-91. [PMID: 23025910 DOI: 10.1016/j.suronc.2012.08.002] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 02/06/2023]
Abstract
Although gallbladder cancer (GBC) is the most common malignancy of the biliary tract, its relatively low incidence and confounding symptomatology result in advanced disease at the time presentation, contributing to the poor prognosis and decreased survival associated with this disease. It is therefore increasingly important to understand its pathogenesis and risk factors to allow for the earliest possible diagnosis. To date, gallbladder cancer is poorly understood compared to other malignancies, and is still most commonly discovered incidentally after cholecystectomy. Moreover, while much is known about biliary neoplasms as a whole, understanding the clinical and molecular nuances of GBC as a separate disease process will prove a cornerstone in the development of early intervention, potential screening and overall more effective treatment strategies. The present work reviews the most current understanding of the pathogenesis, diagnosis, staging and natural history of GBC, with additional focus on surgical treatment. Further, review of current adjuvant therapies for unresectable and advanced disease as well as prognostic factors provide fertile ground for the development of future studies which will hopefully improve treatment outcomes and affect overall survival for this highly morbid, poorly understood malignancy.
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Affiliation(s)
- C Boutros
- University of Maryland School of Medicine, Division of Surgical Oncology, Baltimore, MD, USA
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21
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Zhai G, Yan K, Ji X, Xu W, Yang J, Xiong F, Su J, McNutt MA, Yang H. LAPTM4B allele *2 is a marker of poor prognosis for gallbladder carcinoma. PLoS One 2012; 7:e45290. [PMID: 22984631 PMCID: PMC3440336 DOI: 10.1371/journal.pone.0045290] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 08/14/2012] [Indexed: 12/15/2022] Open
Abstract
Background Lysosomal protein transmembrane 4 beta (LAPTM4B) is a novel cancer-related gene which has two alleles designated LAPTM4B*1 and LAPTM4B*2. In this study we investigated the correlation of LAPTM4B genotype with prognosis and clinicopathologic features in patients who had undergone curative resection for gallbladder carcinoma (GBC). Methodology/Principal Findings PCR assay was performed to determine the LAPTM4B genotype in 85 patients. The correlation of LAPTM4B genotype with clinicopathologic parameters was assessed with the Chi-squared test. Differences in patient survival were determined by the Kaplan–Meier method. Multivariate analysis of prognostic factors was carried out with Cox regression analysis. Patients with LAPTM4B *2 had both significantly shorter overall survival (OS) and shorter disease-free survival (DFS) (both P<0.001). Multivariate analysis showed that LAPTM4B genotype is a prognostic factor for OS and DFS (both P<0.001). Conclusions/Significance LAPTM4B allele *2 is a risk factor associated with poor prognosis in patients with resected GBC, and LAPTM4B status may be therefore be useful preoperatively as an adjunct in evaluation of the operability of GBC.
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Affiliation(s)
- Guojun Zhai
- Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China
| | - Kaowen Yan
- Department of Cell Biology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Xiaoxu Ji
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Wenrui Xu
- Department of Cell Biology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Jiuling Yang
- Department of Cell Biology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Fuxia Xiong
- Department of Pharmacology, Loma Linda University, Loma Linda, California, United States of America
| | - Jing Su
- Department of Pathology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Michael A. McNutt
- Department of Pathology, School of Basic Medical Sciences, Peking University, Beijing, China
| | - Hua Yang
- Department of Cell Biology, School of Basic Medical Sciences, Peking University, Beijing, China
- * E-mail:
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Abstract
AIM The present study was aimed to determine the efficacy of integrated FDG PET/CT in patients with gallbladder cancer (GBC) with suspicion of recurrent disease. METHODS A total of 49 patients (male: 15, female: 34; median age: 52.5 years) with GBC underwent FDG PET/CT for suspected recurrence. A total of 62 PET/CT scans were acquired. Criteria for detection by PET/CT were both a positive FDG uptake and the correct anatomic localization of the tumor. The PET/CT findings were grouped as locoregional disease and metastatic disease. Results of PET/CT were compared with clinical and radiologic follow-up and/or histopathology. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results of PET/CT were also compared with conventional imaging (CI) whenever available. RESULTS Of 62 PET/CT, 43 (69.4%) were positive and 19 (30.6%) were negative for recurrence. Of 43 positive scans, 41 were true positive and 2 were false positive. Among 19 negative PET/CT scans, 18 were true negative and 1 was false negative. PET/CT showed a sensitivity of 97.6% and specificity of 90% in detecting tumor recurrence. The positive predictive value, negative predictive value, and accuracy were 95.3%, 94.7%, and 95.1%, respectively. Locoregional disease was seen in 16 (37.2%) PET/CT studies, distant metastases were seen in 13 (30.2%), and 14 (32.5%) studies showed both locoregional disease and metastasis. When comparable CI was available, PET/CT showed a better specificity than CI for detection of recurrence. CONCLUSIONS Integrated FDG PET/CT can detect recurrence in GBC with high sensitivity and specificity. Routine use of PET/CT in these patients will detect recurrence early and change the subsequent management.
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González ME, Giannini OH, González P, Saldaña B. Adjuvant radio-chemotherapy after extended or simple cholecystectomy in gallbladder cancer. Clin Transl Oncol 2011; 13:480-4. [PMID: 21775275 DOI: 10.1007/s12094-011-0685-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To analyse results of combined treatment of adjuvant radio-chemotherapy (RT-CT) in patients diagnosed with gallbladder cancer (GBC) after complete resection. METHODS AND MATERIAL From June 1993 until July 2006, 67 patients with a diagnosis of GBC who underwent R0 surgical resection and were staged as T1b-2-3N0-1M0 received adjuvant RT-CT. Radiotherapy consisted of whole abdominal irradiation (20 Gy at 100 cGy daily) plus a boost to the tumour bed for a total of 45-59.4 Gy. Concomitant chemotherapy (fluoropyrimidines) was given. Overall survival (OS) and median survival were analysed in relation to different prognostic factors. RESULTS With a median follow-up of 90 months, 5-year OS was 41%, in the group who underwent extended cholecystectomy it reached 57% and it was only 27% in those who underwent simple cholecystectomy (p = 0.005). Median survival was 42 months for the whole population, not yet reached for the extended cholecystectomy subgroup and 23 months for the simple cholecystectomy subgroup. When analysing for histological grade, median survival was 23 months for those graded as high grade (III or IV) and 57 months for those of low-unknown grade (p = 0.029). In multivariate analysis, a statistically significant OS benefit was found for those who underwent extended cholecystectomy (p = 0.003). CONCLUSIONS In the absence of randomised studies, these data support the use of extended cholecystectomy followed by adjuvant RT-CT in patients diagnosed as stages T1b-2- 3N0-1M0 GBC after R0 resection.
