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Alaswad M, Otry AA, Alhosainy Z, Elkordy F, Sabbah BN, Arabi TZ, Abdulkader H, Ghanayem OF, Azzam AZ, Amin T. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy and intraoperative radiation therapy in the management of gallbladder cancer: a case report. Front Oncol 2024; 14:1361017. [PMID: 38634052 PMCID: PMC11021777 DOI: 10.3389/fonc.2024.1361017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Gallbladder cancer (GBC) is a rare and highly aggressive malignancy, often characterized by nonspecific clinical presentations and late diagnosis, which contribute to its poor prognosis. It is commonly detected at advanced stages, leading to low survival rates. Surgical resection is the primary treatment, with the extent of surgery depending on the T stage of the cancer. In advanced cases, surgery is only considered if it can potentially be curative. Despite various treatment approaches for advanced GBC, survival outcomes remain poor. In our case series, we introduce a novel treatment approach combining cytoreductive surgery, intraoperative radiation therapy, and hyperthermic intraperitoneal chemotherapy. Remarkably, we observed a 100% one-year survival rate, with one patient achieving eight years of disease-free survival without recurrence or metastasis. This aggressive treatment strategy did not lead to increased morbidity or mortality, suggesting its safety and feasibility. However, larger-scale studies are required to draw definitive conclusions.
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Affiliation(s)
- Marwan Alaswad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Ziad Alhosainy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fadwa Elkordy
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | | | | | - Ayman Zaki Azzam
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of General Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Tarek Amin
- Department of Surgery, Surgical Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Bai S, Yang P, Qiu J, Wang J, Liu L, Wang C, Wang H, Wen Z, Zhang B. Nomograms to predict long-term survival for patients with gallbladder carcinoma after resection. Cancer Rep (Hoboken) 2024; 7:e1991. [PMID: 38441306 PMCID: PMC10913079 DOI: 10.1002/cnr2.1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Surgical resection remains the primary treatment option for gallbladder carcinoma (GBC). However, there is a pressing demand for prognostic tools that can refine patients' treatment choices and tailor personalized therapies accordingly. AIMS The nomograms were constructed using the data of a training cohort (n = 378) of GBC patients at Eastern Hepatobiliary Surgery Hospital (EHBH) between 2008 and 2018. The model's performance was validated in GBC patients (n = 108) at Guangzhou Centre from 2007 to 2018. METHODS AND RESULTS The 5-year overall survival (OS) rate in the training cohort was 24.4%. Multivariate analyses were performed using preoperative and postoperative data to identify independent predictors of OS. These predictors were then incorporated into preoperative and postoperative nomograms, respectively. The C-index of the preoperative nomogram was 0.661 (95% CI, 0.627 to 0.694) for OS prediction and correctly delineated four subgroups (5-year OS rates: 48.1%, 19.0%, 15.6%, and 8.1%, p < 0.001). The C-index of the postoperative nomogram was 0.778 (95%CI, 0.756 -0.800). Furthermore, this nomogram was superior to the 8th TNM system in both C-index and the net benefit on decision curve analysis. The results were externally validated. CONCLUSION The two nomograms showed an optimally prognostic prediction in GBC patients after curative-intent resection.
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Affiliation(s)
- Shilei Bai
- Department of Hepatic Surgery IIThe Eastern Hepatobiliary Surgery Hospital, Naval Medical UniversityShanghaiChina
| | - Pinghua Yang
- Department of Biliary Surgery IVThe Eastern Hepatobiliary Surgery Hospital, Naval Medical UniversityShanghaiChina
| | - Jiliang Qiu
- Department of Hepatobiliary SurgerySun Yat‐Sen University Cancer CenterGuangzhouChina
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer MedicineSun Yat‐Sen UniversityGuangzhouChina
| | - Jie Wang
- Department of Hepatic Surgery IIThe Eastern Hepatobiliary Surgery Hospital, Naval Medical UniversityShanghaiChina
| | - Liu Liu
- Department of Hepatic Surgery IIThe Eastern Hepatobiliary Surgery Hospital, Naval Medical UniversityShanghaiChina
| | - Chunyan Wang
- Department of Hepatic Surgery IIThe Eastern Hepatobiliary Surgery Hospital, Naval Medical UniversityShanghaiChina
| | - Huifeng Wang
- Department of Hepatic SurgeryThe Fifth Clinical Medical College of Henan University of Chinese Medicine
| | - Zhijian Wen
- Department of Hepatobiliary Pancreatic Vascular SurgeryThe Chenggong Hospital, Xiamen UniversityXiamenChina
| | - Baohua Zhang
- Department of Biliary Surgery IVThe Eastern Hepatobiliary Surgery Hospital, Naval Medical UniversityShanghaiChina
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Kim M, Stroever S, Aploks K, Ostapenko A, Dong XD, Seshadri R. Post-operative morbidity after neoadjuvant chemotherapy and resection for gallbladder cancer: A national surgical quality improvement program analysis. World J Gastrointest Surg 2024; 16:95-102. [PMID: 38328312 PMCID: PMC10845287 DOI: 10.4240/wjgs.v16.i1.95] [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: 09/23/2023] [Revised: 11/27/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Gallbladder cancer is the most common malignancy of the biliary tract. Neoadjuvant chemotherapy (NACT) has improved overall survival by enabling R0 resection. Currently, there is no consensus of guidelines for neoadjuvant therapy in gallbladder cancer. As investigations continue to analyze the regimen and benefit of NACT for ongoing care of gallbladder cancer patients, we examined American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database to determine if there was higher morbidity among the neoadjuvant group within the 30-day post-operative period. We hypothesized patients who underwent NACT were more likely to have higher post-operative morbidity. AIM To investigate the 30-day post-operative morbidity outcomes between patients who received NACT and underwent surgery and patients who only had surgery. METHODS A retrospective analysis of the targeted hepatectomy NSQIP data between 2015 and 2019 was performed to determine if NACT in gallbladder cancer increased the risk for post-operative morbidity (bile leak, infection rate, rate of converting to open surgery, etc.) compared to the group who only had surgery. To calculate the odds ratio for the primary and secondary outcomes, a crude logistic regression was performed. RESULTS Of the 452 patients, 52 patients received NACT prior to surgery. There were no statistically significant differences in the odds of morbidity between the two groups, including bile leak [odds ratio (OR), 0.69; 95% confidence interval (95%CI): 0.16-2.10; P = 0.55], superficial wound infection (OR, 0.58; 95%CI: 0.03-3.02; P = 0.61), and organ space wound infection (OR, 0.63; 95%CI: 0.18-1.63; P = 0.61). CONCLUSION There was no significant difference in the risk of 30-day post-operative morbidity between the NACT and surgery group and the surgery only group.
