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Olecki EJ, Mayhew M, Perez Holguin R, Wong WG, Stahl KA, Peng JS, Dixon ME, Gusani NJ. Gallbladder Cancer Incidentally Found at Cholecystectomy: Perioperative Risk Factors. J Gastrointest Cancer 2024; 55:723-732. [PMID: 38191950 DOI: 10.1007/s12029-023-00973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Risk factors of gallbladder cancer (GBC) are not well-defined resulting in greater than 60% of GBCs being diagnosed incidentally following cholecystectomy performed for presumed benign indications. As most localized GBCs require more extensive oncologic surgery beyond cholecystectomy, this study aims to examine factors associated with incidentally found GBC to improve preoperative and intraoperative diagnoses. METHODS The American College of Surgeons National Surgical Quality Improvement Program Database from 2007 to 2017 was used to identify cholecystectomies performed with and without a final diagnosis of GBC. Univariate and multivariable logistic regressions were used to compare demographic, intraoperative, and postoperative characteristics among those with and without a diagnosis of GBC. RESULTS The incidence of GBC was observed to be 0.11% (441/403,443). Preoperative factors associated with risk of GBC included age > 60 (OR 6.51, p < .001), female sex (OR 1.75, p < .001), history of weight loss (2.58, p < .001), and elevated preoperative alkaline phosphatase level (OR 1.67, p = .001). Open approach was associated with 7 times increased risk of GBC compared to laparoscopic approach (OR 7.33, p < .001). In addition to preoperative factors and surgical approach, longer mean operative times (127 min vs 70.7 min, p < .001) were significantly associated with increased risk of GBC compared to benign final pathology. CONCLUSION This study demonstrates that those with incidentally discovered GBC at cholecystectomy are unique from those undergoing cholecystectomy for benign indications. By identifying predictors of GBC, surgeons can choose high risk individuals for pre-operative oncologic evaluation and consider better tools for identifying GBC such as intraoperative frozen pathology.
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Affiliation(s)
- Elizabeth J Olecki
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
| | - Mackenzie Mayhew
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Rolfy Perez Holguin
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - William G Wong
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Kelly A Stahl
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
- Penn State College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - June S Peng
- Program for Liver, Pancreas, & Foregut Tumors, Department of Surgery College of Medicine, The Pennsylvania State University, PA, USA
| | - Matthew E Dixon
- Division of Surgical Oncology, Department of Surgery, Rush Medical College, Chicago, IL, USA
| | - Niraj J Gusani
- Section of Surgical Oncology, Division of Surgery, Baptist MD Anderson Cancer Center, Jacksonville, FL, USA
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Malik H, Izwan S, Ng J, Teng R, Chan E, Damodaran Prabha R, Puhalla H. Incidence and management of gallbladder cancer in cholecystectomy specimens: a 5-year tertiary centre experience. ANZ J Surg 2023; 93:2481-2486. [PMID: 37338023 DOI: 10.1111/ans.18577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 05/19/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an uncommon, but highly aggressive cancer. Half of these cases are diagnosed pre-operatively, and the remaining cases are discovered incidentally on post-cholecystectomy specimens. There is a significant geographical variability in GBC incidence, with increasing age, female sex, and prolonged duration of cholelithiasis being risk factors for GBC. The primary aim was to define the overall local incidence of GBC incidental GBC and management of these cases. The secondary aim was to determine any pertinent risk factors in our case population. METHODS A retrospective observational study was performed on all the cholecystectomy specimens at the Gold Coast Hospital and Health Service from 1 January 2016 to 2 December 2021. Data was collected via the electronic medical record. The incidence and management of gallbladder cancers was calculated, and association with body mass index (BMI), smoking status, diabetes, inflammatory bowel disease (IBD) was identified. RESULTS 3904 cholecystectomy specimens were reviewed. GBC was identified in 0.46% of cholecystectomies. 50% of these cases were found incidentally. Abdominal pain was the most common presenting complaint (94.4%). GBC was associated with increased age and BMI and female sex. There was no association between smoking status, diabetes or IBD with an increased incidence of cancer. Tumour staging guided surgical and/or adjuvant chemotherapy. CONCLUSION GBC is rare. Patients with symptoms are associated with a poor prognosis. Incidental cancers are common, and negative margin resection based on the T stage of the cancer is the most reliable curative option.
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Affiliation(s)
- Hassan Malik
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Sara Izwan
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Justin Ng
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Roy Teng
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Erick Chan
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Ramesh Damodaran Prabha
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Harald Puhalla
- Department of General Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
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Zhang W, Ouyang DL, Che X. Short- and long-term outcomes of laparoscopic vs open surgery for T2 gallbladder cancer: A systematic review and meta-analysis. World J Gastrointest Surg 2022; 14:1387-1396. [PMID: 36632125 PMCID: PMC9827575 DOI: 10.4240/wjgs.v14.i12.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/28/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND With the development of laparoscopic techniques, gallbladder cancer (GBC) is no longer a contraindication to laparoscopic surgery (LS). Although LS is recommended for stage T1 GBC, the value of LS for stage T2 GBC is still controversial.
AIM To evaluate the short- and long-term outcomes of LS in comparison to those of open surgery (OS) for stage T2 GBC.
METHODS We searched the PubMed, Embase, Cochrane Library, Ovid, Google Scholar, and Web of Science databases for published studies comparing the efficacy of LS and OS in the treatment of stage T2 GBC, with a cutoff date of September 2022. The Stata 15 statistical software was used for analysis. Relative risk (RR) and weighted mean difference (WMD) were calculated to assess binary and continuous outcome indicators, respectively. Begg’s test and Egger’s test were used for detecting publication bias.
RESULTS A total of five studies were included, with a total of 297 patients, 153 in the LS group and 144 in the OS group. Meta-analysis results showed that the LS group was better than the OS group in terms of operative time [WMD = -41.29, 95% confidence interval (CI): -75.66 to -6.92, P = 0.02], estimated blood loss (WMD = -261.96, 95%CI: -472.60 to -51.31, P = 0.01), and hospital stay (WMD = -5.67, 95%CI: -8.53 to -2.81, P = 0.0001), whereas there was no significant difference between the two groups in terms of blood transfusion (RR = 0.60, 95%CI: 0.31-1.15, P = 0.13), complications (RR = 0.72, 95%CI: 0.39-1.33, P = 0.29), number of lymph nodes retrieved (WMD = –1.71, 95%CI: -4.27 to -0.84, P = 0.19), recurrence (RR = 0.41, 95%CI: 0.06-2.84, P = 0.36), 3-year and 5-year overall survival (RR = 0.99, 95%CI: 0.82-1.18, P = 0.89 and RR = 1.02, 95%CI: 0.68-1.53, P = 0.92; respectively), and 3-year and 5-year disease-free survival (RR = 1.01, 95%CI: 0.84-1.21, P = 0.93 and RR = 1.15, 95%CI: 0.90-1.46, P = 0.26; respectively).
CONCLUSION The long-term outcomes of LS for T2 GBC are similar to those of OS, but LS is superior to OS in terms of operative time, intraoperative bleeding, and postoperative hospital stay. Nevertheless, these findings should be validated via high-quality randomized controlled trials and longer follow-ups.
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Affiliation(s)
- Wei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
| | - De-Liang Ouyang
- Department of General Surgery, The Third Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421900, Hunan Province, China
| | - Xu Che
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
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Cassese G, Han HS, Yoon YS, Lee JS, Cho JY, Lee HW, Lee B, Troisi RI. Preoperative Assessment and Perioperative Management of Resectable Gallbladder Cancer in the Era of Precision Medicine and Novel Technologies: State of the Art and Future Perspectives. Diagnostics (Basel) 2022; 12:diagnostics12071630. [PMID: 35885535 PMCID: PMC9320561 DOI: 10.3390/diagnostics12071630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 12/07/2022] Open
Abstract
Gallbladder carcinoma (GBC) is a rare malignancy, with an estimated 5-year survival rate of less than 5% in the case of advanced disease. Surgery is the only radical treatment for early stages, but its application and effectiveness depend on the depth of tumoral invasion. The extent of resection is usually determined according to the T-stage. Therefore, an early and correct preoperative assessment is important for the prognosis, as well as for the selection of the most appropriate surgical procedure, to avoid unnecessary morbid surgeries and to reach the best outcomes. Several modalities can be used to investigate the depth of invasion, from ultrasounds to CT scans and MRI, but an ideal method still does not exist. Thus, different protocols are proposed according to different recommendations and institutions. In this scenario, the indications for laparoscopic and robotic surgery are still debated, as well as the role of new technologies such as next-generation sequencing and liquid biopsies. The aim of this article is to summarize the state of the art current modalities and future perspectives for assessing the depth of invasion in GBC and to clarify their role in perioperative management accordingly.
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Affiliation(s)
- Gianluca Cassese
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
- Correspondence: ; Tel.: +82-31-787-7091
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Jun Suh Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Jai Young Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Hae-Won Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Boram Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Roberto Ivan Troisi
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, 80131 Naples, Italy
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5
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Cho JK, Kim JR, Jang JY, Kim HG, Kim JM, Kwag SJ, Park JH, Kim JY, Ju YT, Jeong CY. Comparison of the Oncological Outcomes of Open versus Laparoscopic Surgery for T2 Gallbladder Cancer: A Propensity-Score-Matched Analysis. J Clin Med 2022; 11:jcm11092644. [PMID: 35566770 PMCID: PMC9099510 DOI: 10.3390/jcm11092644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/25/2022] [Accepted: 05/06/2022] [Indexed: 02/01/2023] Open
Abstract
Although laparoscopic treatment for T1 gallbladder cancer (GBC) has been described previously, the differences in oncologic outcomes between laparoscopic and conventional open surgery for T2 GBC have not been investigated. We aimed to assess the role of laparoscopic surgery using retrospectively collected data for 81 patients with T2 GBC who underwent surgical resection between January 2010 and December 2017. Eligible patients were classified into “laparoscopic” and “open” groups. Propensity-score matching was performed in a 1:1 ratio. The effects of surgery type on surgical and oncological outcomes were investigated. After propensity-score matching, 19 patients were included in the open and laparoscopic surgery groups. The median follow-up durations were 70 and 26 months in the open and laparoscopic groups, respectively. The operative time (316.8 ± 80.3 vs. 218.9 ± 145.0 min, p = 0.016) and length of postoperative hospital stay (14.4 ± 6.0 vs. 8.4 ± 5.9 days, p = 0.004) were significantly shorter in the laparoscopic group. The three-year overall (86.3% vs. 88.9%, p = 0.660) and disease-free (76.4% vs. 60.2%, p = 0.448) survival rates were similar between the groups. Propensity-score matching showed that laparoscopic surgery for T2 GBC yielded similar long-term oncological outcomes and favorable short-term outcomes in comparison with open surgery. Laparoscopic treatment should be considered in patients with T2 GBC.