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Affiliation(s)
- Manuel E González
- Department of Radiotherapy, Instituto Oncológico, Viña del Mar, Chile.
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Srivastava K, Srivastava A, Sharma KL, Mittal B. Candidate gene studies in gallbladder cancer: a systematic review and meta-analysis. Mutat Res 2011; 728:67-79. [PMID: 21708280 DOI: 10.1016/j.mrrev.2011.06.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/11/2011] [Accepted: 06/13/2011] [Indexed: 12/16/2022]
Abstract
Gallbladder cancer (GBC) is the most frequent biliary tract malignancy. Wide variations in GBC incidence and familial and epidemiological data suggest involvement of a genetic component in its etiopathogenesis. A systematic review of genetic association studies in GBC was performed by applying a meta-analysis approach and systematically reviewing PubMed database using appropriate terms. Odds ratios (ORs) and 95% confidence intervals (CIs) were appropriately derived for each gene-disease association using fixed and random effect models. Meta-regression with population size and genotyping method was also performed. Study quality was assessed using a 10-point scoring system designed from published guidelines. Following a review of 44 published manuscripts and one unpublished report, 80 candidate gene variants and 173 polymorphisms were analyzed among 1046 cases and 2310 controls. Majority of studies were of intermediate quality. Four polymorphisms with >3 separate studies were included in the meta-analysis [OGG1 (rs1052133), TP53 (rs1042522), CYP1A1 (rs1048943) and GSTM1 null polymorphism]. The meta-analysis demonstrated no significant associations of any of the above polymorphisms with GBC susceptibility except TP53 (rs1042522) polymorphism. To conclude, existing candidate gene studies in GBC susceptibility have so far been insufficient to confirm any association. Future research should focus on a more comprehensive approach utilizing potential gene-gene, gene-environment interactions and high-risk haplotypes.
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Affiliation(s)
- Kshitij Srivastava
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anvesha Srivastava
- Department of Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
| | - Kiran Lata Sharma
- Department of Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India
| | - Balraj Mittal
- Department of Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, UP, India.
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Maker AV, Butte JM, Oxenberg J, Kuk D, Gonen M, Fong Y, Dematteo RP, D'Angelica MI, Allen PJ, Jarnagin WR. Is port site resection necessary in the surgical management of gallbladder cancer? Ann Surg Oncol 2011; 19:409-17. [PMID: 21698501 DOI: 10.1245/s10434-011-1850-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND In selected patients with incidental gallbladder carcinoma (GBCA) diagnosed after laparoscopic cholecystectomy (LC), definitive resection is warranted. Port site excision has been advocated but remains controversial. METHODS Patients with GBCA were identified through institutional/departmental databases. The subset of patients with incidental tumors identified after LC and submitted to definitive surgical therapy were selected. Those subjected to port site resection were compared with patients who underwent resection without port site removal and analyzed for differences in recurrence patterns and survival. RESULTS From 1992 to 2009, 113 patients with incidental GBCA presented for definitive resection after LC; 69 patients had port site resection and 44 did not. In the resected port site group, depth of tumor invasion was T1b = 6, T2 = 35, T3 = 28, and 13 (19%) had port site metastases. Port site disease was seen only in patients with T2 or T3 tumors and correlated with the development of peritoneal metastases (P = 0.01). Median survival of patients with T2/T3 tumors without port site metastases was 42 months compared to 17 months in patients with port site disease (P = 0.005). When only R0 resected patients were compared and adjusted for T and N stage, port site resection was not associated with overall survival (P = 0.23) or recurrence-free survival (P = 0.69). CONCLUSIONS In patients with incidental GBCA, port site metastases were associated with peritoneal disease and decreased survival. Port site resection was not associated with improved survival or disease recurrence and should not be considered mandatory during definitive surgical treatment.
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Affiliation(s)
- Ajay V Maker
- Division of Surgical Oncology, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.
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Shukla PJ, Barreto SG. Systematic review: should routine resection of the extra-hepatic bile duct be performed in gallbladder cancer? Saudi J Gastroenterol 2010; 16:161-7. [PMID: 20616410 PMCID: PMC3003211 DOI: 10.4103/1319-3767.65184] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND/AIM Complete surgical resection is associated with improved outcomes in gallbladder cancer. Whether the extra-hepatic bile duct (EHBD) should be routinely excised for gallbladder cancer is unclear. OBJECTIVE To analyze literature concerning EHBD excision to determine if it is associated with survival advantage and hence can be routinely recommended. MATERIALS AND METHODS A systematic search using Medline, Embase, and Cochrane Central Register of Controlled Trials for the years 1988-2008. RESULTS EHBD excision was reported to be performed routinely for T1-4 in some studies, while others reported resection to facilitate lymph node clearance or if the EHBD was grossly involved by disease that remained otherwise resectable. While one study demonstrated 100% survival in T1 disease, other reports do not demonstrate any survival benefit of EHBD excision in T1 disease. Four studies (level IV-V) demonstrated 60% to 90% five-year survival for routine excision in T2 disease, while three other studies demonstrated no survival advantage but increased morbidity due to the procedure. In T3/4 disease, one study (level IV-V) demonstrated a benefit in T4 disease only, and another study (level IV-V) reported a survival advantage in patients in whom the bile duct was not involved; five other studies showed no impact of routine EHBD excision on survival but reported morbidity following anastomotic leaks. CONCLUSIONS Available evidence does not support routine resection of EHBD in gallbladder cancer. EHBD excision should be performed in the presence of specific indications, viz., to achieve an R0 resection of the primary tumor and/ or to aid complete lymph node dissection that would compromise the EHBD by devascularization.