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Affiliation(s)
- Minha Kim
- Department of General Surgery, Danbury Hospital, Danbury, CT 06810, United States
| | - Stephanie Stroever
- Department of Research and Innovation, Nuvance Health, Danbury, CT 06810, United States
| | - Krist Aploks
- Department of General Surgery, Danbury Hospital, Danbury, CT 06810, United States
| | - Alexander Ostapenko
- Department of General Surgery, Danbury Hospital, Danbury, CT 06810, United States
| | - Xiang Da Dong
- Division of Surgical Oncology/Hepato-Pancreato-Biliary Surgery, Danbury Hospital, Danbury, CT 06810, United States
| | - Ramanathan Seshadri
- Division of Surgical Oncology/Hepato-Pancreato-Biliary Surgery, Danbury Hospital, Danbury, CT 06810, United States
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Bisht N, Lohia N, Singh S, Sarin A, Mahato A, Paliwal D, Sinha I, Bhatnagar S. Utility of 18-Flurodeoxyglucose Positron Emission Tomography-Computed Tomography ( 18 FDG PET-CT) in Gallbladder Cancer: Experience from a Tertiary Care Hospital. World J Nucl Med 2023; 22:276-283. [PMID: 38152099 PMCID: PMC10751134 DOI: 10.1055/s-0043-1777699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction Gallbladder cancer (GBC) is one of the most common and aggressive malignancies of the Indo-Gangetic plains. Despite its widespread use in GBC cases, the role of 18-flurodeoxyglucose positron emission tomography-computed tomography ( 18 FDG PET-CT) in the management of this disease is not well defined. In our study, we present the practice trends of the utilization of this investigative modality in our hospital and its benefits in aiding diagnosis, staging, and surveillance for recurrence. Materials and Methods All cases of suspected and biopsy-proven GBCs who underwent PET-CT at our institute between 2016 and 2019 were retrospectively evaluated for the indication of PET-CT testing and its impact on the management of the case. The indications were classified into three categories: (i) staging and metastatic workup, (ii) response assessment post-chemotherapy, and (iii) post-therapy surveillance of patients. Results A total of 79 PET-CT scans were carried out during the study period. PET-CT was used for less than one-third of the total patients of GBC presenting at our center. Initial staging and workup (49%) was the most common indication followed by surveillance (28%) and response assessment (23%). PET-CT had a substantially better sensitivity in detecting distant metastases compared to conventional imaging in both initial workup and during follow-up. PET-CT provided additional information in 42% scans that led to change in the management of the patient. As a response assessment tool PET-CT aided not only in evaluating efficacy of therapy but also for documenting progressive disease for patients on therapy. Conclusion PET-CT is a valuable tool to not only rule out metastatic disease while selecting patients for surgery but also for post-therapy surveillance for recurrence in patients of GBC. Larger prospective studies may help in finally elucidating the exact role of PET-CT in this disease.
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Affiliation(s)
| | - Nishant Lohia
- Radiation Oncology, Assam Cancer Care Foundation (ACCF), Kokrajhar, Assam, India
| | - Sankalp Singh
- Radiation Oncology, Army Hospital (RR), Delhi, India
| | - Arti Sarin
- Radiation Oncology, Army Hospital (RR), Delhi, India
| | - Abhishek Mahato
- Nuclear Medicine Specialist, Command Hospital (CC), Lucknow, Uttar Pradesh, India
| | - Dharmesh Paliwal
- Nuclear Medicine Specialist, Command Hospital (CC), Lucknow, Uttar Pradesh, India
| | - Indranil Sinha
- Nuclear Medicine Specialist, Command Hospital (CC), Lucknow, Uttar Pradesh, India
| | - Sharad Bhatnagar
- Radiation Oncology, ESI Medical College, Faridabad, Haryana, India
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Fontana AP, Russolillo N, Di Menno Stavron J, Langella S, Tesoriere RL, Ricotti A, Ferrero A. Inverse probability of treatment weighting analysis of laparoscopic versus open Sg4b-5 bi-segmentectomy in patients with gallbladder cancer. Updates Surg 2023; 75:1471-1480. [PMID: 37495871 DOI: 10.1007/s13304-023-01599-0] [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: 04/10/2023] [Accepted: 07/15/2023] [Indexed: 07/28/2023]
Abstract
Sg4b-5 anatomical bi-segmentectomy with regional lymphadenectomy (Sg4b5) is a surgical option for gallbladder cancer (GBC) treatment. The laparoscopic approach to this challenging operation is still controversial. Aim of this study was to compare short- and long-term outcomes of laparoscopic versus open Sg4b5 in a single institution series of patients. All consecutive patients who underwent Sg4b5 for GBC from January 2000 to September 2021 were retrospectively reviewed. Inverse probability of treatment weighting (IPTW) analysis was performed. 75 patients were analyzed, 18 in the laparoscopic and 57 in the open group. After IPTW, laparoscopic approach was associated with a significantly decreased median intraoperative blood loss (100 vs 237.09 ml, p = 0.001), shorter median length of hospital stay (4 vs 8 days, p = < 0.001) and a higher median number of harvested nodes (9 vs 7, p = 0.026). Operation time was shorter in the open group (355 vs 259 min, p < 0.001). No significant differences were found regarding clear resection margins, overall and major (Clavien-Dindo ≥ 3) morbidity, bile leakage rate, 90 days post-operative mortality, overall and disease-free survival. Laparoscopic Sg4b-5 anatomical bi-segmentectomy and regional lymphadenectomy is feasible and safe with long term outcome comparable to open approach at least in early stages. Laparoscopic approach confirms its well-known short-term benefits with less intraoperative bleeding and shorter length of stay. Moreover, it might allow a better lymphadenectomy.
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Affiliation(s)
- Andrea P Fontana
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy.
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Juliana Di Menno Stavron
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Andrea Ricotti
- Clinical Trial Unit, Medical Direction of Hospital, Mauriziano Hospital, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
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Takagi C, Sato M, Tomita M, Sugita A, Tokuda T, Fujiwara K, Ando N. Induction chemotherapy and hepatic artery embolization followed by extended resection for locally advanced gallbladder cancer: a case report. Surg Case Rep 2023; 9:79. [PMID: 37184729 DOI: 10.1186/s40792-023-01664-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Surgical resection plays a critical role in the curative therapy of patients with gallbladder cancer. However, extended resection for locally advanced gallbladder cancer is a controversial procedure because of the high operative morbidity, mortality, and poor prognosis after surgery, without consensus of its suitability. Several reports have described preoperative treatment modalities to reduce the risk of mortality and morbidity and improve the curability of surgery for locally advanced GBCA. However, only a few well-designed studies have verified the benefits of these preoperative strategies. CASE PRESENTATION A 62-year-old male patient presented to our department with a gallbladder tumor detected on abdominal ultrasound during an annual medical checkup. Multi-phase enhanced CT revealed a gallbladder tumor with a maximum diameter of 34 mm, invading the right hepatic artery, pancreatic head, hepatic flexure of the colon, and first portion of the duodenum. We diagnosed gallbladder carcinoma as cT4 cN0 cM0 cStage IVA in the Union for International Cancer Control (UICC) classification 8th edition. After administration of 12 cycles of gemcitabine and cisplatin plus S-1 regimen, tumor shrinkage was observed on computed tomography, and elevated serum CA19-9 levels were reduced to normal limits. After preoperative hepatic artery embolization, we performed gallbladder bed resection with pancreaticoduodenectomy (minor hepatopancreatoduodenectomy) and combined resection of the right hepatic artery and hepatic flexure of the colon. Histological examination revealed no evidence of lymph node metastasis (ypT4 ypN0 ycM0 yp Stage IVA in the 8th edition of the UICC). The proximal bile duct and dissected margins were negative. CONCLUSIONS The combination of induction chemotherapy and preoperative hepatic artery embolization, followed by minor hepatopancreatoduodenectomy and combined resection of the involved arteries and partial colon, could be a feasible treatment strategy for patients with locally advanced gallbladder cancer invading neighboring organs.