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Affiliation(s)
- Jin-Kyu Cho
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Jae-Ri Kim
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, 11, Samjeongja-ro, Changwon-si 51472, Korea; (J.-R.K.); (J.-Y.J.)
| | - Jae-Yool Jang
- Department of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, 11, Samjeongja-ro, Changwon-si 51472, Korea; (J.-R.K.); (J.-Y.J.)
| | - Han-Gil Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Jae-Myung Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Seung-Jin Kwag
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Ji-Ho Park
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Ju-Yeon Kim
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Young-Tae Ju
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, 79, Gangnam-ro, Jinju 52727, Korea; (J.-K.C.); (H.-G.K.); (J.-M.K.); (S.-J.K.); (J.-H.P.); (J.-Y.K.); (Y.-T.J.)
- Correspondence: ; Tel.: +82-10-9360-8294
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6
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Nakanishi H, Miangul S, Oluwaremi TT, Sim BL, Hong SS, Than CA. Open versus laparoscopic surgery in the management of patients with gallbladder cancer: A systematic review and meta-analysis. Am J Surg 2022; 224:348-357. [DOI: 10.1016/j.amjsurg.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 02/06/2022] [Accepted: 03/01/2022] [Indexed: 02/07/2023]
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7
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Morimoto M, Matsuo T, Mori N. Management of Porcelain Gallbladder, Its Risk Factors, and Complications: A Review. Diagnostics (Basel) 2021; 11:1073. [PMID: 34200963 PMCID: PMC8230643 DOI: 10.3390/diagnostics11061073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
The porcelain gallbladder condition describes gallbladder calcification. While gallbladder calcification is believed to increase the risk of developing gallbladder cancer, recent reports have shown that the malignancy risk is much lower than previously reported. Symptomatic patients with porcelain gallbladder should be recommended for cholecystectomy, but the management of asymptomatic patients is debatable. Based on recent evidence, prophylactic cholecystectomy is not routinely recommended in all patients with porcelain gallbladder. From the assessment of the current literature, there are three essential factors in the management of patients with porcelain gallbladder: (1) symptoms or complications of gallbladder disease, (2) calcification pattern and (3) patient age and comorbidities. Patients who do not undergo cholecystectomy should be educated about the symptoms of gallbladder diseases, and a thorough discussion is essential between patients and clinicians.
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Affiliation(s)
- Masaya Morimoto
- Department of Infectious Diseases, St. Luke’s International Hospital, Tokyo 104-8560, Japan; (T.M.); (N.M.)
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Zhang Y, You WH, Li X, Wang P, Sha B, Liang Y, Qiu J, Zhou J, Hu H, Lu L. Single-cell RNA-seq reveals transcriptional landscape and intratumor heterogenicity in gallbladder cancer liver metastasis microenvironment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:889. [PMID: 34164523 PMCID: PMC8184464 DOI: 10.21037/atm-21-2227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Gallbladder cancer (GBC) is a highly aggressive biliary epithelial malignancy. The median survival time of GBC patients was less than 1 year. Tumor invasion and metastasis are the major cause of high mortality of GBC patients. However, the molecular mechanisms involved in GBC metastases are still unclear. Methods We performed 10X genomics single-cell RNA sequencing (scRNA-seq) on GBC liver metastasis tissue to evaluate the characteristics of the GBC liver metastasis microenvironment. Results In this study, 8 cell types, a total of 7,788 cells, including T cells, B cells, malignant cells, fibroblasts, endothelial cells, macrophages, dendritic cells (DCs), and mast cells were identified. Malignant cells displayed a high degree of intratumor heterogenicity, while neutrophils were found to promote GBC cell proliferation, migration, and invasion. Furthermore, cytotoxic cluster of differentiation (CD8+) T cells became exhausted and CD4+ regulatory T cells (Tregs) exhibited immunosuppressive characteristics. Macrophages played an important role in the tumor microenvironment (TME). We identified three distinct macrophage subsets and emergent M2 polarization. We also found that cancer-associated fibroblasts exhibited heterogeneity and may be associated with GBC metastasis. Conclusions Although preliminary in nature, our study provides a landscape view at the single-cell level. These results offer a unique perspective into understanding the liver metastasis of GBC.
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Affiliation(s)
- Yigang Zhang
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, The First Affiliated Hospital of Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.,Jiangsu Key Lab of Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Wen-Hua You
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, The First Affiliated Hospital of Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.,Jiangsu Key Lab of Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China.,School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Xiangyu Li
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, The First Affiliated Hospital of Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.,Jiangsu Key Lab of Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Peng Wang
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, The First Affiliated Hospital of Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.,Jiangsu Key Lab of Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Bowen Sha
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, The First Affiliated Hospital of Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.,Jiangsu Key Lab of Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Yuan Liang
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, The First Affiliated Hospital of Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.,Jiangsu Key Lab of Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China.,School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China
| | - Jiannan Qiu
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, The First Affiliated Hospital of Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.,Jiangsu Key Lab of Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Jinren Zhou
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, The First Affiliated Hospital of Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.,Jiangsu Key Lab of Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Haoran Hu
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, The First Affiliated Hospital of Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.,Jiangsu Key Lab of Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
| | - Ling Lu
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, The First Affiliated Hospital of Nanjing Medical University, Research Unit of Liver Transplantation and Transplant Immunology, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.,Jiangsu Key Lab of Collaborative Innovation Center for Personalized Cancer Medicine, Nanjing Medical University, Nanjing, China
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Lv TR, Yang C, Regmi P, Ma WJ, Hu HJ, Liu F, Yin CH, Jin YW, Li FY. The role of laparoscopic surgery in the surgical management of gallbladder carcinoma: A systematic review and meta-analysis. Asian J Surg 2021; 44:1493-1502. [PMID: 33895048 DOI: 10.1016/j.asjsur.2021.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 02/24/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
Previous studies have explored the role of laparoscopic surgery (LS) in the surgical management of gallbladder carcinoma (GBC) and obtained satisfactory outcomes versus conventional open surgery. However, most of them either included a small number of patients or mainly focused on the early-staged lesions. Therefore, their results were less statistical powerful and a more comprehensive evaluation on the role of LS in GBC is warranted. A thorough database searching was performed in PubMed, EMBASE and Cochrane Library for comparative studies between the laparoscopic and open approach in the surgical management of GBC and 18 comparative studies were finally identified. RevMan 5.3 and Stata 13.0 software were used for statistical analyses. Pooled results revealed that patients in the laparoscopic group recovered faster with less intraoperative hemorrhage and less postoperative morbidity. Comparable operative time, overall recurrence rate, R0 resection rate, lymph node yield, intraoperative gallbladder violation rate and postoperative survival outcomes were also acquired. Regarding the debating issue of port-site recurrence, a significantly higher incidence of port-site recurrence was observed in laparoscopic group. However, having excluded studies on incidental gallbladder carcinoma, the subsequent pooled result showed no significant difference. Considering the inherent inconsistency of the surgical indication between laparoscopic and open surgeries and the deficiency of advanced lesions, we drew a conclusion that laparoscopic surgery seems to be only safe and feasible for early- or middle-staged lesions. Upcoming random controlled trials or comparative studies with equivalent surgical indication focused on advanced lesions are warranted for further evaluation.
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Affiliation(s)
- Tian-Run Lv
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Chen Yang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Parbatraj Regmi
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Chang-Hao Yin
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yan-Wen Jin
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Satoh T, Kikuyama M, Sasaki K, Ishiwatari H, Kawaguchi S, Sato J, Kaneko J, Matsubayashi H. Detectability on Plain CT is an Effective Discriminator between Carcinoma and Benign Disorder for a Polyp >10 mm in the Gallbladder. Diagnostics (Basel) 2021; 11:diagnostics11030388. [PMID: 33668755 PMCID: PMC7996218 DOI: 10.3390/diagnostics11030388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 12/25/2022] Open
Abstract
An appropriate diagnosis is required to avoid unnecessary surgery for gallbladder cholesterol polyps (GChPs) and to appropriately treat pedunculated gallbladder carcinomas (GCs). Generally, polyps >10 mm are regarded as surgical candidates. We retrospectively evaluated plain and contrast-enhanced (CE) computed tomography (CT) findings and histopathological features of 11 early GCs and 10 GChPs sized 10–30 mm to differentiate between GC and GChP >10 mm and determine their histopathological background. Patient characteristics, including polyp size, did not significantly differ between groups. All GCs and GChPs were detected on CE-CT; GCs were detected more often than GChPs on plain CT (73% vs. 9%; p < 0.01). Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for GCs were 73%, 90%, 89%, 75%, and 81%, respectively. On multivariate analysis, lesion detectability on plain CT was independently associated with GCs (odds ratio, 27.1; p = 0.044). Histopathologically, GChPs consisted of adipose tissue. Although larger vessel areas in GCs than in GChPs was not significant (52,737 μm2 vs. 31,906 μm2; p = 0.51), cell densities were significantly greater in GCs (0.015/μm2 vs. 0.0080/μm2; p < 0.01). Among GPs larger than 10 mm, plain CT could contribute to differentiating GCs from GChPs.
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Affiliation(s)
- Tatsunori Satoh
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan; (H.I.); (J.S.); (J.K.); (H.M.)
- Correspondence: ; Tel.: +81-55-989-5222
| | - Masataka Kikuyama
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 113-0021, Japan;
| | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, Shizuoka 411-8777, Japan;
| | - Hirotoshi Ishiwatari
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan; (H.I.); (J.S.); (J.K.); (H.M.)
| | - Shinya Kawaguchi
- Department of Gastroenterology, Shizuoka General Hospital, Shizuoka 420-8527, Japan;
| | - Junya Sato
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan; (H.I.); (J.S.); (J.K.); (H.M.)
| | - Junichi Kaneko
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan; (H.I.); (J.S.); (J.K.); (H.M.)
| | - Hiroyuki Matsubayashi
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka 411-8777, Japan; (H.I.); (J.S.); (J.K.); (H.M.)
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Qin JM. Causes of misdiagnosis and missed diagnosis and therapeutic and preventive strategies for unexpected gallbladder carcinoma. Shijie Huaren Xiaohua Zazhi 2020; 28:1167-1176. [DOI: 10.11569/wcjd.v28.i23.1167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic cholecystectomy (LC) has been widely used in the treatment of gallbladder diseases. Since the indications for operation are constantly expanding, the intraoperative or postoperative incidence of unexpected gallbladder carcinoma (UGC) is gradually increasing. The incidence of UGC in LC and open cholecystectomy is 2.09% and 0.91%, respectively. Because gallbladder carcinoma is often accompanied by gallstones or inflammation and lacks specific clinical manifestations, imaging features, and specific serum tumor markers, the preoperative diagnostic rate of gallbladder carcinoma is only 30%, and 30% of cases of gallbladder carcinoma are diagnosed intraoperatively or postoperatively. Pathological T stage, lymph node metastasis, and gallbladder rupture are independent risk factors for the prognosis of patients with UGC. Preoperative imaging combined with serological tumor markers, intraoperative careful exploration, and rapid pathological examination are important measures to reduce the misdiagnosis and missed diagnosis of UGC. For patients with benign gallbladder diseases with a high potential of canceration, performing cholecystectomy in time and strictly grasping the indications for preserving gallbladder for benign gallbladder diseases are important preventive measures to reduce the incidence of UGC.