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Affiliation(s)
- Parul J. Shukla
- Department of Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Mumbai, India,Address for correspondence: Dr. Parul J. Shukla, Department of Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai - 400 012, India. E-mail:
| | - Savio G. Barreto
- Department of General and Digestive Surgery, Flinders Medical Center, Adelaide, Australia
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Manterola C, Vial M, Roa JC. Survival of a cohort of patients with Intermediate and advanced gall bladder cancer treated with a prospective therapeutic protocol. Acta Cir Bras 2010; 25:225-30. [DOI: 10.1590/s0102-86502010000300003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 03/18/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To evaluate the results of a prospective therapeutic protocol with long-term follow up in terms of survival rates in a cohort of patients treated with Intermediate and Advanced GBC (GBC). METHODS: Prospective cohort of patients with intermediate and advanced stages of GBC treated between 1996 and 2006. All cases were treated with a partial hepatic segmentectomy on segments IVb and V and a regional lymph node dissection and six cycles of out-patient chemotherapy (5-FU and leukovorin). With an average follow-up of 31.5 months, the morbidity, operative mortality, hepatic and lymphatic infiltration and actuarial survival were measured. Descriptive statistics were applied as well as bivariate analysis applying Fisher's exact test and non-parametrical tests and Kaplan Meier survival curves. Also logistic regression and proportional risk of Cox were applied. RESULTS: 40 patients were included in this protocol, with an average age of 59.5 years (40-85 years), of which 28 were women (70%). Depth of wall infiltration: muscular 8 patients (20%), subserosal 12 patients (30%), serosal 12 patients (30%) and perivesicular adipose tissue 8 patients (20%). The series morbidity was 27.5%. There was no operative mortality. The chemotherapy was well tolerated. The overall actuarial survival in the series was 50% at 60 months. CONCLUSION: Our protocol treatment has morbidity, mortality and survival rates similar to previously reported series.
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Kim WS, Choi DW, You DD, Ho CY, Heo JS, Choi SH. Risk factors influencing recurrence, patterns of recurrence, and the efficacy of adjuvant therapy after radical resection for gallbladder carcinoma. J Gastrointest Surg 2010; 14:679-87. [PMID: 20094817 DOI: 10.1007/s11605-009-1140-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 12/14/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUNDS Gallbladder carcinoma (GBC) is an aggressive neoplasm, and resection is the only curative modality. Recurrence frequently occurs after the curative resection of advanced GBC. Adjuvant treatment, particularly radiotherapy, is recommended and is used without any evidence of a beneficial effect. The aim of this study was to characterize patterns of recurrence and to identify the factors that influence recurrence and the efficacy of adjuvant therapy after the curative resection of GBC. METHODS The records of patients that underwent surgical resection with curative intent for gallbladder carcinoma from October 1994 and August 2007 were retrospectively reviewed. Recurrence patterns, times to recurrence, and survival rates were analyzed. Sites of recurrence were identified retrospectively and categorized as locoregional or distant. RESULTS One hundred sixty-six patients underwent surgical resection with curative intent for gallbladder adenocarcinoma. The 5-year recurrence rates of stages IA, IB, IIA, and IIB patients were 0%, 24.3%, 44.9%, and 58.3%, retrospectively. Positivity for lymph node metastases was found to have predictive significance for disease-free survival (p = 0.009). Regional lymph node recurrence (27.7%) was observed most frequently. There was no significant disease-free survival rates between the no adjuvant therapy and the adjuvant therapy groups. CONCLUSIONS The regional lymph nodes and the liver were found to be the most common sites of recurrence after curative resection. Lymph node metastases were identified as an independent predictor of tumor recurrence by multivariate analysis. Based on the disease-free survivals observed in this study, the authors find it would be difficult to advocate the routine use of adjuvant radiotherapy and/or chemotherapy.
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Affiliation(s)
- Woo Seok Kim
- Department of Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
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Abstract
Gallbladder cancer (GBC) represents the most common and aggressive type among the biliary tree cancers (BTCs). Complete surgical resection offers the only chance for cure; however, only 10% of patients with GBC present with early-stage disease and are considered surgical candidates. Among those patients who do undergo "curative" resection, recurrence rates are high. There are no established adjuvant treatments in this setting. Patients with unresectable or metastatic GBC have a poor prognosis. There has been a paucity of randomized phase III data in this field. A recent report demonstrated longer overall survival with gemcitabine in combination with cisplatin than with gemcitabine alone in patients with advanced or metastatic BTCs. Molecularly targeted agents are under development. In this review, we attempt to discuss the current status and key issues involved in the management of GBC.
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Affiliation(s)
- Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts 02114, USA.
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Shrikhande SV, Barreto SG. Surgery for gallbladder cancer: The need to generate greater evidence. World J Gastrointest Surg 2009; 1:26-9. [PMID: 21160792 PMCID: PMC2999113 DOI: 10.4240/wjgs.v1.i1.26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 10/30/2009] [Accepted: 11/06/2009] [Indexed: 02/06/2023] Open
Abstract
The outcomes for gallbladder cancer remain largely dismal to this day. Overall, the low incidence of gallbladder cancer around the world coupled with an even lower number of patients amenable to surgery at the time of presentation, has precluded the generation of evidence-based guidelines for the management of this cancer. However, while the incidence of the cancer may be decreasing in some parts of the world, in other countries such as India, Japan and Chile, gallbladder cancer continues to affect a sizeable population of patients. As such, there is a growing need to define what constitutes an adequate surgery for each stage of this cancer, based on sound evidence. This editorial provides a broad overview of the existing problems in the management of gallbladder cancer and appeals for multi-institutional studies aimed at answering some of the pertinent questions on the surgical management of gallbladder cancer.