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Affiliation(s)
- Chisato Takagi
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama-City, Kanagawa, 245-0006, Japan.
| | - Michio Sato
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama-City, Kanagawa, 245-0006, Japan
| | - Masato Tomita
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama-City, Kanagawa, 245-0006, Japan
| | - Atsushi Sugita
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama-City, Kanagawa, 245-0006, Japan
| | - Toshiki Tokuda
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama-City, Kanagawa, 245-0006, Japan
| | - Koki Fujiwara
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama-City, Kanagawa, 245-0006, Japan
| | - Nobutoshi Ando
- Department of Surgery, International Goodwill Hospital, 1-28-1, Nishigaoka, Izumi-Ku, Yokohama-City, Kanagawa, 245-0006, Japan
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Zhou Y, Yuan K, Yang Y, Ji Z, Zhou D, Ouyang J, Wang Z, Wang F, Liu C, Li Q, Zhang Q, Li Q, Shan X, Zhou J. Gallbladder cancer: current and future treatment options. Front Pharmacol 2023; 14:1183619. [PMID: 37251319 PMCID: PMC10213899 DOI: 10.3389/fphar.2023.1183619] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Surgery remains the preferred treatment option for early-stage gallbladder cancer (GBC). According to the anatomical position of the primary tumor, accurate preoperative stage and strict control of surgical indications, appropriate surgical strategies are selected to achieve the optimal surgical effect. However, most patients have already been at the locally advanced stage or the tumor has metastasized at the initial diagnosis. The postoperative recurrence rate and 5-year survival rate remain unsatisfactory even after radical resection for gallbladder cancer. Hence, there is an urgent need for more treatment options, such as neoadjuvant therapy, postoperative adjuvant therapy and first-line and second-line treatments of local progression and metastasis, in the whole-course treatment management of gallbladder cancer patients. In recent years, the application of molecular targeted drugs and immunotherapy has brought greater hope and broader prospects for the treatment of gallbladder cancer, but their effects in improving the prognosis of patients still lack sufficient evidence-based medicine evidence, so many problems should be addressed by further research. Based on the latest progress in gallbladder cancer research, this review systematically analyzes the treatment trends of gallbladder cancer.
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Affiliation(s)
- Yanzhao Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
- Department of Hepatobiliary Cancer, Liver Cancer Research Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Kun Yuan
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Yi Yang
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zemin Ji
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Dezheng Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Jingzhong Ouyang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Zhengzheng Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Fuqiang Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Chang Liu
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Qingjun Li
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Qi Zhang
- Department of Hepatobiliary Cancer, Liver Cancer Research Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Qiang Li
- Department of Hepatobiliary Cancer, Liver Cancer Research Center, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Xiao Shan
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Jinxue Zhou
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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Karunaratne S, Gamage A, Bagwan IN. Descriptive analysis of incidental and operable gallbladder carcinoma cases: a UK centre experience. Pathologica 2022; 114:138-145. [PMID: 35481564 PMCID: PMC9248258 DOI: 10.32074/1591-951x-291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/08/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To identify and compare significant or relevant prognostic factors in pre-operatively diagnosed, surgically resectable, gallbladder cancer and in incidentally detected gallbladder cancer cases. Material and methods Gallbladder resections (October 2009-March 2016) were identified on the histopathology Winpath database. Cases with a final histological diagnosis of gallbladder cancer (GBC) were categorised into: Group A: clinically suspected operable GBC (n = 13). Group B: incidental GBC with staged liver bed resection (n = 5). Group C: incidental GBC without staged liver bed resection (n = 15). The clinicopathological features were analysed in each group separately. Results The overall incidence of primary (GBC) was 0.66% and all the cases were adenocarcinomas, of which, 6 of 33 (18.2%) were grade 1 and 15 of 33 (45.4%) were grade 3. Male to female ratio is 1:2.3. Of the 33 patients with GBC 14 (42.4%) has died of disease at 18-month follow-up. 15 of 33 had perineural invasion and 10/21 (47.6%) cases showed lymph node matastasis. Six cases had positive surgical margin and 9/15 showed direct liver invasion. Higher stage disease (T3/T4) was seen in 10/14 cases. Conclusion The prognosis of primary GBC is poor and best clinical outcomes can be achieved with early diagnosis followed by radical cholecystectomy and staged liver resection with negative margins.
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Affiliation(s)
- Sanwandana Karunaratne
- Department of Histopathology, Berkshire Surrey Pathology Services, Royal Surrey County Hospital, Guildford, UK
| | - Amila Gamage
- Department of Histopathology, Berkshire Surrey Pathology Services, Royal Surrey County Hospital, Guildford, UK
| | - Izhar N Bagwan
- Department of Histopathology, Berkshire Surrey Pathology Services, Royal Surrey County Hospital, Guildford, UK
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Engineer R, Sinha S, Ostwal V, Ramaswamy A, Chopra S, Shetty N. Radiotherapy for locally advanced unresectable gallbladder cancer - A way forward: Comparative study of chemotherapy versus chemoradiotherapy. J Cancer Res Ther 2022; 18:147-151. [DOI: 10.4103/jcrt.jcrt_1568_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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10
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Residual disease in lymph nodes has no influence on survival in patients with incidental gallbladder cancer - institution experience with literature review. Radiol Oncol 2021; 56:208-215. [PMID: 34957726 PMCID: PMC9122290 DOI: 10.2478/raon-2021-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/27/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A better appreciation of the course and factors that influence incidental gallbladder cancer (iGBC) is needed to develop treatment strategies aimed to improve outcomes. The purpose of the study was to determine the influence of residual disease in the liver and lymph nodes on overall survival in re-resected patients with iGBC. PATIENTS AND METHODS Patients undergoing radical re-resection for iGBC from January 2012 to December 2018 were retrospectively identified. Patients with a 5-year follow-up and submitted to complete resection with stage I, II and III disease were analysed. The influence of residual disease (RD) in liver and lymph nodes on survival was assessed using the Kaplan-Meier curves. In addition, the rest of the group was assessed based on type of primary/secondary procedure, number of harvested lymph nodes and RD in liver and/or lymph nodes. RESULTS In this retrospective study 48 out of 58 (83%) patients underwent re-resection. Among the group with a 5-year follow-up (re-operation between 2012-2014), 22 patients out of 28 (79%) were re-resected. Survival analysis showed that patients with no RD in the liver and lymph nodes had statistically significant better 5-year survival than those with RD. Comparing 5-year survival rate in patients with RD in the liver or lymph nodes against no RD group, patients with RD in the liver had statistically significantly worse 5-year survival, while lymph node metastases did not show any statistically significant different in 5-year survival. Besides, a statistically significant better prognosis was found in stage II disease compared to stage III, as expected. CONCLUSIONS The most important predictors of a 5-year survival in our study were RD in liver and stage of the disease. Lymph node metastases did not have any impact on the overall 5-year survival rate.