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Affiliation(s)
- Jian-Min Qin
- Department of General Surgery, The Third Hospital Affiliated to Naval Military Medical University, Shanghai 201805, China
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12
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Muszynska C, Nilsson J, Lundgren L, Lindell G, Andersson R, Sandström P, Andersson B. A risk score model to predict incidental gallbladder cancer in patients scheduled for cholecystectomy. Am J Surg 2020; 220:741-744. [PMID: 32037044 DOI: 10.1016/j.amjsurg.2020.01.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 12/12/2022]
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13
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Feasibility and Safety of Laparoscopic Treatment for Early and T3 Stage Gallbladder Cancer: A Systematic Review. Surg Laparosc Endosc Percutan Tech 2020; 31:113-123. [PMID: 32810031 DOI: 10.1097/sle.0000000000000852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Effect of laparoscopic approach in the treatment of gallbladder cancer (GBC) is still controversial. MATERIALS AND METHODS Literature published before December 2019 was retrieved from PubMed, EMBASE, and Cochrane Library databases for a comparative study between laparoscopic group (LG) and open group (OG) for GBC. Revman 5.3 statistical software was used for analysis. RESULTS Nine comparative studies were eligible and included 654 patients, 287 were in LG and 367 were in OG. Meta-analysis showed that the operation time, estimated blood loss, drainage tube time, and hospitalization time after LG were significantly less than those in the OG [weighted mean difference (WMD)=-27.5; 95% confidence interval (CI), -36.6 to -18.4; P<0.00001; WMD=-267.56, 95% CI, -372.25 to -162.86; P<0.00001; WMD=-1.35; 95% CI, -2.26 to -0.44; P=0.004; WMD=-6.44; 95% CI,-9.07 to -3.81; P<0.00001, respectively). There was no significant difference between LG and OG in postoperative complications, mortality, lymph node dissection, R0 rate, scar recurrence, recurrence, and the 3- and 5-year overall survival (OS) rates. The 1-year OS of all patients, and the 1- and 2-year OS of patients with T3 tumors in the LG were significantly better than those in the OG [relative risk (RR)=1.11; 95% CI, 1.01 to 1.22; P=0.04; RR=1.46; 95% CI, 1.03 to 2.08, P=0.04 and RR=1.71; 95% CI, 1.02 to 2.84; P=0.04, respectively]. CONCLUSIONS The safety and efficacy of LG for early GBC is comparable to OG, and to some extent, it can reduce operation time, estimated blood loss, drainage tube time, and hospitalization time, and have a higher 1-year OS. Patients in T3 stage may have a longer survival by LC, however, this conclusion still needs to be validated by more high-quality clinical studies, especially prospective randomized controlled trials.
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Wang Z, Xu Y, Hu D, Wu X, Chen Y, Ye Q, Wang J, Zhu J. Laparoscopy Versus Open Reoperation for Incidental Gallbladder Carcinoma After Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2020; 30:764-768. [PMID: 32429744 DOI: 10.1089/lap.2019.0802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Zhijiang Wang
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Youhon Xu
- School Clinic of Zhejiang University, Hangzhou, China
| | - Dandan Hu
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiangsong Wu
- Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Chen
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qinghuang Ye
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianwei Wang
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jinhui Zhu
- Department of General Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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15
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Lovell S, Singh A, Zur Linden A, Hagen C, Cuq B. Gallbladder leiomyoma treated by laparoscopic cholecystectomy in a dog. J Am Vet Med Assoc 2020; 255:85-89. [PMID: 31194662 DOI: 10.2460/javma.255.1.85] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 12-year-old spayed female Chinese Crested was referred because of a mass detected in the gallbladder during ultrasonographic evaluation of the abdomen, which had been prompted by a history of high serum liver enzyme activities. CLINICAL FINDINGS Serum biochemical analysis revealed mild hypoglobulinemia and high alkaline phosphatase, γ-glutamyltransferase, and alanine aminotransferase activities. Abdominal ultrasonography revealed diffuse hepatopathy and multiple pedunculated mucosal structures within the gallbladder. TREATMENT AND OUTCOME Following initial treatment with ursodiol (11.4 mg/kg [5.18 mg/lb], PO, q 12 h) and S-adenosylmethionine (30 mg/kg [13.6 mg/lb], PO, q 24 h) for 1 month to address possible cholestasis, no change was noted in ultrasonographic or serum biochemical findings. Consequently, laparoscopic cholecystectomy was performed concurrently with laparoscopic liver biopsy. Histologic evaluation of resected gallbladder tissue and the liver biopsy specimen revealed evidence of multifocal to coalescing leiomyomas of the gallbladder and multifocal lipogranulomas of the liver. Eleven days after the dog was discharged from the hospital, it was taken to an emergency clinic because of anorexia, vomiting, and diarrhea. Mild pancreatitis or gastroenteritis was suspected, supportive treatment was provided, and ursodiol and S-adenosylmethionine administration was reinitiated. At the time of follow-up telephone contact with the owner 234 days after surgery, the dog continued to receive ursodiol and S-adenosylmethionine and had no clinical signs associated with hepatobiliary disease. CLINICAL RELEVANCE Leiomyomas, although rare, can develop in dogs and should be considered as a differential diagnosis for intramural gallbladder lesions. Laparoscopic cholecystectomy served as a minimally invasive surgical treatment for this benign neoplasia.
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16
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Tokumitsu Y, Shindo Y, Matsui H, Matsukuma S, Nakajima M, Yoshida S, Iida M, Suzuki N, Takeda S, Nagano H. Laparoscopic total biopsy for suspected gallbladder cancer: A case series. Health Sci Rep 2020; 3:e156. [PMID: 32318627 PMCID: PMC7167592 DOI: 10.1002/hsr2.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Imaging diagnosis of gallbladder cancer remains difficult to achieve preoperatively. We developed a novel approach based on laparoscopic whole-layer cholecystectomy (LWLC) and laparoscopic gallbladder bed dissection (LGBD) for total biopsy, for ultimately determining the optimal treatment strategy for suspected gallbladder cancer detected on preoperative imaging. Here, we describe a case series of patients who underwent this procedure at our institution. METHODS We retrospectively examined clinicopathological data of consecutive patients with suspected gallbladder carcinoma at Yamaguchi University Graduate School of Medicine from September 2016 to July 2018 on which a laparoscopic approach was used. Preoperative imaging findings suggestive of gallbladder cancer were defined as follows: elevated lesion >10 mm in diameter, increasing tumor size over time compared with the previous imaging, sessile lesion, irregular wall thickness lesion mimicking cancer, elevated lesion with dense enhancement, or positive results on fluorodeoxyglucose positron emission tomography. LWLC was performed for early-stage or suspected malignant lesions without liver invasion, and LGBD was performed for lesions with an unclear border between the gallbladder and the liver. When postoperative pathological examination revealed the presence of gallbladder cancer invading into the subserosal layer, additional gallbladder bed resection and regional lymphadenectomy were considered. Patient characteristics, perioperative findings, pathological findings, and postoperative outcomes of patients who underwent LWLC or LGBD were reviewed retrospectively, and the short-term outcomes of the laparoscopic approach were analyzed. RESULTS Fifteen consecutive patients were included in the study. The median age of the patients was 63 years (IQR 42-76 years); 7 patients were males. We performed LWLC in 12 cases and LBGD in 3 cases. Median (IQR) operation time was 159 (140-193) min and median blood loss was 10 (5-30) mL. No bile leakage caused by intraoperative perforation of the gallbladder was seen. Median hospital stay was 7 (5-9) days. Only one patient developed postoperative complications (abdominal abscess). Histologically, gallbladder cancer was diagnosed in five cases (pT1a, n = 2; pT2, n = 3), and two of the pT2 patients underwent additional open surgery. CONCLUSIONS Our laparoscopic-based approach for suspected gallbladder cancer might represent a safe strategy and could play an important role in defining the optimal treatment strategy.
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Affiliation(s)
- Yukio Tokumitsu
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Yoshitaro Shindo
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Hiroto Matsui
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Satoshi Matsukuma
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Masao Nakajima
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Shin Yoshida
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Michihisa Iida
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Nobuaki Suzuki
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Shigeru Takeda
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineUbeYamaguchiJapan
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Abutaka A, El-Matbouly M, Helmy I, Elmoghazy W, Sulieman I, Ben Gashir M, Soofi M, Khalaf H, Elaffandi A. Repeat liver resection for pure large cell neuroendocrine carcinoma of the gallbladder: a favorable outcome. World J Surg Oncol 2019; 17:126. [PMID: 31325969 PMCID: PMC6642490 DOI: 10.1186/s12957-019-1666-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023] Open
Abstract
Background The pure large cell type is a rare variant of primary neuroendocrine carcinoma of the gallbladder. Few reports have mentioned extended survival. Although a multimodal treatment has been described in the treatment of such rare disease, redo liver resection has not yet been mentioned. Case report A 67-year-old lady was found to have poorly differentiated, high grade, pure large cell neuroendocrine tumor of the gallbladder after cholecystectomy for gallstones. After the diagnosis, staging workup showed a lesion in segment IVB/V of the liver, and chromogranin was elevated (982 mcg/L). The patient underwent central inferior hepatectomy and wedge excision of a lesion in segment III (discovered intra-operatively), with hilar lymphadenectomy. Three months after the first liver resection, she developed a new liver lesion II/III and underwent left lateral liver resection. The patient remained disease-free for 4 months following the second liver resection but then developed recurrent liver disease and was started on chemotherapy. Further progression led to multi-organ failure and death at 26 months from initial diagnosis. Conclusion This is the first reported repeat liver resection in such a rare disease that has led to extended overall survival. We suggest that a group of selected patients with this rare malignancy, and liver-limited disease, may benefit from repeated liver resection.
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Affiliation(s)
- Ahmad Abutaka
- Department of General Surgery, Hamad General Hospital, Doha, Qatar
| | | | - Irfan Helmy
- Weill Cornell Medical College Qatar, Qatar Foundation, Doha, Qatar
| | - Walid Elmoghazy
- Department of HPB Surgery and Liver Transplantation, Hamad General Hospital, Doha, Qatar.,Department of Surgery, Sohag University, Cairo, Egypt
| | - Ibnouf Sulieman
- Department of HPB Surgery and Liver Transplantation, Hamad General Hospital, Doha, Qatar
| | - Mohamed Ben Gashir
- Department of Laboratory Medicine and Pathology, Hamad General Hospital, Doha, Qatar
| | - Madiha Soofi
- Department of Laboratory Medicine and Pathology, Hamad General Hospital, Doha, Qatar
| | - Hatem Khalaf
- Department of HPB Surgery and Liver Transplantation, Hamad General Hospital, Doha, Qatar
| | - Ahmed Elaffandi
- Department of HPB Surgery and Liver Transplantation, Hamad General Hospital, Doha, Qatar. .,Department of Surgical Oncology, National Cancer Institute, Cairo, Egypt.