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Affiliation(s)
- Shailesh V Shrikhande
- Shailesh V Shrikhande, Department of Gastrointestinal Surgical Oncology, Tata Memorial Hospital, Mumbai 400012, India
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Butte JM, Redondo F, Waugh E, Meneses M, Pruzzo R, Parada H, Amaral H, De La Fuente HA. The role of PET-CT in patients with incidental gallbladder cancer. HPB (Oxford) 2009; 11:585-91. [PMID: 20495711 PMCID: PMC2785954 DOI: 10.1111/j.1477-2574.2009.00104.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Accepted: 06/16/2009] [Indexed: 12/12/2022]
Abstract
INTRODUCTION After a cholecystectomy, incidental gallbladder cancer (IGC) requires accurate imaging studies to determine the actual extent of the disease to properly tailor subsequent treatment. The aim of this study was to evaluate the utility of (18)F-fluorodeoxyglucose positron emission tomography-computed tomography ((18)FDG PET-CT) to provide optimal pre-treatment staging in patients with IGC. MATERIAL AND METHODS Between January 2006 and August 2008, all patients with IGC and at least muscular layer invasion were studied with (18)FDG PET-CT. The examination was considered positive when the standardized uptake values (SUV) were >/=2.5. In all instances patients were offered to undergo definitive exploration and possible radical resection. RESULTS The series included 32 patients, 26 women and 6 men, with a median age of 57 years (range 30-81 years). The examination was performed at a median time of 6 weeks after cholecystectomy (range 2-52 weeks). (18)FDG PET-CT was negative in 13 patients and positive in 19 patients: 9 with localized potentially resectable disease (PRD) and in 10 with disseminated disease. Of the 13 patients with negative PET-CT, 9 refused surgery and 4 underwent formal exploration: 3 patients were resected with no disease identified in the final pathology report (FPR) and 1 was not resected as a result of peritoneal carcinomatosis. Of the 9 with PRD, 4 patients refused reoperation and 5 underwent exploration: 3 were resected with residual disease noted in the FPR and 2 did not undergo resection because of dissemination. Two patients with disseminated disease were reoperated and in both instances disseminated disease was confirmed. The median survival for the entire group was 20.3 months (range 1.6-32.9 months). The median survival for those patients with negative PET-CT was 13.5 months (range 5.6-32.9 months), 6.2 months (range 1.6-18.7 months) for localized potentially resectable disease and 4.9 months (range 2-14.1 months) for disseminated disease (P < 0.003). CONCLUSIONS For patients presenting with stage T1b or greater IGC, the use of (18)FDG PET-CT will help reduce the number of patients undergoing non-therapeutic re-exploration and may help to determine the likely prognosis. (18)FDG PET-CT might be a useful tool for the selection of patients for potentially curative treatment.
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Affiliation(s)
- Jean M Butte
- Instituto Oncológico Fundación Arturo López Pérez Santiago, Chile
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Löhe F, Meimarakis G, Schauer C, Angele M, Jauch KW, Schauer RJ. The time of diagnosis impacts surgical management but not the outcome of patients with gallbladder carcinoma. Eur J Med Res 2009; 14:345-51. [PMID: 19666394 PMCID: PMC3352165 DOI: 10.1186/2047-783x-14-8-345] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Only 50% of gallbladder cancers (GBC) are recognized before operation and the remaining tumors are diagnosed during surgery or afterwards by the pathologist. These situations may demand substantial modifications of the proceeding during surgery as well as the need for reoperation in some cases. Therefore, the time of diagnosis may strongly influence the surgical management of GBC and the prognosis of the patients. Methods Records and follow-up of 152 patients with gallbladder carcinoma who underwent surgery between 1980 and 2004 were examined according to the time of diagnosis, TNM staging system, surgical procedures, morbidity and predictors of survival. There were 76 patients with preoperative diagnosis of GBC (50%; group1), 44 patients with intraoperative diagnosis (29%; group 2) and 32 patients (21%; group 3) with postoperatively incidental finding of GBC. In all cases radical resection of the GBC was intended, except in 5 patients from group 1. Surgical procedures comprised from simple cholecystectomy to multivisceral resections. Results Overall 5-year survival rate was 7% with a significantly better median survival in group 3 (53.2 month), when compared to only 6.1 month (group 2) and 5.4 month (group 1), respectively. Findings at operation forced significant modifications of the surgical strategy in 85%. Complete resection of GBC was achieved in 38% of the patients. Stage- dependent survival was comparable between the groups following R0 resection. Tumor stage, in particular the nodal status and radicality of the procedure, but not the time of diagnosis were the most powerful predictors of outcome. Conclusions Complete tumor resection may provide long-term survival even in locally advanced GBC. Although the time of diagnosis of GBC causes significant changes of the intended procedures during and after surgery, it has no influence on the prognosis provided that radical (R0) resection was accomplished.
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Affiliation(s)
- F Löhe
- Surgical Department, Klinikum Traunstein, Cuno-Niggl-Str. 3, 83278 Traunstein, Germany
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Hueman MT, Vollmer CM, Pawlik TM. Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol 2009; 16:2101-15. [PMID: 19495882 DOI: 10.1245/s10434-009-0538-x] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2009] [Revised: 04/27/2009] [Accepted: 04/28/2009] [Indexed: 12/13/2022]
Abstract
Gallbladder cancer is an uncommon cancer that has traditionally been associated with a poor prognosis. In the era of laparoscopic cholecystectomy, incidental gallbladder cancer has dramatically increased and now constitutes the major way patients present with gallbladder cancer. While patients with incidental gallbladder cancer have a better survival than patients with nonincidental gallbladder cancer, incidental gallbladder cancer can be associated with a varied prognosis. Imaging with computed tomography (CT), magnetic resonance imaging (MRI), and [18]F-fluorodeoxyglucose (FDG) positron emission tomography (PET), as well as diagnostic laparoscopy, all have varying roles in the workup of patients with incidental gallbladder cancer. For patients with T1b, T2, and T3 incidental gallbladder cancer re-resection is generally recommended. At re-exploration, many patients with incidental gallbladder cancer will have residual disease. Definitive oncologic management requires re-resection of the liver, portal lymphadenectomy, and attention to the common bile duct. The extent of the hepatic resection should be dictated by the ability to achieve a microscopically negative (R0) margin. Routine resection of the common bile duct is unnecessary but should be undertaken in the setting of a positive cystic duct margin. If an incidental gallbladder cancer is discovered at the time of surgery, whether the surgeon should directly proceed with a more definitive oncologic operation should depend on the surgeon's skill-set and experience. Gallbladder cancer has a propensity to recur. Although data for adjuvant therapy following resection are limited, some data do suggest a survival benefit for adjuvant chemoradiation therapy. Management of patients with gallbladder cancer requires a multidisciplinary approach with input from a surgeon skilled in hepatobiliary surgery.
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Affiliation(s)
- Matthew T Hueman
- Departments of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Pilgrim C, Usatoff V, Evans PM. A review of the surgical strategies for the management of gallbladder carcinoma based on T stage and growth type of the tumour. Eur J Surg Oncol 2009; 35:903-7. [PMID: 19261430 DOI: 10.1016/j.ejso.2009.02.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 12/18/2008] [Accepted: 02/02/2009] [Indexed: 02/06/2023] Open
Abstract
AIMS Surgery for gallbladder carcinoma is a technically challenging exercise. The extent of resection varies based on a number of factors, and controversy exists regarding what constitutes an acceptable resection. A review of current recommendations and practice was undertaken. METHODS A comprehensive literature review was performed, searching Medline for articles published since 2000, using the MeSH heading of 'gallbladder cancer' and 'surgery'. Abstracts were reviewed and articles retrieved if the main focus of the article centred on the surgical management of gallbladder carcinoma. OBSERVATIONS The extent of hepatic resection and lymph node dissection required varies in particular with T stage. Growth pattern and anatomical location of the tumour within the gallbladder also influence surgical management. CONCLUSIONS Discrepancy exists between the Eastern and Western literature in terms of what constitutes an acceptable limit of resection, and these issues are discussed.