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Gupta S, Prakash P, Kumar V, Chaturvedi A, Misra S, Akhtar N, Rajan S, Agarwal P, Smith LM, Are C. Radical surgery for de novo gallbladder carcinoma-Single-center analysis of prognostic factors and survival outcomes from an endemic region. J Surg Oncol 2021; 125:631-641. [PMID: 34894351 DOI: 10.1002/jso.26766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Gallbladder cancer (GBC) is an aggressive malignancy where curative resection is possible in few and survival is poor. There are limited data on outcomes in patients with de novo GBC from endemic regions undergoing surgery for curative intent. We report survival outcomes in this group of patients from a region with high incidence of disease. METHODS We reviewed the records of all GBC patients (2014-2018) and included those who underwent radical cholecystectomy (RC) for de novo GBC. Univariable and multivariable analyses were performed to identify factors influencing recurrence and survival. RESULTS A total of 649 patients with GBC were evaluated for surgery and curative intent surgery was attempted in 246 (38%) patients. Of these 246 patients, RC was performed in 115 patients, with histologically confirmed de novo GBC. Locally advanced disease (≥stage IIIB) was present in 52 (45.2%) patients. Median time to recurrence and overall survival (OS) were 31 and 36 months, respectively. Lymph node positivity (p = 0.005) and grade significantly influenced OS on multivariable analysis. CONCLUSION Satisfactory survival outcomes are possible after RC for de novo GBC. Extended resections performed in high volume centers combined with appropriate adjuvant treatment can offer significant survival benefits, with acceptable morbidity and mortality rates.
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Affiliation(s)
- Sameer Gupta
- Department of Surgical Oncology, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Puneet Prakash
- Department of Surgical Oncology, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Vijay Kumar
- Department of Surgical Oncology, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Arun Chaturvedi
- Department of Surgical Oncology, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Sanjeev Misra
- Department of Surgical Oncology, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India.,AIIMS, Jodhpur, Rajasthan, India
| | - Naseem Akhtar
- Department of Surgical Oncology, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Shiv Rajan
- Department of Surgical Oncology, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Preeti Agarwal
- Department of Pathology, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India
| | - Lynette M Smith
- Department of Biostatistics, University of Nebraska Medical Centre, Omaha, Nebraska, USA
| | - Chandrakanth Are
- Department of Surgery, Department of Surgical Oncology, University of Nebraska Medical Centre, Omaha, Nebraska, USA
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12
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Yuan C, Tao Q, Wang J, Wang K, Zou S, Hu Z. Nomogram Based on Log Odds of Positive Lymph Nodes Predicting Cancer-Specific Survival in Patients With T3 and T4 Gallbladder Cancer After Radical Resection. Front Surg 2021; 8:675661. [PMID: 34778352 PMCID: PMC8578716 DOI: 10.3389/fsurg.2021.675661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this study based on log odds of positive lymph nodes (LODDS) is to develop and validate an effective prognostic nomogram for patients with T3 and T4 gallbladder cancer (GBC) after resection. Patients and Methods: A total of 728 T3 and T4 gallbladder cancer patients after resection from the Surveillance, Epidemiology, and End Results (SEER) database, randomly divided into training cohort and validation cohort according to 7:3. Another 128 patients from The Second Affiliated Hospital of Nanchang University for external validation. The nomograms were built by the Cox regression model and the Fine and Grey's model. Concordance index (C-index), calibration curve and the area under receiver operating characteristic (ROC) curve (AUC) were used to evaluate the nomogram and internal verification. The decision curve analysis (DCA) was used to measure clinical applicability. Result: LODDS was independent prognostic predictor for overall survival (OS) and cancer-specific survival (CSS), and established the nomograms on this basis. The nomogram we have established has a good evaluation effect, with a C-index of 0.719 (95%CI, 0.707–0.731) for OS and 0.747 (95%CI, 0.733–0.760) for CSS. The calibration curves of OS and CSS both showed good calibration capability, and the AUC for predicting 1-, 2-, and 3-year 0.858, 0.848 were and 0.811 for OS, and 0.794, 0.793, and 0.750 for CSS. The DCA of nomograms both showed good clinical applicability. Conclusion: The nomogram can provide effective OS and CSS prediction for patients with advanced gallbladder cancer after surgery.
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Affiliation(s)
- Chen Yuan
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qiaomeng Tao
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jian Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kai Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shubing Zou
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhigang Hu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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13
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Chen C, Rui Z, Yuhan W, Yongjie Z, Yinghe Q, Ning Y, Tianqiang S, Jianying L, Jiangtao L, Xianhai M, Shengping L, Shubin S, Zhiqiang C, Zhaohui T, Zhimin G. Optimal Lymph Node Staging System in Evaluating Prognosis of Gallbladder Carcinoma: A Multi-institutional Study. Ann Surg Oncol 2021; 28:8142-8151. [PMID: 34532819 DOI: 10.1245/s10434-021-10749-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/24/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lymph node (LN) involvement is a critical prognostic factor in patients with gallbladder carcinoma (GBC). Controversy exists regarding optimal categorization of nodal metastasis status, including anatomical location of positive nodes (AJCC 7th N staging), number of metastatic lymph nodes (NMLN), log odds of metastatic LNs (LODDS), and lymph node ratio (LNR). METHODS Patients who underwent curative-intent resection for GBC from six Chinese tertiary hospitals between 2008 and 2013 were analyzed retrospectively. The relative discriminative abilities of the different LN staging systems were assessed by different models including the tree-augmented naïve Bayesian (TAN) model, Cox proportional hazards regression model, and binary logistic regression model. RESULTS A total of 226 patients were involved in this cohort. Based on the TAN model and composite importance measures, the most important factor affecting the prognosis in the different LN staging systems was NMLN. Among the four TAN models which were built with 4 metastatic LN markers and baseline variables, the accuracy of the NMLN-based prognostic model was 88.15%, higher than 7th N staging (86.44%), LNR (87.34%), and LODDS (85.19%). The Cox model based on NMLN (C-index: 0.763, AIC: 1371.62) had a higher fitness than the others (7th N staging C-index: 0.756, AIC: 1375.51; LNR C-index: 0.759, AIC: 1378.82; LODDS C-index 0.748, AIC: 1390.99). The AUCs of different staging binary logistic regression models were NMLN (0.872), LNR (0.872), 7th N staging (0.869) and LODDS (0.856), respectively. CONCLUSIONS NMLN was the optimal LN staging system in evaluating prognosis of GBC.