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18
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Lopez-Aguiar AG, Ethun CG, McInnis MR, Pawlik TM, Poultsides G, Tran T, Idrees K, Isom CA, Fields RC, Krasnick BA, Weber SM, Salem A, Martin RCG, Scoggins CR, Shen P, Mogal HD, Schmidt C, Beal EW, Hatzaras I, Shenoy R, Cardona K, Maithel SK. Association of perioperative transfusion with survival and recurrence after resection of gallbladder cancer: A 10-institution study from the US Extrahepatic Biliary Malignancy Consortium. J Surg Oncol 2018; 117:1638-1647. [PMID: 29761515 PMCID: PMC10182890 DOI: 10.1002/jso.25086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/02/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Perioperative blood transfusion is associated with poor outcomes in several malignancies. Its effect in gallbladder cancer (GBC) is unknown. METHODS All patients with GBC who underwent curative-intent resection at 10-institutions from 2000 to 2015 were included. The effect of blood transfusion on overall survival (OS) and recurrence-free (RFS) was evaluated. RESULTS Of 262 patients with curative-intent resection for GBC, 61 patients (23%) received blood transfusions. Radical cholecystectomy was the most common procedure (80%), but major hepatectomy was more frequent in the transfusion versus no-transfusion group (13% vs 4%; P = 0.02). The transfusion group was less likely to have incidentally discovered disease (57% vs 74%) and receive adjuvant therapy (29% vs 48%), but more likely to have preoperative jaundice (23% vs 11%), T3/T4 tumors (60% vs 39%), LVI (71% vs 40%), PNI (71% vs 48%), and major complications (39% vs 12%) (all P < 0.05). Transfusion was associated with lower median OS compared to no-transfusion (20 vs 32 mos; P < 0.001), which persisted on multivariable (MV) analysis (HR:1.9; 95%CI 1.1-3.5; P = 0.035), controlling for comorbidities, serum albumin, INR, preoperative jaundice, major hepatectomy, incidental discovery, margin status, T-Stage, LN status, and major complications. Median RFS of transfused patients was 13mo compared to 49mo for non-transfused patients (P = 0.1). Transfusion, however, was an independent predictor of decreased RFS on MV analysis (HR:2.3; 95%CI 1.1-5.1; P = 0.035). CONCLUSIONS Perioperative blood transfusion is associated with decreased OS and RFS after resection for GCC, accounting for other adverse factors. Transfusions should thus be administered with well-defined protocols.
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Affiliation(s)
- Alexandra G. Lopez-Aguiar
- Division of Surgical Oncology, Department of Surgery; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Cecilia G. Ethun
- Division of Surgical Oncology, Department of Surgery; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Mia R. McInnis
- Division of Surgical Oncology, Department of Surgery; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Timothy M. Pawlik
- Division of Surgical Oncology, Department of Surgery; The Johns Hopkins Hospital; Baltimore Maryland
- Division of Surgical Oncology; The Ohio State University Comprehensive Cancer Center; Columbus Ohio
| | - George Poultsides
- Department of Surgery; Stanford University Medical Center; Stanford California
| | - Thuy Tran
- Department of Surgery; Stanford University Medical Center; Stanford California
| | - Kamran Idrees
- Division of Surgical Oncology, Department of Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Chelsea A. Isom
- Division of Surgical Oncology, Department of Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Ryan C. Fields
- Department of Surgery; Washington University School of Medicine; St Louis Missouri
| | - Bradley A. Krasnick
- Department of Surgery; Washington University School of Medicine; St Louis Missouri
| | - Sharon M. Weber
- Department of Surgery; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
| | - Ahmed Salem
- Department of Surgery; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
| | - Robert C. G. Martin
- Division of Surgical Oncology; Department of Surgery, University of Louisville; Louisville Kentucky
| | - Charles R. Scoggins
- Division of Surgical Oncology; Department of Surgery, University of Louisville; Louisville Kentucky
| | - Perry Shen
- Department of Surgery; Wake Forest University; Winston-Salem North Carolina
| | - Harveshp D. Mogal
- Department of Surgery; Wake Forest University; Winston-Salem North Carolina
| | - Carl Schmidt
- Division of Surgical Oncology; The Ohio State University Comprehensive Cancer Center; Columbus Ohio
| | - Eliza W. Beal
- Division of Surgical Oncology; The Ohio State University Comprehensive Cancer Center; Columbus Ohio
| | | | - Rivfka Shenoy
- Department of Surgery; New York University; New York New York
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery; Winship Cancer Institute, Emory University; Atlanta Georgia
| | - Shishir K. Maithel
- Division of Surgical Oncology, Department of Surgery; Winship Cancer Institute, Emory University; Atlanta Georgia
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19
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Oven Ustaalioglu BB, Bilici A, Seker M, Kefeli U, Aydin D, Celik S, Demir T, Erkol B. Prognostic Factors for Operated Gallbladder Cancer. J Gastrointest Cancer 2018; 50:451-457. [DOI: 10.1007/s12029-018-0099-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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20
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Goussous N, Maqsood H, Patel K, Ferdosi H, Muhammad N, Sill AM, Kowdley GC, Cunningham SC. Clues to predict incidental gallbladder cancer. Hepatobiliary Pancreat Dis Int 2018; 17:149-154. [PMID: 29709218 DOI: 10.1016/j.hbpd.2018.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 10/30/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Consequences of incidental gallbladder cancer (iGBC) following cholecystectomy may include repeat operation (depending on T stage) and worse survival (if bile spillage occurred), both avoidable if iGBC were suspected preoperatively. METHODS A retrospective single-institution review was done. Ultrasound images for cases and controls were blindly reviewed by a radiologist. Chi-square and Student's t tests, as well as logistic regression and Kaplan-Meier analyses were used. A P ≤ 0.01 was considered significant. RESULTS Among 5796 cholecystectomies performed 2000-2013, 26 (0.45%) were iGBC cases. These patients were older (75.61 versus 52.27 years), had more laparoscopic-to-open conversions (23.1% versus 3.9%), underwent more imaging tests, had larger common bile duct diameter (7.13 versus 5.04 mm) and higher alkaline phosphatase. Ultrasound imaging showed that gallbladder wall thickening (GBWT) without pericholecystic fluid (PCCF), but not focal-versus-diffuse GBWT, was associated significantly with iGBC (73.9% versus 47.4%). On multivariable logistic regression analysis, GBWT without PCCF, and age were the strongest predictors of iGBC. The consequences iGBC depended significantly on intraoperative bile spillage, with nearly all such patients developing carcinomatosis and significantly worse survival. CONCLUSIONS Besides age, GBWT, dilated common bile duct, and elevated alkaline phosphatase, number of preoperative imaging modalities and the presence of GBWT without PCCF are useful predictors of iGBC. Bile spillage causes poor survival in patients with iGBC.
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Affiliation(s)
- Naeem Goussous
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Hadia Maqsood
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Kalpesh Patel
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Hamid Ferdosi
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Naseem Muhammad
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Anne M Sill
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Gopal C Kowdley
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA
| | - Steven C Cunningham
- Department of Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA.
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21
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PLZF inhibits proliferation and metastasis of gallbladder cancer by regulating IFIT2. Cell Death Dis 2018; 9:71. [PMID: 29358655 PMCID: PMC5833736 DOI: 10.1038/s41419-017-0107-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 02/06/2023]
Abstract
Gallbladder cancer (GBC) is a malignant cancer with very poor prognosis. Although promyelocytic leukemia zinc-finger protein (PLZF) was reported to be deregulated in numerous cancers and also relevant to clinical prognosis, its role in GBC progression has been little known. In this study, we found PLZF expression was decreased in GBC, correlating to advanced TNM stage, distant metastasis, and shorter overall survival. Moreover, ectopic PLZF expression in GBC cells (NOZ and GBC-SD) significantly reduced the cell proliferation, migration, and invasion. Consistently, overexpression of PLZF in xenograft mice model could suppress tumor growth and liver metastasis. Mechanical investigations verified PLZF could regulate the expression of cell cycle arrest-associated gene p21 and epithelial–mesenchymal transition (EMT)-related genes (E-cadherin and N-cadherin) in GBC cell lines. Importantly, PLZF remarkably increased the mRNA transcription of interferon-induced protein with tetratricopeptide repeat 2 (IFIT2) by increasing STAT1 protein level, a known factor involved in tumor progression. Furthermore, ablation of IFIT2 in PLZF overexpression cells abrogated the tumor-suppressive function of PLZF, at least partially, leading to impaired tumor growth and EMT program. These studies indicated PLZF inhibited the proliferation and metastasis via regulation of IFIT2. In conclusion, our study demonstrated PLZF could be a promising tumor biomarker for GBC, and also be a potential therapeutic target.
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Zhang L, Hou C, Xu Z, Wang L, Ling X, Xiu D. Laparoscopic treatment for suspected gallbladder cancer confined to the wall: a 10-year study from a single institution. Chin J Cancer Res 2018; 30:84-92. [PMID: 29545722 DOI: 10.21147/j.issn.1000-9604.2018.01.09] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective Although laparoscopic treatment of gallbladder cancer (GBC) has been explored in the last decade, long-term results are still rare. This study evaluates long-term results of intended laparoscopic treatment for suspected GBC confined to the gallbladder wall, based on our experience over 10 years. Methods Between August 2006 and December 2015, 164 patients with suspected GBC confined to the wall were enrolled in the protocol for laparoscopic surgery. The process for GBC treatment was analyzed to evaluate the feasibility of computed tomography (CT) and/or magnetic resonance imaging (MRI) combined with frozen-section examination in identifying GBC confined to the wall. Of 159 patients who underwent the intended laparoscopic radical treatment, 47 with pathologically proven GBC were investigated to determine the safety and oncologic outcomes of a laparoscopic approach to GBC. Results Among the 164 patients, 5 patients avoided further radical surgery because of unresectable disease and 12 were converted to open surgery; in the remaining 147 patients, totally laparoscopic treatment was successfully accomplished. Extended cholecystectomy was performed in 37 patients and simple cholecystectomy in 10. The T stages based on final pathology were Tis (n=6), T1a (n=2), T1b (n=9), T2 (n=26), and T3 (n=4). Recurrence was detected in 11 patients over a median follow-up of 51 months. The disease-specific 5-year survival rate of these 47 patients was 68.8%, and rose to 85% for patients with a normal cancer antigen 19-9 (CA19-9) level. Conclusions The favorable long-term outcomes demonstrate the feasibility of combined CT/MRI and frozen-section examination in the selection of patients with GBC confined to the gallbladder wall, confirm the oncologic safety of laparoscopic treatment in selected GBC patients, and favor measurement of preoperative CA19-9 in the selection of GBCs suitable for laparoscopic treatment.