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Affiliation(s)
- C Pilgrim
- The Alfred Hospital, Upper Gastrointestinal Surgery, Commercial Rd, Melbourne, VIC 3000, Australia.
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Shukla PJ, Barreto SG, Arya S, Shrikhande SV, Hawaldar R, Purandare N, Rangarajan V. Does PET-CT scan have a role prior to radical re-resection for incidental gallbladder cancer? HPB (Oxford) 2008; 10:439-45. [PMID: 19088931 PMCID: PMC2597311 DOI: 10.1080/13651820802286910] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Radical re-resection is offered to patients with non-metastatic, invasive, incidental gallbladder cancer. Data evaluating (18)F-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG PET-CT) in patients with incidental gallbladder cancer is sparse. AIM To evaluate the efficacy of integrated (18)F-FDG PET-CT in determining occult metastatic or residual local-regional disease in patients with incidental gallbladder cancer. METHODS Patients referred with incidental gallbladder cancer for radical re-resection were evaluated using multidetector computed tomography (MDCT) and PET-CT. Based on preoperative imaging, 24 out of 92 patients were found suitable for surgery. The two imaging modalities were evaluated with respect to residual and resectable disease. RESULTS In determining residual disease, MDCT had a sensitivity and positive predictive value (PPV) of 42.8%, each, while PET-CT had a sensitivity and PPV of 28.5 and 20%, respectively. In determining resectability, MDCT had a sensitivity, PPV, and accuracy of 100, 87.5, and 87.5%, respectively, as compared to PET-CT (sensitivity=100%, PPV=91.3%, accuracy=91.6%). CONCLUSIONS From our study, it appears that in patients with incidental gall bladder cancer without metastatic disease, PET-CT and MDCT seem to have roles complementing each other. PET-CT was able to detect occult metastatic or residual local-regional disease in some of these patients, and seems to be useful in the preoperative diagnostic algorithm of patients whose MDCT is normal or indicates locally advanced disease.
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Affiliation(s)
- Parul J. Shukla
- Department of Gastrointestinal Surgical Oncology, Tata Memorial HospitalParel MumbaiIndia
| | - Savio G. Barreto
- Department of Gastrointestinal Surgical Oncology, Tata Memorial HospitalParel MumbaiIndia
| | - Supreeta Arya
- Clinical Research Secretariat, Tata Memorial HospitalMumbaiIndia
| | - Shailesh V. Shrikhande
- Department of Gastrointestinal Surgical Oncology, Tata Memorial HospitalParel MumbaiIndia
| | - Rohini Hawaldar
- Department of Radiodiagnosis, Tata Memorial HospitalMumbaiIndia
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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 2008; 16:806-16. [PMID: 18985272 DOI: 10.1245/s10434-008-0189-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 09/22/2008] [Accepted: 09/22/2008] [Indexed: 02/06/2023]
Abstract
Gallbladder cancer has historically been considered an incurable malignancy; although, extended resection has been associated with cure in selected patients. However, the optimal extent of resection is unknown. The objective of this study was to analyze the impact of the extent of resection for gallbladder adenocarcinoma on disease-specific survival (DSS) and perioperative morbidity. Analysis of a prospective hepatobiliary surgery database identified patients undergoing surgical resection for gallbladder adenocarcinoma from 1990 to 2002. Clinicopathologic factors including extent of resection were analyzed for their association with DSS and perioperative morbidity. Long-term outcome was evaluable in 104 patients. With median follow-up of 58 months for survivors, the actuarial 5-year DSS was 42%. Thirty-six patients (35%) underwent major hepatectomy, but in 15 this was not mandatory to clear all disease. Sixty-eight patients (65%) underwent common bile duct (CBD) excision, but 32 were performed empirically. Twenty-one patients (20%) underwent en bloc resection of adjacent organs other than the liver. The performance of a major hepatectomy or a CBD excision was not associated with other clinicopathologic variables or long-term survival. Resection of adjacent organs were associated with advanced T stage but not with survival. T stage, N stage, histologic differentiation, and CBD involvement were independently associated with survival. Major hepatectomy and CBD excision were significantly associated with perioperative morbidity. We conclude that tumor biology and stage, rather than extent of resection, predict outcome after resection for gallbladder cancer. Major hepatic resections, including major hepatectomy and CBD excision, are appropriate when necessary to clear disease but are not mandatory in all cases.
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Affiliation(s)
- Michael D'Angelica
- Hepatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Coburn NG, Cleary SP, Tan JCC, Law CHL. Surgery for gallbladder cancer: a population-based analysis. J Am Coll Surg 2008; 207:371-82. [PMID: 18722943 DOI: 10.1016/j.jamcollsurg.2008.02.031] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Revised: 02/22/2008] [Accepted: 02/26/2008] [Indexed: 12/16/2022]
Abstract
BACKGROUND Gallbladder cancer is an aggressive neoplasm, and resection is the only curative modality. Single institutional studies report an aggressive surgical approach improves survival. This analysis was performed to examine the components of surgical resection and resultant survival. STUDY DESIGN From 1988 to 2003, patients aged 18 to 85 years, resected of T1-3 M0 gallbladder cancer, were identified from the Surveillance, Epidemiology, and End Results (SEER) registry. Resections were classified as en bloc (cholecystectomy + at least one adjacent organ) or simple (cholecystectomy only); lymphadenectomy was defined as three or more lymph nodes assessed. RESULTS Of the 2,835 resected patients with T1-T3 M0 cancer, only 8.6% underwent an en bloc resection, and 5.3% had a lymphadenectomy. In multivariable analysis, age, year of resection, region, and advanced T-stage were associated with more aggressive resection. In univariate analysis, improved survival was associated with en bloc resection for T1/2 cancers, and lymphadenectomy for T2/3 cancers. In multivariable analysis, the following were associated with improved survival: for T1 cancers, en bloc resection, younger age, lower grade, and recent year of resection; for T2 cancers, Caucasian race (versus African-American), lower grade, and node negative disease, with trends for en bloc resection and lymphadenectomy; and for T3 cancers, female gender, Caucasian race (versus American Indian), lower grade, node negative disease, and recent year of resection, with a strong trend for lymphadenectomy. CONCLUSIONS Very few patients underwent aggressive surgery. En bloc resection and lymphadenectomy may have stage-specific effects on survival. Additional studies should explore the underuse of aggressive operations, verify survival advantages, and define stage-specific resection strategies.