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Affiliation(s)
- Chen Chen
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhang Rui
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wu Yuhan
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, China
| | - Zhang Yongjie
- Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Affiliated to Naval Medical University, Shanghai, China
| | - Qiu Yinghe
- Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Affiliated to Naval Medical University, Shanghai, China
| | - Yang Ning
- Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, Affiliated to Naval Medical University, Shanghai, China
| | - Song Tianqiang
- Department of Hepatobiliary Oncology, Tianjin Medical University Cancer Hospital, Tianjin, China
| | - Lou Jianying
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Li Jiangtao
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Mao Xianhai
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Changsha, China
| | - Li Shengping
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Si Shubin
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, China
| | - Cai Zhiqiang
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, China
| | - Tang Zhaohui
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Geng Zhimin
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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14
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Role of Inflammatory and Immune-Nutritional Prognostic Markers in Patients Undergoing Surgical Resection for Biliary Tract Cancers. Cancers (Basel) 2021; 13:cancers13143594. [PMID: 34298807 PMCID: PMC8305862 DOI: 10.3390/cancers13143594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/03/2021] [Accepted: 07/16/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Biliary tract cancers (BTCs) are a heterogeneous group of malignancies, which arise from the epithelial cells of the biliary tree, with a high rate of local invasion and metastatic spreading. Surgical resection remains the treatment which offers the best chance of long-term survival. However, new chemotherapy regimens and multimodal strategies have showed encouraging results, supporting the need for simple and readily available preoperative tools able to predict survival and guide the treatment strategy. Recently, the prognostic role of several nutritional and inflammatory indexes in growth, biological aggressiveness, and spread has been investigated in different types of cancers. Nevertheless, complete and conclusive results on BTCs are lacking. By identifying a preoperative immune and inflammatory prognostic index based on simple routine blood samples, we may have an additional element that is useful in guiding the treatment strategy by assigning selected patients to preoperative or postoperative treatments despite pathological results. Abstract The relationship between immune-nutritional status and tumor growth; biological aggressiveness and survival, is still debated. Therefore, this study aimed to evaluate the prognostic performance of different inflammatory and immune-nutritional markers in patients who underwent surgery for biliary tract cancer (BTC). The prognostic role of the following inflammatory and immune-nutritional markers were investigated: Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Index (PI), Neutrophil to Lymphocyte ratio (NLR), Platelet to Lymphocyte ratio (PLR), Lymphocyte to Monocyte ratio (LMR), Prognostic Nutritional Index (PNI). A total of 282 patients undergoing surgery for BTC were included. According to Cox regression and ROC curves analysis for survival, LMR had the best prognostic performances, with hazard ratio (HR) of 1.656 (p = 0.005) and AUC of 0.652. Multivariable survival analysis identified the following independent prognostic factors: type of BTC (p = 0.002), T stage (p = 0.014), N stage (p < 0.001), histological grading (p = 0.045), and LMR (p = 0.025). Conversely, PNI was related to higher risk of severe morbidity (p < 0.001) and postoperative mortality (p = 0.005). In conclusion, LMR appears an independent prognostic factor of long-term survival, whilst PNI seems associated with worse short-term outcomes.
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15
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Ando T, Sakata J, Nomura T, Takano K, Takizawa K, Miura K, Hirose Y, Kobayashi T, Ichikawa H, Hanyu T, Shimada Y, Nagahashi M, Kosugi SI, Wakai T. Anatomic location of residual disease after initial cholecystectomy independently determines outcomes after re-resection for incidental gallbladder cancer. Langenbecks Arch Surg 2021; 406:1521-1532. [PMID: 33839959 DOI: 10.1007/s00423-021-02165-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to elucidate the impact of anatomic location of residual disease (RD) after initial cholecystectomy on survival following re-resection of incidental gallbladder cancer (IGBC). METHODS Patients with pT2 or pT3 gallbladder cancer (36 with IGBC and 171 with non-IGBC) who underwent resection were analyzed. Patients with IGBC were classified as follows according to the anatomic location of RD after initial cholecystectomy: no RD (group 1); RD in the gallbladder bed, stump of the cystic duct, and/or regional lymph nodes (group 2); and RD in the extrahepatic bile duct and/or distant sites (group 3). RESULTS Timing of resection (IGBC vs. non-IGBC) did not affect survival in either multivariate or propensity score matching analysis. RD was found in 16 (44.4%) of the 36 patients with IGBC; R0 resection following re-resection was achieved in 32 patients (88.9%). Overall survival (OS) following re-resection was worse in group 3 (n = 7; 5-year OS, 14.3%) than in group 2 (n = 9; 5-year OS, 55.6%) (p = 0.035) or in group 1 (n = 20; 5-year OS, 88.7%) (p < 0.001). There was no survival difference between groups 1 and 2 (p = 0.256). Anatomic location of RD was independently associated with OS (group 2, HR 2.425, p = 0.223; group 3, HR 9.627, p = 0.024). CONCLUSION The anatomic location of RD independently predicts survival following re-resection, which is effective for locoregional disease control in IGBC, similar to resection for non-IGBC. Not all patients with RD have poor survival following re-resection for IGBC.