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Affiliation(s)
- Lingfu Zhang
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Chunsheng Hou
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Zhi Xu
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Lixin Wang
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Xiaofeng Ling
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
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Minimally invasive and open gallbladder cancer resections: 30- vs 90-day mortality. Hepatobiliary Pancreat Dis Int 2017; 16:405-411. [PMID: 28823371 DOI: 10.1016/s1499-3872(17)60025-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 03/17/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Minimally invasive surgery is increasingly used for gallbladder cancer resection. Postoperative mortality at 30 days is low, but 90-day mortality is underreported. METHODS Using National Cancer Database (1998-2012), all resection patients were included. Thirty- and 90-day mortality rates were compared. RESULTS A total of 36 067 patients were identified, 19 139 (53%) of whom underwent resection. Median age was 71 years and 70.7% were female. Ninety-day mortality following surgical resection was 2.3-fold higher than 30-mortality (17.1% vs 7.4%). There was a statistically significant increase in 30- and 90-day mortality with poorly differentiated tumors, presence of lymphovascular invasion, tumor stage, incomplete surgical resection and low-volume centers (P<0.001 for all). Even for the 1885 patients who underwent minimally invasive resection between 2010 and 2012, the 90-day mortality was 2.8-fold higher than the 30-day mortality (12.0% vs 4.3%). CONCLUSIONS Ninety-day mortality following gallbladder cancer resection is significantly higher than 30-day mortality. Postoperative mortality is associated with tumor grade, lymphovascular invasion, tumor stage, type and completeness of surgical resection as well as type and volume of facility.
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Muszynska C, Lundgren L, Lindell G, Andersson R, Nilsson J, Sandström P, Andersson B. Predictors of incidental gallbladder cancer in patients undergoing cholecystectomy for benign gallbladder disease: Results from a population-based gallstone surgery registry. Surgery 2017; 162:256-263. [PMID: 28400123 DOI: 10.1016/j.surg.2017.02.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/12/2017] [Accepted: 02/24/2017] [Indexed: 02/06/2023]
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Kuga D, Ebata T, Yokoyama Y, Igami T, Sugawara G, Mizuno T, Yamaguchi J, Nagino M. Long-term survival after multidisciplinary therapy for residual gallbladder cancer with peritoneal dissemination: a case report. Surg Case Rep 2017; 3:76. [PMID: 28616794 PMCID: PMC5471273 DOI: 10.1186/s40792-017-0351-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/08/2017] [Indexed: 02/06/2023] Open
Abstract
Background Although surgical resection is the only curative treatment for gallbladder cancer (GBC), concomitant peritoneal dissemination is considered far beyond the scope of resection. We report a long-term survivor with a residual GBC with multiple peritoneal disseminations who underwent an extended resection after effective chemotherapy. Case presentation A 59-year-old male underwent an open cholecystectomy for Mirizzi syndrome at a local hospital. Because of severe inflammation, the gallbladder was perforated during surgery, ending in a piecemeal resection. A pathological examination revealed GBC with positive margins, and the patient was referred to our hospital 1 month after surgery for further treatment. A multidetector-row computed tomography (MDCT) showed three hypoattenuated tumours: a tumour (3.9 cm) at the left medial segment corresponding to the gallbladder bed, a tumour (1.8 cm) around the hepatic flexure of the transverse colon, and a tumour (1.0 cm) at the stump of the cystic duct. Percutaneous needle biopsy was performed, which provided histologic evidence of adenocarcinoma. Thus, the patient had a rapidly progressive local relapse with limited peritoneal dissemination, labelled ycT3N0M1, stage IVB disease according to the UICC system. After the administration of 3 cycles of gemcitabine plus cisplatin combination chemotherapy, the size of all tumours and the CA19-9 level decreased significantly. Since the patient’s general condition and liver function reserve were satisfactory, we decided the initial unresectable scenario to perform surgical therapy. After portal vein embolization, right hepatectomy, resection of the extrahepatic bile duct, partial duodenectomy, and partial colectomy were performed. Operative time was 555 min, and intraoperative blood loss was 1654 mL. Pathologic diagnosis of residual gallbladder carcinoma with peritoneal dissemination was confirmed, and the surgical margins were tumour-free. The patient was discharged on postoperative day 29, with a Clavien-Dindo IIIa complication (abdominal wall abscess). Postoperative adjuvant chemotherapy with tegafur/gimeracil/oteracil was administered during 1 year after surgery. The patient is doing well 6 years after the second surgery without evidence of disease. Conclusions Although specific clinical factors were associated with a favourable outcome in this patient, the present report suggests that multidisciplinary therapy may be a promising option in selected patients with distant metastatic GBC.
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Affiliation(s)
- Daisuke Kuga
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Gen Sugawara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masato Nagino
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Jang JY, Heo JS, Han Y, Chang J, Kim JR, Kim H, Kwon W, Kim SW, Choi SH, Choi DW, Lee K, Jang KT, Han SS, Park SJ. Impact of Type of Surgery on Survival Outcome in Patients With Early Gallbladder Cancer in the Era of Minimally Invasive Surgery: Oncologic Safety of Laparoscopic Surgery. Medicine (Baltimore) 2016; 95:e3675. [PMID: 27258495 PMCID: PMC4900703 DOI: 10.1097/md.0000000000003675] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Laparoscopic surgery has been widely accepted as a feasible and safe treatment modality in many cancers of the gastrointestinal tract. However, most guidelines on gallbladder cancer (GBC) regard laparoscopic surgery as a contraindication, even for early GBC. This study aims to evaluate and compare recent surgical outcomes of laparoscopic and open surgery for T1(a,b) GBC and to determine the optimal surgical strategy for T1 GBC.The study enrolled 197 patients with histopathologically proven T1 GBC and no history of other cancers who underwent surgery from 2000 to 2014 at 3 major tertiary referral hospitals with specialized biliary-pancreas pathologists and optimal pathologic handling protocols. Median follow-up was 56 months. The effects of depth of invasion and type of surgery on disease-specific survival and recurrence patterns were investigated.Of the 197 patients, 116 (58.9%) underwent simple cholecystectomy, including 31 (15.7%) who underwent open cholecystectomy and 85 (43.1%) laparoscopic cholecystectomy. The remaining 81 (41.1%) patients underwent extended cholecystectomy. Five-year disease-specific survival rates were similar in patients who underwent simple and extended cholecystectomy (96.7% vs 100%, P = 0.483), as well as being similar in patients in the simple cholecystectomy group who underwent open and laparoscopic cholecystectomy (100% vs 97.6%, P = 0.543). Type of surgery had no effect on recurrence patterns.Laparoscopic cholecystectomy for T1 gallbladder cancer can provide similar survival outcomes compared to open surgery. Considering less blood loss and shorter hospital stay with better cosmetic outcome, laparoscopic cholecystectomy can be justified as a standard treatment for T1b as well as T1a gallbladder cancer when done by well-experienced surgeons based on exact pathologic diagnosis.
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Affiliation(s)
- Jin-Young Jang
- From the Department of Surgery and Cancer Research Institute (J-YJ, YH, JC, JRK, HK, WK, S-WK), Seoul National University College of Medicine; Department of Surgery (JSH, WK, SHC, DWC), Sungkyunkwan University School of Medicine; Department of Pathology (KL), Seoul National University College of Medicine; Department of Pathology and Translational Genomics (K-TJ), Sungkyunkwan University School of Medicine, Seoul; and Center for Liver Cancer (S-SH, S-JP), National Cancer Center, Gyeonggido, Republic of Korea
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Choudhary S, Asthana AK. Impact of Adjuvant Therapy on Survival in Curatively Resected Gallbladder Carcinoma. J Clin Diagn Res 2015; 9:XC01-XC04. [PMID: 26500994 DOI: 10.7860/jcdr/2015/15113.6436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/15/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND Gallbladder carcinoma (GBC) has the propensity to fail at loco-regional (LR) and distant sites despite aggressive radical surgery. Adjuvant therapy in the form of radiotherapy (RT), systemic chemotherapy (CT) and chemoradiation (CRT) is the usual practice. Due to rarity of this disease, there is limited evidence to suggest the type of adjuvant treatment which should be offered to the patients. AIM The study was conducted to evaluate the impact of adjuvant treatment on curatively resected GBC patients. SETTINGS AND DESIGN Histological proven patients of GBC registered between June, 2008 and July, 2014 were identified from our hospital database and retrospective analysis was done. MATERIALS AND METHODS Patients of GBC who had curative resection followed by adjuvant treatment as RT alone, CT alone or CRT were included in the study. STATISTICAL ANALYSIS Adverse prognostic factors and the effect of adjuvant treatment on overall survival (OS) and disease free survival (DFS) were evaluated using Cox Regression Method and Kaplan Meier plot. RESULTS We identified 33 patients of which 23 were Stage I or II disease (Early disease) and the remaining 10 were Stage III or IV disease (Advanced disease). All except one patient had adenocarcinoma. A total of 5 patients were treated with RT alone while 16 patients received CT alone. The remaining 12 patients were treated with CRT. Median follow-up period was 8.5 months. At analysis 4 were alive while the remaining 29 were dead due to disease. With regard to "Early disease" patients who had RT alone, CT alone and CRT, the median OS was 22.3, 10.3 and 15.2 months respectively (p = .440). Cohort of patients with "Advanced disease" who were treated with CT alone and CRT the median OS was 7.5 and 7.0 months respectively (p = .643). On multivariate analysis none of the prognostic factors had an adverse impact on survival. CONCLUSION The impact of adjuvant treatment in the form of RT, CT or CRT after curative resection in GBC patients was seen in terms of improved survival but was not statistically significant.
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Affiliation(s)
- Sunil Choudhary
- Assistant Professor, Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University , Varanasi, India
| | - Anupam Kumar Asthana
- Professor, Department of Radiotherapy & Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University , Varanasi, India
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Lai QY, Wang DS. Surgical treatment of gallbladder cancer: Strategy and optimization. Shijie Huaren Xiaohua Zazhi 2015; 23:1865-1872. [DOI: 10.11569/wcjd.v23.i12.1865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gallbladder cancer is the most common malignant tumor of the biliary tract. It is difficult to diagnose early due to the lack of special symptoms and physical signs. Most cases are diagnosed in advanced stages and the response to traditional chemotherapy and radiotherapy is extremely limited, with modest impact on overall survival. Despite improvements in outcome associated with extended resections, selection of patients for such extensive surgery remains controversial. In this article, we analyze and discuss the key issues about the surgical management of gallbladder cancer, with the hope of a more comprehensive recognition of this malignancy.
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Miyazaki M, Yoshitomi H, Miyakawa S, Uesaka K, Unno M, Endo I, Ota T, Ohtsuka M, Kinoshita H, Shimada K, Shimizu H, Tabata M, Chijiiwa K, Nagino M, Hirano S, Wakai T, Wada K, Isayama H, Iasayama H, Okusaka T, Tsuyuguchi T, Fujita N, Furuse J, Yamao K, Murakami K, Yamazaki H, Kijima H, Nakanuma Y, Yoshida M, Takayashiki T, Takada T. Clinical practice guidelines for the management of biliary tract cancers 2015: the 2nd English edition. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:249-73. [PMID: 25787274 DOI: 10.1002/jhbp.233] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Japanese Society of Hepato-Biliary-Pancreatic Surgery launched the clinical practice guidelines for the management of biliary tract and ampullary carcinomas in 2008. Novel treatment modalities and handling of clinical issues have been proposed after the publication. New approaches for editing clinical guidelines, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, also have been introduced for better and clearer grading of recommendations. METHODS Clinical questions (CQs) were proposed in seven topics. Recommendation, grade of recommendation and statement for each CQ were discussed and finalized by evidence-based approach. Recommendation was graded to grade 1 (strong) and 2 (weak) according to the concept of GRADE system. RESULTS The 29 CQs covered seven topics: (1) prophylactic treatment, (2) diagnosis, (3) biliary drainage, (4) surgical treatment, (5) chemotherapy, (6) radiation therapy, and (7) pathology. In 27 CQs, 19 recommendations were rated strong and 11 recommendations weak. Each CQ included the statement of how the recommendation was graded. CONCLUSIONS This guideline provides recommendation for important clinical aspects based on evidence. Future collaboration with cancer registry will be a key for assessment of the guidelines and establishment of new evidence. Free full-text articles and a mobile application of this guideline are available via http://www.jshbps.jp/en/guideline/biliary-tract2.html.