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Affiliation(s)
- Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Park JS, Jung WH, Kim JK, Hwang HK, Cho SI, Yoon DS, Chi HS, Kim BR. Estrogen receptor alpha, estrogen receptor beta, and progesterone receptor as possible prognostic factor in radically resected gallbladder carcinoma. J Surg Res 2008; 152:104-10. [PMID: 18394649 DOI: 10.1016/j.jss.2008.01.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 01/22/2008] [Accepted: 01/27/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Gallbladder carcinoma is a relatively rare malignancy with a poor prognosis. We have often encountered patients in whom the course of their disease differed substantially from what would be predicted based on their clinical staging, which highlights the needs to consider additional predictive factors. Gallbladder carcinoma occurs more frequently in women than men, yet expression of the estrogen receptor (ER) and progesterone (PR) have not been studied. We applied an immunohistochemical stain to examine the expression of ER(alpha), ER(beta), and PR in radically resected gallbladder carcinoma. MATERIAL AND METHODS We immunohistochemically investigated 30 specimens of gallbladder adenocarcinoma tissues using ER(alpha), ER(beta), and PR antibodies. RESULTS Adenocarcinoma of gallbladder is negative for both ER(alpha) and PR. However, 22 of 30 cases (73.3%) were confirmed positive for ER(beta), which was significantly correlated with tumor differentiation. Five-year survival rates of ER(beta) positive and negative patients were 53.3% and 31.1%, respectively (P = 0.034). In multivariate analysis, only a low proportion score of ER(beta) status was a statistically significant factor (P = 0.033). CONCLUSIONS Evaluation of ER(beta) expression in gallbladder carcinoma may be an important factor in identifying a poor prognostic group of gallbladder carcinoma.
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Affiliation(s)
- Joon Seong Park
- Department of Surgery and Pathology, Yonsei University College of Medicine, Seoul, Korea
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Corvera CU, Blumgart LH, Akhurst T, DeMatteo RP, D'Angelica M, Fong Y, Jarnagin WR. 18F-fluorodeoxyglucose positron emission tomography influences management decisions in patients with biliary cancer. J Am Coll Surg 2007; 206:57-65. [PMID: 18155569 DOI: 10.1016/j.jamcollsurg.2007.07.002] [Citation(s) in RCA: 167] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 07/02/2007] [Accepted: 07/02/2007] [Indexed: 01/02/2023]
Abstract
BACKGROUND Although (18)F-fluorodeoxyglucose positron emission tomography (PET) has widespread clinical use, its role in cancers of the biliary tract is ill-defined. The aim of this study was to determine if preoperative PET provided additional staging information in patients with biliary tract cancer, beyond that obtained through conventional anatomic imaging. The role of PET in detecting disease recurrence after resection was also examined. STUDY DESIGN Between March 2001 and October 2003, 126 patients with biopsy-proved or presumed biliary tract cancer (intrahepatic or extrahepatic cholangiocarcinoma and gallbladder carcinoma) underwent PET in addition to standard imaging evaluation. Histologic confirmation of the diagnosis was used as the reference standard with which PET results were compared. Patient followup information and serial imaging were reviewed for progression of lesions detected by PET. RESULTS Of the 126 study patients, 93 (74%) underwent preoperative staging PET scans, the results of which changed the stage and treatment in 22 patients (24%): 15 of 62 (24%) with cholangiocarcinoma and 7 of 31 (23%) with gallbladder carcinoma. When used to assess for cancer recurrence (n=33), PET identified disease in 86% of patients but altered treatment in only 9%. So, of the entire study group, the findings of PET influenced management in 20% of patients (24% preoperative staging and 9% cancer recurrence). The sensitivity of PET for identifying the primary tumor was 80% overall: 78% for cholangiocarcinoma, 86% for gallbladder carcinoma. CONCLUSIONS Most biliary tract cancers are (18)F-fluorodeoxyglucose avid tumors. In patients with potentially resectable tumors based on conventional imaging, PET identified occult metastatic disease and changed management in nearly one-fourth of all patients. PET also helped confirm recurrent cancer after resection.
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Affiliation(s)
- Carlos U Corvera
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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40
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Cleary SP, Dawson LA, Knox JJ, Gallinger S. Cancer of the gallbladder and extrahepatic bile ducts. Curr Probl Surg 2007; 44:396-482. [PMID: 17693325 DOI: 10.1067/j.cpsurg.2007.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Sean P Cleary
- Department of Surgery, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
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41
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Abstract
Gallbladder cancer is a relatively unusual, but often lethal malignancy. Surgical management has historically been palliative only; however, with the advancement of techniques in hepatobiliary surgery, varying extents of surgical intervention have been advocated for cure. This article reviews the current approach to the surgical management of gallbladder cancer and discusses the rationale for an aggressive approach to this disease.
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Affiliation(s)
- Kristin L Mekeel
- Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ 85054, USA.
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Reddy SK, Marroquin CE, Kuo PC, Pappas TN, Clary BM. Extended hepatic resection for gallbladder cancer. Am J Surg 2007; 194:355-61. [PMID: 17693282 DOI: 10.1016/j.amjsurg.2007.02.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2007] [Revised: 02/01/2007] [Accepted: 02/01/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although radical cholecystectomy is the standard of care for gallbladder cancers that invade perimuscular connective tissue or perforate visceral peritoneum, the role of extended right hepatectomy in achieving negative resection margins is not clear. METHODS Clinicopathologic, perioperative, and long-term outcome data were reviewed from patients who underwent hepatic resection for gallbladder cancer. RESULTS From 1995 to 2005, 22 consecutive patients underwent hepatic resection for gallbladder cancer, and 11 underwent extended hepatectomy. Negative resection margins were achieved in all patients. There were no significant differences in postoperative morbidity, mortality, and long-term survival after extended and minor hepatectomy. T3 tumors negatively predicted overall and recurrence-free survival. COMMENTS Extended hepatectomy achieves negative resection margins for patients with gallbladder cancer and is associated with acceptable morbidity and long-term survival.
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Affiliation(s)
- Srinevas K Reddy
- Division of General Surgery, Department of Surgery, Duke University Medical Center, Box 3247, Durham, NC 27710, USA.