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Affiliation(s)
- Takuya Ando
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Jun Sakata
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
| | - Tatsuya Nomura
- Department of Gastrointestinal Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata City, Niigata, 951-8566, Japan
| | - Kabuto Takano
- Department of Gastrointestinal Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata City, Niigata, 951-8566, Japan
| | - Kazuyasu Takizawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Kohei Miura
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Yuki Hirose
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Takashi Kobayashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Hiroshi Ichikawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Takaaki Hanyu
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Yoshifumi Shimada
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Masayuki Nagahashi
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Shin-Ichi Kosugi
- Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minami-Uonuma, Niigata, 949-7302, Japan
| | - Toshifumi Wakai
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
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16
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Locally advanced gallbladder cancer: a review of the criteria and role of imaging. Abdom Radiol (NY) 2021; 46:998-1007. [PMID: 32945922 DOI: 10.1007/s00261-020-02756-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 12/24/2022]
Abstract
Gallbladder carcinoma (GBC) is among one of the gastrointestinal malignancies with extremely dismal prognosis. This is due to the advanced stage at presentation. Majority of the patients with GBC are not considered candidates for surgery because of the locally advanced disease or metastases. However, with the accumulating evidence regarding the role of neoadjuvant chemotherapy, there is a need to correctly identify a subset of patients with locally advanced GBC who will benefit maximally from neoadjuvant chemotherapy and will be successfully downstaged to receive curative (R0) surgery. In this context, there is a lack of consensus and different groups have resorted to criteria for locally advanced disease eligible for neoadjuvant chemotherapy based on personal or institutional experiences. Imaging plays a critical role in the evaluation of patients with GBC as it helps stratify patients into resectable and unresectable. Imaging also has the potential to identify patients with locally advanced GBC and hence facilitate neoadjuvant chemotherapy and improve outcomes. In this review, we evaluate the various criteria for locally advanced GBC and the role of imaging in this scenario.
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17
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Resectional surgery in gallbladder cancer with jaundice-how to improve the outcome? Langenbecks Arch Surg 2021; 406:791-800. [PMID: 33619629 DOI: 10.1007/s00423-020-02075-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the surgical outcomes of patients with gallbladder cancer (GBC) with jaundice due to as-yet unelucidated prognostic factors. METHODS A total of 348 GBC patients underwent resection at our institute between 1985 and 2016. Of these, 67 had jaundice (serum total bilirubin ≥ 2 mg/dL). Preoperative biliary drainage was performed, with portal vein embolization as required. All patients underwent radical surgery. We retrospectively evaluated the outcomes, performed multivariate analysis for overall survival, and compared our findings to those reported in the literature. RESULTS The 5-year survival rate of M0 (no distant metastasis) GBC patients with jaundice, who underwent resectional surgery, was 21.9%, versus 68.3% in those without jaundice (p < 0.05). Since 2000, surgical mortality in GBC patients with jaundice has decreased from 12 to 6.8%. Patients with jaundice had more advanced disease and underwent major hepatectomies and vascular resections; however, preoperative jaundice alone was not a prognostic factor. Multivariate analysis of jaundiced patients revealed that percutaneous biliary drainage (PTBD) (vis-à-vis endoscopic drainage [EBD], hazard ratio [HR] 2.82), postoperative morbidity (Clavien-Dindo classification ≥ 3, HR 2.31), and distant metastasis (HR 1.85) were predictors of poor long-term survival. The 5-year survival and peritoneal recurrence rates in M0 patients with jaundice were 16% and 44%, respectively, for patients with PTBD and 39% (p < 0.05) and 13% (p = 0.07) for those with EBD. CONCLUSION M0 GBC patients with jaundice should undergo surgery if R0 resection is possible. Preoperative EBD may be superior to PTBD in M0 GBC patients with jaundice, although further studies are needed.
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18
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Chen M, Li S, Topatana W, Lv X, Cao J, Hu J, Lin J, Juengpanich S, Shen J, Cai X. Development and Validation of a Nomogram for Predicting Survival in Gallbladder Cancer Patients With Recurrence After Surgery. Front Oncol 2021; 10:537789. [PMID: 33505902 PMCID: PMC7829964 DOI: 10.3389/fonc.2020.537789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The management of gallbladder cancer (GBC) patients with recurrence who need additional therapy or intensive follow-up remains controversial. Therefore, we aim to develop a nomogram to predict survival in GBC patients with recurrence after surgery. METHODS A total of 313 GBC patients with recurrence from our center was identified as a primary cohort, which were randomly divided into a training cohort (N = 209) and an internal validation cohort (N = 104). In addition, 105 patients from other centers were selected as an external validation cohort. Independent prognostic factors, identified by univariate and multivariable analysis, were used to construct a nomogram. The performance of this nomogram was measured using Harrell's concordance index (C-index) and calibration curves. RESULTS Our nomogram was established by four factors, including time-to-recurrence, site of recurrence, CA19-9 at recurrence, and treatment of recurrence. The C-index of this nomogram in the training, internal and external validation cohort was 0.871, 0.812, and 0.754, respectively. The calibration curves showed an optimal agreement between nomogram prediction and actual observation. Notably, this nomogram could accurately stratify patients into different risk subgroups, which allowed more significant distinction of Kaplan-Meier curves than that of using T category. The 3-year post-recurrence survival (PRS) rates in the low-, medium-, and high-risk subgroups from the external validation cohort were 53.3, 26.2, and 4.1%, respectively. CONCLUSION This nomogram provides a tool to predict 1- and 3-year PRS rates in GBC patients with recurrence after surgery.
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Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou, China
| | - Shijie Li
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Win Topatana
- Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaozhong Lv
- Department of General Surgery, First People’s Hospital, Mudanjiang, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiahao Hu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Lin
- Department of General Surgery, Longyou People’s Hospital, Quzhou, China
| | | | - Jiliang Shen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University School of Medicine, Hangzhou, China
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19
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de Savornin Lohman EAJ, Kuipers H, van Dooren M, Verhoeven RHA, Erdmann JI, Groot Koerkamp B, Braat AE, Hagendoorn J, Daams F, van Dam R, van Gulik TM, de Boer MT, de Reuver PR. Should jaundice preclude resection in patients with gallbladder cancer? Results from a nation-wide cohort study. HPB (Oxford) 2020; 22:1686-1694. [PMID: 32340859 DOI: 10.1016/j.hpb.2020.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 03/08/2020] [Accepted: 03/16/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND It is controversial whether patients with gallbladder cancer (GBC) presenting with jaundice benefit from resection. This study re-evaluates the impact of jaundice on resectability and survival. METHODS Data was collected on surgically explored GBC patients in all Dutch academic hospitals from 2000 to 2018. Survival and prognostic factors were assessed. RESULTS In total 202 patients underwent exploration and 148 were resected; 124 non-jaundiced patients (104 resected) and 75 jaundiced patients (44 resected). Jaundiced patients had significantly (P < 0.05) more pT3/T4 tumors, extended (≥3 segments) liver- and organ resections, major post-operative complications and margin-positive resection. 90-day mortality was higher in jaundiced patients (14% vs. 0%, P < 0.001). Median overall survival (OS) was 7.7 months in jaundiced patients (2-year survival 17%) vs. 26.1 months in non-jaundiced patients (2-year survival 39%, P < 0.001). In multivariate analysis, jaundice (HR1.89) was a poor prognostic factor for OS in surgically explored but not in resected patients. Six jaundiced patients did not develop a recurrence; none had liver- or common bile duct (CBD) invasion on imaging. CONCLUSION Jaundice is associated with poor survival. However, jaundice is not an independent adverse prognostic factor in resected patients. Surgery should be considered in patients with limited disease and no CBD invasion on imaging.