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Affiliation(s)
- Masaru Miyazaki
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Tsirlis T, Ausania F, White SA, French JJ, Jaques BC, Charnley RM, Manas DM. Implications of the index cholecystectomy and timing of referral for radical resection of advanced incidental gallbladder cancer. Ann R Coll Surg Engl 2015; 97:131-6. [PMID: 25723690 PMCID: PMC4473390 DOI: 10.1308/003588414x14055925060073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Advanced (pT2/T3) incidental gallbladder cancer is often deemed unresectable after restaging. This study assesses the impact of the primary operation, tumour characteristics and timing of management on re-resection. METHODS The records of 60 consecutive referrals for incidental gallbladder cancer in a single tertiary centre from 2003 to 2011 were reviewed retrospectively. Decision on re-resection of incidental gallbladder cancer was based on delayed interval restaging at three months following cholecystectomy. Demographics, index cholecystectomy data, primary pathology, CA19-9 tumour marker levels at referral and time from cholecystectomy to referral as well as from referral to restaging were analysed. RESULTS Thirty-seven patients with pT2 and twelve patients with pT3 incidental gallbladder cancer were candidates for radical re-resection. Following interval restaging, 24 patients (49%) underwent radical resection and 25 (51%) were deemed inoperable. The inoperable group had significantly more patients with positive resection margins at cholecystectomy (p=0.002), significantly higher median CA19-9 levels at referral (p=0.018) and were referred significantly earlier (p=0.004) than the patients who had resectable tumours. On multivariate analysis, urgent referral (p=0.036) and incomplete cholecystectomy (p=0.048) were associated significantly with inoperable disease following restaging. CONCLUSIONS In patients with incidental, potentially resectable, pT2/T3 gallbladder cancer, inappropriate index cholecystectomy may have a significant impact on tumour dissemination. Early referral of breached tumours is not associated with resectability.
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Affiliation(s)
- T Tsirlis
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - F Ausania
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - SA White
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - JJ French
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - BC Jaques
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - RM Charnley
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - DM Manas
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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Abstract
Among biliary tract cancers, gallbladder cancer (GBC) is a potentially lethal malignancy with abysmal long-term survival. Surgery is central to the management of GBC, and presently, provides the only ray of hope for long-term survival. Radical cholecystectomy, which includes cholecystectomy with a limited hepatic resection, regional lymphadenectomy and adjacent organ resection if required is used to encompass the tumor with negative margins - R'0' resection is the standard surgical treatment for the management of GBC. Absence of randomized controlled trials to address various surgical controversies due to rarity of disease in western world, advanced disease at presentation, high frequency of unresectability/inoperability at surgery, deficient neoadjuvant/adjuvant strategies and nihilistic views of oncologists due to aggressive disease biology has resulted in marked heterogeneity in surgical strategies employed to manage GBC across the surgical centers globally.
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Affiliation(s)
- Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Dilshad Garden, Delhi 110095, India
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Goetze TO, Paolucci V. Influence of high- and low-volume liver surgery in gallbladder carcinoma. World J Gastroenterol 2014; 20:18445-18451. [PMID: 25561815 PMCID: PMC4277985 DOI: 10.3748/wjg.v20.i48.18445] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/17/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To clarify whether the performance of liver resections (LR) for incidental gallbladder carcinoma (IGBC)’s depends more on the experience of the hospitals in liver surgery than on complying with the guidelines in Germany.
METHODS: For data analysis, we used the Surgical Association of Endoscopy and Ultrasound and Minimally Invasive Surgery Central Registry of “IGBC” of the German Society of Surgery (the German Registry). In 2010, we started a second form by requesting the frequency of LR at the various hospitals in Germany. The indication for LR was irrelevant. The aim was to determine the overall frequency of liver resections at the hospitals. We divided the hospitals according to their experience in liver surgery into high- (HV), mid- (MV), and low-volume (LV) LR hospitals.
RESULTS: This study includes 487 IGBC’s from 167 centers. There were 36 high-volume, 32 mid-volume, and 99 low-volume centers. In the high-volume centers, the mean (range) number of liver resections was 101 (40-300). In the mid-volume centers, the mean (range) number of liver resections was 26 (20-39). In the low-volume centers, the mean (range) number of liver resections was 6.5 (0-19) (P < 0.001). LV’s perform LR for T2-3 gallbladder carcinomas significantly less often than high-volume or mid-volume centers (χ2 = 13.78, P = 0.001). In HV’s and MV’s, 61% of the patients with an indication for liver resection underwent LR, but in LV centers, only 41% with an indication for LR underwent LR (P < 0.001). In cases of T1b carcinomas, LR was performed significantly more often in HV’s (P = 0.009).
CONCLUSION: The central problem is that the performance of the required liver resection in IGBC in Germany depends on the hospital experience in liver surgery and not on the recommendations of the German guidelines.
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Zhang HY, Dou KF. PCBP1 is an important mediator of TGF-β-induced epithelial to mesenchymal transition in gall bladder cancer cell line GBC-SD. Mol Biol Rep 2014; 41:5519-24. [PMID: 24889597 DOI: 10.1007/s11033-014-3428-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/17/2014] [Indexed: 02/06/2023]
Abstract
Gall bladder carcinoma (GBC) is the seventh most common cancer across the globe and the most common malignancy of the biliary tract. Most GBC related deaths occur due to secondary progression and metastasis to distant organs. Epithelial-mesenchymal transition (EMT) is an important pre-requisite for tumor metastasis, however its mechanism in GBC has not yet been defined. Using the GBC-SD cell line, we have uncovered an important mediator, poly r(C) binding protein-1 (PCBP1), of transforming growth factor-beta (TGF-β)-induced EMT in GBC. Our results show that TGF-β treatment resulted in PCBP1 phosphorylation in accordance with similar observation in other model systems. We further showed through gain- and loss-of-function assays that PCBP1 expression levels regulate the capacity of GBC-SD cells to migrate and invade in vitro. Finally, our results showed that PCBP1 expression levels also regulate generation of CD44(+)CD24(-) progenitor cell population in GBC-SD cells after TGF-β treatment. Cumulatively, our results indicate, pending further validation, that PCBP1 might be a prognostic marker for GBC metastasis.
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Affiliation(s)
- Hang-Yu Zhang
- Department of Hepatobiliary Surgery, The Fourth Military Medical University Xijing Hospital, No. 15 Changlexi Road, Xi'an City, 710032, Shaanxi Province, China
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Judge JM, Stukenborg GJ, Johnston WF, Guilford WH, Slingluff CL, Hallowell PT. Design, development, and evaluation of a novel retraction device for gallbladder extraction during laparoscopic cholecystectomy. J Gastrointest Surg 2014; 18:334-9. [PMID: 23897085 PMCID: PMC4465918 DOI: 10.1007/s11605-013-2292-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 07/15/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND A source of frustration during laparoscopic cholecystectomy involves extraction of the gallbladder through port sites smaller than the gallbladder itself. We describe the development and testing of a novel device for the safe, minimal enlargement of laparoscopic port sites to extract large, stone-filled gallbladders from the abdomen. METHODS The study device consists of a handle with a retraction tongue to shield the specimen and a guide for a scalpel to incise the fascia within the incision. Patients enrolled underwent laparoscopic cholecystectomy. Gallbladder extraction was attempted. If standard measures failed, the device was implemented. Extraction time and device utility scores were recorded for each patient. Patients returned 3-4 weeks postoperatively for assessment of pain level, cosmetic effect, and presence of infectious complications. RESULTS Twenty (51 %) of 39 patients required the device. Average extraction time for the first eight patients was 120 s. After interim analysis, an improved device was used in 12 patients and average extraction time was 24 s. There were no adverse events. Postoperative pain ratings and incision cosmesis were comparable between patients with and without use of the device. CONCLUSION The study device enables safe and rapid extraction of impacted gallbladders through the abdominal wall.
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Affiliation(s)
- Joshua M. Judge
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - George J. Stukenborg
- Department of Public Health Science, University of Virginia, Charlottesville, Virginia
| | | | - William H. Guilford
- Department of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
| | - Craig L. Slingluff
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Peter T. Hallowell
- Department of Surgery, University of Virginia, Charlottesville, Virginia
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MiR-20a triggers metastasis of gallbladder carcinoma. J Hepatol 2013; 59:518-27. [PMID: 23665284 DOI: 10.1016/j.jhep.2013.04.034] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/02/2013] [Accepted: 04/24/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS The dysfunction of miRNAs has been demonstrated to participate in the development of various tumors. However, whether miRNAs are involved in metastasis and progression of gallbladder carcinoma (GBC) remains unknown. METHODS A new designed gain-of-function miRNA screening technology was applied to filter out pro-metastatic miRNAs in GBC. Their expression in GBC tissues was validated by real-time PCR. The biological functions of miRNAs were intensively studied by transwell, immunoblot, immunohistochemical, and in situ hybridization assays. Tumorigenicity and liver metastasis were further examined in nude mice. RESULTS Of 880 miRNAs, 17 were filtered out as the prominent metastatic inducers of GBCs. Among them, the upregulation of pro-metastatic miR-20a was closely associated with local invasion, distant metastasis, and poor prognosis of 67 followed-up GBC patients, clinically. Patients with higher miR-20a expression exhibited worse overall survival (OS and median OS time was 5 and 20 months, respectively) than the lower expression group. A dramatically increased TGF-β1 level was found in GBC patients, which was responsible for the elevation of miR-20a. The ectopic expression of miR-20a could induce epithelial-mesenchymal transition and enhance metastasis of GBC cells in vitro and in vivo, by directly targeting the 3' UTR of Smad7, and subsequently promoting nuclear translocation of β-catenin. Conversely, the blockage of miR-20a by specific antagomir effectively restored the expression of Smad7 and attenuated TGF-β-induced cell metastasis. CONCLUSIONS TGF-β1-mediated activation of the miR-20a/Smad7/β-catenin axis plays a pivotal role in the pathogenesis and worse prognosis of GBCs and may serve as a potential therapeutic target in the future.