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Park JS, Yoon DS, Kim KS, Choi JS, Lee WJ, Chi HS, Kim BR. Actual recurrence patterns and risk factors influencing recurrence after curative resection with stage II gallbladder carcinoma. J Gastrointest Surg 2007; 11:631-7. [PMID: 17468922 DOI: 10.1007/s11605-007-0109-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite the advances in imaging techniques, most patients can only be diagnosed at advanced stage: The prognosis is very poor. Recent studies showed that aggressive radical resection for advanced gallbladder carcinoma can give an acceptable prognosis. However, recurrence frequently remains the main problem after curative resection of advanced gallbladder carcinoma. The aim of this study was to identify the patterns and risk factors of recurrence after curative resection for stage II gallbladder carcinoma. Between January 1991 and December 2003, 100 patients received radical curative resection for gallbladder carcinoma at Yonsei University Medical Center. Of these, 77 were defined with stage II gallbladder carcinoma according to the Union Internationale Contre Le Cancer classification (sixth edition). Of the 77 patients, 67 were reviewed for the predictors of tumor recurrence. Among the 67 patients, 38 (56.7%) suffered a recurrence. The mean length to the recurrence was 21.1 +/- 26.7 months, with the most common site being the intraabdominal organs: liver and aortocaval lymph nodes. Infiltrating and poorly differentiated types were identified as independent prognostic factors of recurrence after curative resection for stage II gallbladder carcinoma and it suggests that large multicenter randomized control trials are necessary to clarify the role of adjuvant chemotherapy in these patients.
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Affiliation(s)
- Joon Seong Park
- Department of Surgery, Yongdong Severance Hospital, Yonsei University College of Medicine, 146-92, Dogok-dong, Kangnam-Gu, Seoul 135-720, Korea
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44
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Deziel DJ. Cancer of the Gallbladder. Surg Oncol 2006. [DOI: 10.1007/0-387-21701-0_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Abstract
BACKGROUND The aim of the present study was to review the long-term result of patients with carcinoma of gallbladder with adequate investigations and aggressive surgical resection. METHODS A retrospective study was carried out on patients with carcinoma of gallbladder treated at the Division of Hepatopancreatobiliary Surgery, the Chinese University of Hong Kong from January 1997 to December 2002. RESULTS Of the 47 patients with carcinoma of gallbladder, 28 patients were treated symptomatically because they were found to have metastatic disease (n = 22), unresectable disease (n = 2) or poor associated medical disease (n = 4). One patient had carcinoma in-situ after laparoscopic cholecystectomy. No further treatment was considered necessary. The remaining 18 patients (38.3%) came to laparotomy after preoperative investigations with ultrasonography, computed tomography, endoscopic or percutaneous cholangiography, and visceral angiography. Laparoscopy and laparoscopic ultrasound were used in the later part of the study. Radical cholecystectomy was carried out in 14 patients (77.8%). The in-hospital mortality rate was 5.3% and the surgical morbidity was 31.6%. The remaining four patients underwent palliative cholecystectomy because of the extent of the disease. The overall 5-year survival for the 47 patients was 19.1%, for the 18 patients who came to laparotomy was 44.4%, and for the 14 patients who underwent resection with curative intent was 57.1%. CONCLUSIONS With adequate preoperative investigations, and the use of laparoscopy and laparoscopic ultrasound, radical resection was possible in the majority of patients who came to laparotomy for carcinoma of gallbladder. Aggressive radical resection gave good results.
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Affiliation(s)
- Eric C H Lai
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
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Shimizu Y, Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, Yoshidome H, Kato A, Miyazaki M. Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer? Surgery 2005; 136:1012-7; discussion 1018. [PMID: 15523394 DOI: 10.1016/j.surg.2004.04.032] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence and mode of spread of carcinoma of the gallbladder into the hepatoduodenal ligament have not been well described pathologically for gallbladder carcinoma extending into the subserosa and beyond. METHODS Between 1985 and 2002, 50 consecutive patients with gallbladder carcinoma extending into the subserosa or beyond underwent radical surgery, including extrahepatic bile duct resection. Serial sections of specimens of the resected extrahepatic bile ducts were examined to determine the incidence and the pattern of invasion of the hepatoduodenal ligament from the primary cancer. RESULTS Invasion of the hepatoduodenal ligament was present in 30 of the 50 specimens. Of these, 9 showed direct extramural spread (type I), 4 showed continuous intramural spread (type II), 5 showed distant spread separated from the primary tumor (type III), and 4 showed spread of cancer cells from metastatic lymph nodes (type IV). The remaining 8 patients had more than 1 type: 1 patient had types I + III; 3 had types I + III + IV; and 4 had types III+IV. Invasion of the hepatoduodenal ligament was present in 24 of 44 patients without preoperative obstructive jaundice and in 2 of 13 patients with stage IB disease. Patients with types II, III, and IV spread into the hepatoduodenal ligament had significantly better survival than those with type I spread. CONCLUSIONS Gallbladder carcinoma extending into the subserosa or beyond invades the hepatoduodenal ligament with relatively high frequency. Preoperative diagnosis of this invasion is difficult; therefore, strong consideration should be given to resection of the extrahepatic bile ducts and lymph nodes.
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Affiliation(s)
- Yasuhito Shimizu
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba 560-8670, Japan
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Memon MA, Anwar S, Shiwani MH, Memon B. Gallbladder carcinoma: a retrospective analysis of twenty-two years experience of a single teaching hospital. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2005; 2:6. [PMID: 15774016 PMCID: PMC1079924 DOI: 10.1186/1477-7800-2-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 03/17/2005] [Indexed: 12/20/2022]
Abstract
Background The purpose of this study was to retrospectively evaluate our experience with gallbladder cancer since the establishment of a tumour registry in our institute. Methods Between 1975 and 1998, 23 consecutive patients with gallbladder cancer were identified using the tumour registry database. There were 18 females (78%) and 5 (22%) males. The mean age at diagnosis was 70.6 (range 42–85) years. The diagnosis was achieved either intra-operatively or following the histological analysis of the gallbladder (n = 17), following gallbladder or liver biopsy (n = 4) or at autopsy (n = 2). Presenting symptoms included upper abdominal pain, weight loss, nausea, vomiting, fever, painless jaundice, hepatomegaly, upper abdominal mass, upper abdominal tenderness, and gastrointestinal haemorrhage. Results Histological examination revealed 20 adenocarcinomas (87%), 2 squamous cell carcinomas (9%) and one spindle cell sarcoma (4%). At presentation, 14 (61%) gallbladder cancers were stage IV, 5 (22%) were stage III and 4 (17%) were stage II. Kaplan Meier analysis revealed a mean survival of 3.2, 7.8 and 8.2 months for stage IV, III, and II disease respectively. Out of 14 patients with stage IV disease, 8 patients received adjuvant chemotherapy and survived for 4.6 months whereas six patients who did not receive adjuvant chemotherapy survived for 1.3 months. This difference was statistically significant (p = 0.04). Conclusion The majority of patients with gallbladder cancer presented with advanced stage disease (stage IV) which carries a dismal prognosis. Patients who received chemotherapy with stage IV disease, however, did better than those who did not, but this is probably a reflection of patient selection.