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Affiliation(s)
| | - Hendrien Kuipers
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Groningen, P.O. Box 30001, 97700 RB, Groningen, the Netherlands
| | - Mike van Dooren
- Department of Surgery, Radboudumc, P.O. Box 9101, Internal Code 618, 6500 HB, Nijmegen, the Netherlands
| | - Rob H A Verhoeven
- Department of Surgery, Radboudumc, P.O. Box 9101, Internal Code 618, 6500 HB, Nijmegen, the Netherlands; Department of Research & Development, Netherlands Comprehensive Cancer Organization, P.O. Box 19079, 3501 DB, Utrecht, the Netherlands
| | - Joris I Erdmann
- Department of Surgery, Amsterdam University Medical Centers, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmusmc, P.O. Box 2060, 3000 CB, Rotterdam, the Netherlands
| | - Andries E Braat
- Department of Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - Jeroen Hagendoorn
- Department of Surgery, UMC Utrecht Cancer Center, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands; Department of Surgery, St Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam University Medical Centers, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Ronald van Dam
- Department of Surgery, Maastricht University Medical Center +, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam University Medical Centers, P.O. Box 22660, 1100 DD, Amsterdam, the Netherlands
| | - Marieke T de Boer
- Department of Hepatobiliary and Transplant Surgery, University Medical Center Groningen, P.O. Box 30001, 97700 RB, Groningen, the Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboudumc, P.O. Box 9101, Internal Code 618, 6500 HB, Nijmegen, the Netherlands.
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20
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Surgical management of biliary malignancy. Curr Probl Surg 2020; 58:100854. [PMID: 33531120 DOI: 10.1016/j.cpsurg.2020.100854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
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21
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Patkar S, Chaturvedi A, Goel M, Rangarajan V, Sharma A, Engineer R. Role of positron emission tomography-contrast enhanced computed tomography in locally advanced gallbladder cancer. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2020; 27:164-170. [PMID: 31945262 DOI: 10.1002/jhbp.712] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/13/2019] [Accepted: 01/08/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION This study aims to define the role of flurodeoxyglucose (18F -FDG) positron emission tomography-contrast enhanced computed tomography (PETCECT) scan in upstaging disease in patients with locally advanced gallbladder cancer (LAGBC). METHODS An analysis of a prospectively maintained database of gallbladder cancer (GBC) patients was performed. Patients found to have locally advanced (T3 and/or T4 or N+) but non-metastatic disease on initial imaging, either a contrast enhanced computed tomography (CECT) or a magnetic resonance imaging (MRI) scan, underwent an additional PETCECT for staging and the results impacting treatment decision were recorded. RESULTS One hundred and three patients of LAGBC underwent CECT/MRI and PETCECT. 48/103 (46.6%) were found to be upstaged to stage IV after PETCECT. The most common metastatic site was non-regional retroperitoneal lymph nodes (12 patients, 11.7%) followed by satellite lesions in liver (11, 10.7%). Fourteen (13.6%) patients had equivocal findings on PET scan that required confirmation by tissue sampling out of which 10 (71.4%) were subsequently found to have metastatic disease. The only statistically significant factor predicting distant spread on PETCECT was the presence of loco-regional nodes on CT scan (odds ratio 6.15, P = .006). CONCLUSION PETCECT is a valuable tool to rule out metastatic disease in patients presenting with LAGBC.
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Affiliation(s)
- Shraddha Patkar
- Gastrointestinal and Hepatopancreaticobiliary Services, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Aditi Chaturvedi
- Gastrointestinal and Hepatopancreaticobiliary Services, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Mahesh Goel
- Gastrointestinal and Hepatopancreaticobiliary Services, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Ashutosh Sharma
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
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Xiao Z, Shi Z, Hu L, Gao Y, Zhao J, Liu Y, Xu Q, Huang D. A new nomogram from the SEER database for predicting the prognosis of gallbladder cancer patients after surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:738. [PMID: 32042754 DOI: 10.21037/atm.2019.11.112] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background To study the prognostic significance in gallbladder cancer (GBC) patients of the four N stage methods of log odds of positive lymph nodes (LODDS), lymph node ratio (LNR), and N stage in the 7th and 8th editions of the American Joint Committee on Cancer (AJCC), and to establish a prognostic model of GBC based on LODDS. Methods Data of 1,321 patients with GBC who underwent surgical resection of lymph nodes from 2010 to 2014 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. We then randomly divided these data into a training set (n=925) and a validation set (n=396). C-index, Akaike information criterion (AIC), and area under the curve (AUC) were calculated to evaluate the accuracy of LODDS, LNR, and N stage in the 7th and 8th editions of the AJCC. Cox multivariate analysis was performed to determine whether LODDS was an independent prognostic factor, and a nomogram model was established. C-index was used to evaluate the accuracy of the nomogram. A receiver operating characteristic (ROC) curve was drawn and the area under the AUC was calculated to evaluate the accuracy of the nomogram in predicting patients' 1-, 3-, and 5-year overall survival (OS). Results Univariate analysis showed that the four methods were all correlated with OS. Through C-index, AIC and AUC, We found that LODDS had the best accuracy of the four methods. C-index and AUC analysis revealed that the nomogram based on LODDS had excellent prognostic ability. All the results were verified in the validation set. Conclusions LODDS is an independent prognostic factor for GBC patients, and it is the best N stage in the SEER database. This new nomogram-containing LODDS system is a great model to predict the prognosis of GBC patients.