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PSCA and Oct-4 expression in the benign and malignant lesions of gallbladder: implication for carcinogenesis, progression, and prognosis of gallbladder adenocarcinoma. BIOMED RESEARCH INTERNATIONAL 2013; 2013:648420. [PMID: 23984394 PMCID: PMC3747335 DOI: 10.1155/2013/648420] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 06/09/2013] [Indexed: 02/06/2023]
Abstract
PSCA and Oct-4 have been thought as markers of cancer stem cells. Although overexpression of PSCA and Oct-4 in cancer has been reported, little is known about the clinical and pathological significance with PSCA and Oct-4 expression in gallbladder adenocarcinoma. In this study, overexpression of PSCA and Oct-4 was detected in gallbladder adenocarcinoma (54.6% and
55.6%). Less expression of PSCA and Oct-4 was detected in the pericancerous tissues (19.6% and 21.7%), gallbladder polyps (13.3% and 13.3%), and gallbladder epithelium with chronic cholecystitis (14.3% and 14.3%). The overexpression of PSCA and Oct-4 was significantly associated with differentiation, tumor mass, lymph node metastasis, invasion of gallbladder adenocarcinoma, and decreased overall survival. Our study suggested that overexpression of PSCA and Oct-4 might be closely related to the carcinogenesis, progression, metastasis, or invasive potential and prognosis of gallbladder carcinoma.
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Lai HC, Chang SN, Lin CC, Chen CC, Chou JW, Peng CY, Lai SW, Sung FC, Li YF. Does diabetes mellitus with or without gallstones increase the risk of gallbladder cancer? Results from a population-based cohort study. J Gastroenterol 2013; 48:856-65. [PMID: 23065035 DOI: 10.1007/s00535-012-0683-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 09/07/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Previous studies have suggested that diabetes mellitus (DM) is a risk factor for gallbladder cancer; however, it remains unclear whether DM with or without gallstones increases the risk of gallbladder cancer. The aim of this study was to evaluate the risk factors for gallbladder cancer, including sex, hypertension, hyperlipidemia, gallstones, and DM. METHODS The study cohort consisted of 214,179 subjects newly diagnosed with diabetes (cases) collected from the claims data of the Health Insurance Program of Taiwan from 2000 to 2001 who were retrospectively enrolled. The control group consisted of 206,860 subjects without diabetes, matched with the cases for sex, age, and index year. The subjects were followed up until the end of 2008. The effects of the risk factors on the incidence of gallbladder cancer were evaluated with Cox's proportional hazard regression models. RESULTS The risk of gallbladder cancer was higher in the DM group than in the non-DM group, with a hazard ratio (HR) of 1.53 [95 % confidence interval (CI) 1.22-1.90]. Gallstones were also a risk factor for gallbladder cancer, with an HR of 2.52 (95 % CI 1.11-5.73). DM and gallstones were synergistic risk factors for gallbladder cancer (p < 0.0001), with an HR of 5.37 (95 % CI 3.17-9.10) for subjects with both diseases in relation to those with neither of these conditions. CONCLUSIONS In the present long-term cohort study, DM with or without gallstones increased the risk of gallbladder cancer. Gallstones were independently related to gallbladder cancer, and DM and gallstones were synergistic risk factors for gallbladder cancer.
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Affiliation(s)
- Hsueh-Chou Lai
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
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Fuks D, Regimbeau JM, Pessaux P, Bachellier P, Raventos A, Mantion G, Gigot JF, Chiche L, Pascal G, Azoulay D, Laurent A, Letoublon C, Boleslawski E, Rivoire M, Mabrut JY, Adham M, Le Treut YP, Delpero JR, Navarro F, Ayav A, Boudjema K, Nuzzo G, Scotte M, Farges O. Is port-site resection necessary in the surgical management of gallbladder cancer? J Visc Surg 2013; 150:277-84. [PMID: 23665059 DOI: 10.1016/j.jviscsurg.2013.03.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Gallbladder carcinoma is frequently discovered incidentally on pathologic examination of the specimen after laparoscopic cholecystectomy (LC) performed for presumed "benign" disease. The objective of the present study was to assess the role of excision of port-sites from the initial LC for patients with incidental gallbladder carcinoma (IGBC) in a French registry. METHODS Data on patients with IGBC identified after LC between 1998 and 2008 were retrospectively collated in a French multicenter database. Among those patients undergoing re-operation with curative intent, patients with port-site excision (PSE) were compared with patients without PSE and analyzed for differences in recurrence patterns and survival. RESULTS Among 218 patients with IGBC after LC (68 men, 150 women, median age 64 years), 148 underwent re-resection with curative intent; 54 patients had PSE and 94 did not. Both groups were comparable with regard to demographic data (gender, age > 70, co-morbidities), surgical procedures (major resection, lymphadenectomy, main bile duct resection) and postoperative morbidity. In the PSE group, depth of tumor invasion was T1b in six, T2 in 24, T3 in 22, and T4 in two; this was not significantly different from patients without PSE (P = 0.69). Port-site metastasis was observed in only one (2%) patient with a T3 tumor who died with peritoneal metastases 15 months after resection. PSE did not improve the overall survival (77%, 58%, 21% at 1, 3, 5 years, respectively) compared to patients with no PSE (78%, 55%, 33% at 1, 3, 5 years, respectively, P = 0.37). Eight percent of patients developed incisional hernia at the port-site after excision. CONCLUSION In patients with IGBC, PSE was not associated with improved survival and should not be considered mandatory during definitive surgical treatment.
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Affiliation(s)
- D Fuks
- Département de chirurgie digestive et métabolique, université de Picardie, hôpital Nord-Amiens, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 01, France
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Goetze TO, Paolucci V. Prognosis of incidental gallbladder carcinoma is not influenced by the primary access technique: analysis of 837 incidental gallbladder carcinomas in the German Registry. Surg Endosc 2013; 27:2821-8. [PMID: 23404149 DOI: 10.1007/s00464-013-2819-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/28/2012] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of the laparoscopic approach (LC) for gallbladder carcinoma and incidental gallbladder carcinomas (IGBC) remains controversial. However, recent studies suggest that LC has no adverse effects relative to the open approach. A definitive conclusion regarding the safety of LC that is based on data from a large patient cohort is needed. METHODS To draw a definite conclusion about the safety of LC in IGBC, data from the 837 patients with IGBC [registered in the German Registry (GR)] were analyzed. RESULTS Of the 837 patients, 492 underwent LC, 200 underwent open surgery (OC), and 142 initially underwent LC, but the approach was converted to OC. The 5-year survival rates of the three groups indicated that LC was associated with significantly better survival. LC was not associated with a poorer prognosis in patients with T1, T2, or T3 stage disease or in patients who underwent immediate radical re-resection (IRR; n = 330). LC was associated with a significant survival benefit in the 490 patients who did not undergo IRR. LC was comparable with OC in terms of overall recurrence rates and the rate of accidental intraoperative perforation. CONCLUSIONS The GR data, which relate to a large homogenous patient cohort, showed that when other potential influencing factors, e.g., IRR were eliminated, the primary access technique had no effect on prognosis. Stage-adjusted therapy should always be performed irrespective of the primary access technique.
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Unsuspected gallbladder carcinoma discovered during or after cholecystectomy: focus on appropriate radical re-resection according to the T-stage. Clin Transl Oncol 2013; 15:652-8. [PMID: 23359177 DOI: 10.1007/s12094-012-0988-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 12/05/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The long-term survival of patients with unsuspected gallbladder carcinoma (UGC) and the role of radical re-resection for this disease remain unclear. METHODS A retrospective study was carried out on 38 UGC patients. The time-to-event data were demonstrated by Kaplan-Meier curves. Comparing survival curves of two groups using the log-rank test. RESULTS The overall incidence of UGC in patients underwent cholecystectomy in our hospital was 0.18 % (25 of 14,073). Distribution according to actual pT-stage (the UICC) was: pT1a: n = 3; pT1b: n = 11; pT2: n = 4; pT3: n = 12; pT4: n = 8. The preoperative diagnosis included a high rate of acute biliary tract inflammation (24 of 38, 63.2 %). Compared with other gallbladder carcinoma patients, UGC group had significantly higher proportion of early stages (pT1) (36.8 %, 14 of 38 cases) (p < 0.01), and better prognosis. The comparison of radical re-resection versus simple cholecystectomy showed a significant benefit in overall survival for the pT3 group (22.0 ± 5.48 vs. 5.0 ± 0.9 months; p = 0.02). There are median survival differences between the two subgroups of patients with pT1b tumors whether received re-resection or not. Median survival was 62.0 months and 24.0 ± 8.5 months, respectively, though the differences are not statistically significant (p = 0.131). CONCLUSION Radical re-resection is strongly recommended for patients with pT1b-stage cancer. The reoperation should be performed as soon as possible, preferably within 10 days after the initial operation.
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Koshenkov VP, Koru-Sengul T, Franceschi D, Dipasco PJ, Rodgers SE. Predictors of incidental gallbladder cancer in patients undergoing cholecystectomy for benign gallbladder disease. J Surg Oncol 2012; 107:118-23. [PMID: 22886779 DOI: 10.1002/jso.23239] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 07/16/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Discovery of incidental gallbladder cancer (IGC) has become more frequent due to adoption of laparoscopy. Gallbladder spillage during operation can disseminate cancer and worsen the prognosis. METHODS Patients who underwent laparoscopic or open cholecystectomy for benign gallbladder disease January 1996 to August 2011 at two tertiary care facilities were reviewed. Unmatched controls were randomly selected in 2:1 ratio. Preoperative variables were compared between the two groups. RESULTS Sixty-seven patients with IGC were identified and compared to 134 controls. Mean age was 68 for index cases and 49 for controls; 70% of cases and 75% of controls were female. Multivariate analysis showed that higher risk of IGC was significantly associated with age ≥ 65 (OR = 10.61, P < 0.0001), dilated bile ducts (OR = 4.76, P = 0.0028), and presence of gallbladder wall thickening (OR = 4.39, P = 0.0003). This model yielded a very good area under the curve of receiver operating characteristic (AUC = 0.83) for discriminating the patients with IGC from controls. CONCLUSIONS IGC is more likely to be found in patients when age is ≥65, with dilated bile ducts and gallbladder wall thickening. Preoperative suspicion of gallbladder cancer should prompt the surgeon to be more careful not to perforate the gallbladder during laparoscopic approach, and to have a lower threshold for conversion if necessary.
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Affiliation(s)
- Vadim P Koshenkov
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Fuks D, Regimbeau JM, Le Treut YP, Bachellier P, Raventos A, Pruvot FR, Chiche L, Farges O. Incidental gallbladder cancer by the AFC-GBC-2009 Study Group. World J Surg 2011; 35:1887-97. [PMID: 21547420 DOI: 10.1007/s00268-011-1134-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidental gallbladder cancer (GBC) is frequently discovered on the specimen when cholecystectomy for a benign disease is performed. The objective of the present study was to assess the management of incidental GBC patients in a French registry. METHODS Data on patients with GBC treated between 1998 and 2008 were retrospectively collated in a French, multicenter database. RESULTS The registry contained 218 patients with incidental GBC (67 men and 151 women; median age = 64 years; age range = 31-88). One hundred forty-eight (68%) patients underwent re-resection after a median time interval of 48 days (range = 2-245). The most common complete procedure (66% of cases) was 4b + 5 segmentectomy with lymphadenectomy but not bile duct resection. Port-site excision was performed in 54 patients. The mortality and morbidity rates were 3 and 37%, respectively. Resection of the common bile duct (43%) increased postoperative complications (60 vs. 23%, p = 0.0001). Local residual tumor was found in 83 (56%) patients; it was significantly correlated with the T stage and influenced long-term survival. R0 was obtained in 143 (97%) patients and port-site invasion was histologically confirmed in one patient (1.8%). After a median follow-up period of 34 months, the 1-, 3-, and 5-year survival rates for the 148 patients with re-resection were 76, 54, and 41%, respectively. Re-resection significantly increased survival in patients with T2 (p = 0.0001) and T3 (p = 0.04) disease. Resection of the common bile duct increased neither R0 resection nor overall survival (p = 0.06). CONCLUSION This study validates the concept of re-resection in T2 and T3 GBC. Bile duct resection increases postoperative morbidity but does not improve survival. There is currently a modification in the surgical management of incidental GBC, with minor liver resection and no common bile duct resection.