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Affiliation(s)
- Muhammed Ashraf Memon
- Department of Surgery, Creighton University, Omaha, Nebraska, USA
- Department of Surgery, Whiston Hospital, Prescot, Merseyside, L35 5DR, UK
| | - Suhail Anwar
- Department of Surgery, Barnsley District General Hospital, Barnsley, South Yorkshire, S75 2EP, UK
| | - M Hanif Shiwani
- Department of Surgery, Barnsley District General Hospital, Barnsley, South Yorkshire, S75 2EP, UK
| | - Breda Memon
- Private Clinic, Astley House, Whitehall Road, Darwen, Lancashire, BB3 2LH, UK
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Chan KM, Yeh TS, Yu MC, Jan YY, Hwang TL, Chen MF. Gallbladder Carcinoma with Biliary Invasion: Clinical Analysis of the Differences from Nonbiliary Invasion. World J Surg 2004; 29:72-5. [PMID: 15599737 DOI: 10.1007/s00268-004-7544-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Gallbladder carcinoma is the most common malignancy of the biliary tract. Because of a lack of specific presentations, this condition frequently is diagnosed only at an advanced stage. The clinical difference between gallbladder carcinoma with and without biliary involvement remains uncertain. This study recruited all patients with gallbladder carcinoma treated at Chang Gung Memorial Hospital (Taoyuan, Taiwan) from 1987 to 2002. The sample included 120 patients aged 28 to 91 years (mean 65.5 +/- 12.3 years) (39 men, 81 women), whose medical records were reviewed retrospectively. Based on the 2002 newly revised TNM classification, 25, 38, 28, and 29 patients had stage I, II, III, and IV disease, respectively. After we excluded patients with stage I, the other patients were classified into two groups as follows: group I, gallbladder carcinoma with biliary invasion (n = 41); group II, carcinoma without biliary involvement (n = 54). The clinical presentations, laboratory data, operative methods, and outcome of these two groups were compared. The two groups did not differ in terms of age, sex distribution, cholelithiasis, and most clinical presentations. Chemistry laboratory data also identified patients in group I with significantly elevated liver function tests. Group II had a borderline tendency toward better curative resectability than group I (p = 0.09). Survival was significantly better for group I patients who underwent curative resection (n = 5) via cholecystectomy, partial hepatectomy, and bile duct resection than for those with noncurative resection (p < 0.05). However, long-term survival demonstrated that gallbladder carcinoma had the same poor prognosis in the two groups. In conclusion, gallbladder carcinoma with biliary invasion has been found to a more overt clinical presentation and abnormal laboratory data, which might alert clinicians to consider gallbladder carcinoma at an advanced stage or biliary invasion and examine the underlying disease. Generally, the outcome of gallbladder carcinoma is dismal, and radical curative resection combined with cholecystectomy, partial hepatectomy, and bile duct resection perhaps may offer good benefits for advanced gallbladder carcinoma. Furthermore, surgical resection should be performed whenever possible in patients with gallbladder carcinoma to increase life expectancy.
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Affiliation(s)
- Kun-Ming Chan
- Department of General Surgery, Chang Gung Memorial Hospital, No. 5 Fu-Hsing Street, 333 Kwei-shan, Taoyuan, Taiwan
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Frena A, La Guardia G, Martin F. Outcome of radical surgery for carcinoma of the gallbladder according to the tumor node metastasis and Japanese Society of Biliary Surgery stages. J Gastrointest Surg 2004; 8:580-90. [PMID: 15239995 DOI: 10.1016/j.gassur.2003.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Primary carcinoma of the gallbladder is a progressive, lethal disease. Survival of patients with this neoplasm depends strictly on lymph node involvement and depth of tumor invasion. The aim of the study was to evaluate the results of our surgical series according to the tumor node metastasis and Japanese Society of Biliary Surgery classification systems. A retrospective analysis of our 15-year experience was performed. Of the 79 patients with gallbladder carcinoma observed at our institution between 1984 and 2001, a radical resection was carried out in 20 patients. Patients with stage I-II disease represent a minority of the cases of gallbladder carcinoma; the disease is localized in these patients, and surgical treatment provides the opportunity for good survival. Survival rates for patients with stage III-IV disease demonstrates that radical extended surgery offers the only chance for a relatively prolonged survival.
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Affiliation(s)
- Antonio Frena
- Second Department of General Surgery, Regional Hospital of Bolzano, Bolzano, Italy.
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50
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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; 11:310-5. [PMID: 14993027 DOI: 10.1245/aso.2004.03.011] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In patients with gallbladder cancer, jaundice suggests tumor involvement of the porta hepatis. This study reports on the prevalence, etiology, and clinical significance of jaundice in patients with gallbladder cancer. METHODS Patients who presented with gallbladder cancer from 1995 to 2002 were entered into a prospective database. Disease-specific survival and clinicopathologic correlates were analyzed. RESULTS Eighty-two (34%) of 240 patients with gallbladder cancer presented with jaundice. Jaundiced patients (96%) were more likely (P <.001) to have advanced-stage disease than nonjaundiced patients (60%). Only six (7%) jaundiced patients were resected with curative intent, and only four (5%) had negative surgical margins. This was significantly different from the nonjaundiced group, in which 62 patients (39%) had negative margins (P <.001). The median disease-specific survival in patients presenting with jaundice was 6 months and was significantly lower compared with 16 months in patients without jaundice (P <.0001). In the group presenting with jaundice, there were no disease-free survivors at 2 years, compared with 21% in the group without jaundice. CONCLUSIONS Jaundice is common (34%) in patients who present with gallbladder cancer and is an indicator of advanced malignancy. These data do not support routine operative exploration of patients with jaundice secondary to gallbladder cancer.
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Affiliation(s)
- William G Hawkins
- Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA
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