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Affiliation(s)
- David Fuks
- Department of Digestive Surgery, Hôpital Nord, Amiens, France
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Goetze TO, Paolucci V. The prognostic impact of positive lymph nodes in stages T1 to T3 incidental gallbladder carcinoma: results of the German Registry. Surg Endosc 2011; 26:1382-9. [PMID: 22089259 DOI: 10.1007/s00464-011-2044-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 10/25/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the literature, the 5 year survival rates for incidental gallbladder carcinoma (IGBC) show large variations in the different T-stages because the lymph node status often is not addressed. Most early-stage carcinomas are identified by laparoscopy as IGBC, and radical re-resection is needed. Staging is impossible without lymph node dissection, so comparison between various survival rates is impossible. This study aimed to determine the influence of lymph node status on the survival of patients with stages T1 to T3 IGBC. METHODS For data analysis, the German Registry was used. RESULTS In this study, 709 patients with IGBC were analyzed. The re-resected nodal-negative patients had a significant survival advantage over the re-resected nodal-positive patients. The 5 year survival rate for the patients with nodal-negative re-resected T1 carcinomas was 75%. The re-resected T2 and T3 nodal-negative patients had significantly better survival than the corresponding nodal-positive patients. The influence that the radicalness of the different liver resection techniques had on these results was excluded. 53 patients without radical resection had a known nodal-positive status. Nodal-positive patients with radical re-resection always show a better survival rate than nodal-positive patients without radical re-resection, stage for stage. CONCLUSIONS Nodal-positive status is a significant negative prognostic factor in T1 to T3 IGBC. Patients with radical re-resection show a better survival rate than those without it. Lymph node dissection is to be highly recommended up to stage T1b. In the case of T2 carcinomas, lymph node dissection of the hepatoduodenal ligament seems to be the minimum volume of lymph node dissection required, but more radical procedures could be beneficial for tumors infiltrating the serosa or beyond.
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Lin W, Jiang L, Chen Y, She F, Han S, Zhu J, Zhou L, Tang N, Wang X, Li X. Vascular endothelial growth factor-D promotes growth, lymphangiogenesis and lymphatic metastasis in gallbladder cancer. Cancer Lett 2011; 314:127-36. [PMID: 22071224 DOI: 10.1016/j.canlet.2011.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 09/04/2011] [Accepted: 09/05/2011] [Indexed: 02/06/2023]
Abstract
Lymph node metastasis is a major prognostic factor for patients with gallbladder cancer (GBC), and greater understanding of the molecule mechanism of lymph node metastasis in GBC is needed to improve prognosis. VEGF-D has been implicated in the control of lymphangiogenesis in many carcinomas, but the biological function of VEGF-D in human GBC remains unclear. In this study, we analyzed the role of the VEGF-D in human GBC cells and addressed the functional role of VEGF-D using a xenograft mouse model. We examined the expression of VEGF-D in three human gallbladder cancer cell lines. A lentivirus-based effective VEGF-D siRNA vector was infected into GBC NOZ cells. The effect of VEGF-D siRNA on GBC NOZ cells was investigated by cell proliferation assay and invasion assay. Furthermore, we examined the role of VEGF-D-SiRNA on GBC NOZ cells in the mice of subcutaneous and orthotopic xenograft tumor. Our results are as follows: VEGF-D mRNA and protein were expressed in all three GBC cell lines (GBC-SD, NOZ, and SGC-996). We successfully selected D-3/siRNA as the most effective siRNA to silence VEGF-D expression after four VEGF-D siRNA plasmid transfection in NOZ cells. VEGF-D mRNA and protein expression were suppressed by lentivirus-mediated D-3/siRNA. D-3-RNAi-LV inhibited NOZ cells proliferation and invasion ability in vitro. D-3-RNAi-LV inhibited tumor growth and lymphangiogenesis in the NOZ cell subcutaneous xenograft model. D-3-RNAi-LV inhibited lymphangiogenesis and lymphatic metastasis in the NOZ cell orthotopic xenograft model. Furthermore, D-3-RNAi-LV inhibited tumor ascites and hepatic invasion in the NOZ cell orthotopic xenograft model. In conclusion, VEGF-D is involved and plays an important role in GBC progression, suggesting that VEGF-D may be a potential molecular target in the treatment of GBC.
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Affiliation(s)
- Wei Lin
- Department of Hepatobiliary Surgery, Union Clinical Medical College, Fujian Medical University, Fuzhou 350001, China
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Lee JM, Kim BW, Kim WH, Wang HJ, Kim MW. Clinical Implication of Bile Spillage in Patients Undergoing Laparoscopic Cholecystectomy for Gallbladder Cancer. Am Surg 2011. [DOI: 10.1177/000313481107700623] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We determined the influence of bile spillage on recurrence and survival during laparoscopic cholecystectomy (LC) for gallbladder (GB) cancer. Among the 136 patients with GB cancer treated at Ajou University Hospital between 1994 and 2007, 28 underwent LC alone. We compared patients without bile spillage (bile spillage [-] group, n = 16) with patients who had bile spillage (bile spillage [+] group, n = 12). There was no statistical difference in stage between the groups. In the bile spillage (-) group, all patients underwent curative resection and there were two patients with locoregional recurrences and three patients with systemic recurrences. In the bile spillage (+) group, five patients underwent R1 resection and one patient underwent R2 resection and all eight recurrent patients had systemic recurrences. The disease-free survival and overall survival were shorter in the bile spillage (+) group (disease-free survival, 71.4 vs 20.9 months; P = 0.028; overall survival, 72.6 vs 25.8 months; P = 0.014). Bile spillage is likely to be an association with an incomplete resection and systemic recurrences. When GB cancer is suspected during LC, conversion to open surgery for preventing bile spillage and achieving curative resection should be considered.
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Affiliation(s)
- Jae-Myeong Lee
- Division of Critical Care Medicine for Surgical Patients, Department of Anesthesiology and Pain Medicine
| | - Bong-Wan Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Wook Hwan Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hee-Jung Wang
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Myung Wook Kim
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Gallbladder carcinoma incidentally encountered during laparoscopic cholecystectomy: how to deal with it. Clin Transl Oncol 2011; 13:25-33. [DOI: 10.1007/s12094-011-0613-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Metastatic gallbladder cancer presenting as a gingival tumor and deep neck infection. Kaohsiung J Med Sci 2010; 26:558-61. [PMID: 20950782 DOI: 10.1016/s1607-551x(10)70086-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Accepted: 03/15/2010] [Indexed: 11/21/2022] Open
Abstract
Gallbladder cancer has an extremely poor prognosis because it is often diagnosed at an advanced stage. We describe a 63-year-old woman who was treated 4 years previously for gallbladder cancer, with laparoscopic cholecystectomy and secondary hepatectomy after presenting with acute cholecystitis and gallbladder rupture. At her second presentation, she had a left lower gingival tumor and deep neck infection. Incision and drainage and tumor biopsies were performed, and pathology at both sites revealed adenocarcinoma. Positron emission tomography revealed other tumors in the left breast and left lower lung field, which were both proven to be adenocarcinoma by biopsy. The patient's presentation with a metastatic oral tumor was rare. Although the incidence is very low, physicians should consider the possibility of metastatic cancer in a patient with a history of cancer, who presents with new oral tumor or deep neck infection.
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Reply to Letter to the Editor. World J Surg 2010. [DOI: 10.1007/s00268-010-0540-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Giulianotti PC, Sbrana F, Bianco FM, Addeo P. Robot-assisted laparoscopic extended right hepatectomy with biliary reconstruction. J Laparoendosc Adv Surg Tech A 2010; 20:159-63. [PMID: 20201685 DOI: 10.1089/lap.2009.0383] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Robotic surgery represents one of the most advanced developments in the field of minimally invasive surgery. In this article, we describe the case of an extended right hepatectomy with a left hepaticojejunostomy performed for radical resection of a hilar cholangiocarcinoma. This operation was performed by using the da Vinci Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA). In this case, the operative time was 540 minutes, with an intraoperative blood loss of 800 mL. The postoperative course was uneventful, and the patient was discharged at postoperative day 11. This report confirms the technical feasibility and safety of robot-assisted extended hepatic resections with biliary reconstruction. Further experience and a long follow-up are required to validate this initial report.
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Affiliation(s)
- Pier C Giulianotti
- Division of General, Minimally Invasive, and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
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Unsuspected gallbladder cancer diagnosed after laparoscopic cholecystectomy: focus on acute cholecystitis. World J Surg 2010; 34:114-20. [PMID: 19898893 DOI: 10.1007/s00268-009-0279-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of the present study was to investigate clinicopathological features of patients who were diagnosed with unsuspected gallbladder cancer (UGC) after laparoscopic cholecystectomy (LC) and to clarify the relationship between acute cholecystitis (AC) and unsuspected gallbladder cancer. METHODS From June 1997 to March 2008, a total of 2,607 LCs were performed at Ajou University Medical Center. Twenty-six patients (1.0%) were diagnosed with gallbladder cancer after LC. We excluded patients with preoperatively or intraoperatively suspected gallbladder cancer. RESULTS Of 1,128 patients with AC, 19 (1.6%) were identified with gallbladder cancer after surgery. The preoperative diagnosis included a high rate of acute and severe acute cholecystitis (n = 19; 73.1%). The rate of conversion to open surgery was 15.4% (4/26), and bile spillage occurred in 14 of 26 patients (53.8%). Adenocarcinoma (92.3%) and pT2 (65.4%) were the most common pathological findings. In 19 UGC patients with AC, the most common pathological finding was also pT2 (n = 12; 63.1%). In addition, all 5 of the patients with positive resection margin belonged to the UGC with AC group. Two of 26 patients (7.7%) underwent additional surgery after LC, and 2 patients (7.7%) underwent excision of the port site/wound for recurrence. The overall median survival was 32 months (95% Confidence Interval [CI] = 21-43). There were no significant differences in age, the presence of acute cholecystitis, or bile spillage (P > 0.05) However, tumor differentiation was associated significantly with survival rate. CONCLUSIONS The preoperative diagnosis included a high rate of acute and severe acute cholecystitis. Survival was not associated with the presence of AC and bile spillage. Therefore, we suggest that AC may not influence the prognosis of unsuspected gallbladder cancer after LC. Moreover, good tumor differentiation can guarantee favorable survival, even in UGC with AC.
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