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Affiliation(s)
- Zunqiang Xiao
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310014, China
| | - Zhan Shi
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310014, China
| | - Linjun Hu
- The Medical College of Qingdao University, Qingdao 266071, China
| | - Yuling Gao
- Department of Genetic Laboratory, Shaoxing Women and Children Hospital, Shaoxing 312030, China
| | - Junjun Zhao
- Graduate Department, Bengbu Medical College, Bengbu 233030, China
| | - Yang Liu
- The Medical College of Qingdao University, Qingdao 266071, China
| | - Qiuran Xu
- The Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310014, China
| | - Dongsheng Huang
- The Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310014, China
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Sirivatanauksorn V, Dumronggittigule W, Dulnee B, Srisawat C, Sirivatanauksorn Y, Pongpaibul A, Masaratana P, Somboonyosdech C, Sripinitchai S, Kositamongkol P, Mahawithitwong P, Tovikkai C, Sangserestid P, Limsrichamrern S. Role of stratifin (14-3-3 sigma) in adenocarcinoma of gallbladder: A novel prognostic biomarker. Surg Oncol 2019; 32:57-62. [PMID: 31751820 DOI: 10.1016/j.suronc.2019.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/23/2019] [Accepted: 10/28/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Gallbladder cancer (GBC) is a rare and fatal biliary tract malignancy. Genetic derangements are one of many factors that determine the prognosis of GBC. In this study, the expression of the stratifin (SFN) gene encoding 14-3-3 sigma protein, which is reported to be associated with the metastatic property of cholangiocarcinoma cells, was investigated in GBC. MATERIAL AND METHODS Formalin-fixed paraffin-embedded cancer (n = 37) and non-cancer control tissues (n = 14) of gallbladders from patients who underwent surgical resection from January 2006 to May 2015 were retrieved. The expression of SFN normalized with that of ACTB was determined using RT-qPCR. Multivariate analysis of factors affecting disease-free survival (DFS) and overall survival (OS) including the type of SFN expression was performed. RESULT The average expression level of SFN in cancer was higher than that in control tissues (p = 0.002). The relative SFN expression in cancer tissue was classified as overexpression (n = 14) and control level expression (n = 23) according to the receiver operating characteristic (ROC) curves for discriminating early GBC recurrence or metastasis after surgery. The SFN overexpression group was associated with lower rates of distant metastasis and early tumor recurrence following resection. The univariate analysis demonstrated factors affecting DFS, including resection margin (p < 0.001), lymphovascular invasion (p = 0.040), perineural invasion (p = 0.046), and SFN expression (p < 0.001). The multivariate analysis revealed that the resection margin (p = 0.019) and SFN expression (P = 0.040) were independent prognostic factors of DFS. CONCLUSION To achieve the longest survival, margin-free resection is recommended. The overexpression of SFN in GBC is associated with better prognosis, lower rates of early cancer recurrence, and distant metastasis following resection. SFN expression might be a novel prognostic biomarker in GBC treatment. Further studies to elucidate the role of SFN might unveil its clinical benefit in cancer treatment regimens.
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Affiliation(s)
- Vorapan Sirivatanauksorn
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wethit Dumronggittigule
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Benjamaporn Dulnee
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatchawan Srisawat
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yongyut Sirivatanauksorn
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ananya Pongpaibul
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patarabutr Masaratana
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chayapol Somboonyosdech
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirinapa Sripinitchai
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prawat Kositamongkol
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prawej Mahawithitwong
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chutwichai Tovikkai
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pholasith Sangserestid
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somchai Limsrichamrern
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer. Chronic Dis Transl Med 2019; 5:188-196. [PMID: 31891130 PMCID: PMC6926113 DOI: 10.1016/j.cdtm.2019.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Indexed: 12/12/2022] Open
Abstract
Objectives Most patients with gallbladder cancer (GBC) present with advanced-stage disease and have a poor prognosis. Radical resection remains the only therapeutic option to improve survival in patients with GBC. This study aimed to analyze the prognostic factors in patients with stage Ⅳ GBC and to identify a subgroup of patients who might benefit from R0 resection. Methods A total of 285 patients with stage Ⅳ GBC were retrospectively analyzed at our institution from January 2008 to December 2012. Factors potentially influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analyses. Results The 1-, 3-, and 5-year overall survival rates were 6.6% (15/229), 0.9% (2/229), and 0 (0/229), respectively. Ascites (relative risk [RR] = 1.631, 95% confidence interval [CI]: 1.221-2.180, P = 0.001), pathological grade (RR = 1.337, 95% CI: 1.050-1.702, P = 0.018), T stage (RR = 1.421, 95% CI: 1.099-1.837, P = 0.000), M stage (RR = 1.896, 95% CI: 1.409-2.552, P = 0.000), and surgery (RR = 1.542, 95% CI: 1.022-2.327, P = 0.039) were identified as independent risk factors influencing prognosis. The median survival time (MST) was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection (6.0 vs. 2.7 months; P < 0.001). In subgroup analyses, stage ⅣA patients benefited from R0 resection (MST for R0 vs. R1/R2, 11.0 vs. 4.0 months; P = 0.003), while R0 resection had a significant survival benefit than R1/R2 resection in patient with stage ⅣB GBC without distant metastasis (MST for R0 vs. R1/R2, 6.0 vs. 3.0 months; P = 0.007). Conclusion Ascites, pathological grade, T stage, M stage, and surgery were independent risk factors influencing prognosis in patients with stage IV GBC. N2 lymph node metastasis did not preclude curative resection, and radical resection should be considered in patients with stage Ⅳ GBC without distant metastasis once R0 margin was achieved.
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Chen M, Lin J, Cao J, Zhu H, Zhang B, Wu A, Cai X. Development and validation of a nomogram for survival benefit of lymphadenectomy in resected gallbladder cancer. Hepatobiliary Surg Nutr 2019; 8:480-489. [PMID: 31673537 DOI: 10.21037/hbsn.2019.03.02] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Due to absence of large, prospective, randomized, clinical trial data, the potential survival benefit of lymphadenectomy with different number of regional lymph nodes (LNs) remains controversial. We aim to create a predicting model to help estimate individualized potential survival benefit of lymphadenectomy with more regional LNs for patients with resected gallbladder cancer (GBC). Methods Patients with resected GBC were selected from the Surveillance, Epidemiology, and End Results database who were diagnosed between 2004 and 2014. Covariates included age, race, sex, grade, histological stage, tumor sizes and receipt of non-primary surgery. Two types of multivariate survival regression models were constructed and compared. The best model performance was tested by the external validation data from our hospital. Results A total of 1,669 patients met the inclusion criteria for this study. The lognormal survival model showed the best performance and was tested by the external validation data, including 193 patients with resected GBC from our hospital. Nomograms, which based on the accelerated failure time parametric survival model, were built to estimate individualized survival. C-index, was up to 0.754 and 0.710 in internal validation for more and less regional LNs removed, respectively. Both of internal and external calibration curves showed good agreement between predicted and observed outcomes in the 1-, 3-, and 5-year overall survival (OS). Conclusions A predicting model can be used as a decision model to predict which patients may obtain benefit from lymphadenectomy with more regional LNs.
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Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China.,Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
| | - Jian Lin
- Longyou People's Hospital, Quzhou 324400, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
| | - Hepan Zhu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
| | - Bin Zhang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
| | - Angela Wu
- Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China.,Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
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26
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Engineer R, Patkar S, Lewis SC, Sharma AD, Shetty N, Ostwal V, Ramaswamy A, Chopra S, Agrawal A, Patil P, Mehta S, Goel M. A phase III randomised clinical trial of perioperative therapy (neoadjuvant chemotherapy versus chemoradiotherapy) in locally advanced gallbladder cancers (POLCAGB): study protocol. BMJ Open 2019; 9:e028147. [PMID: 31253621 PMCID: PMC6609079 DOI: 10.1136/bmjopen-2018-028147] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NACT) is considered the current standard for locally advanced gallbladder cancer (GBC). There is no consensus on the optimal neoadjuvant approach. A pilot study from our institution has shown improved overall survival (OS) and progression-free survival (PFS) with neoadjuvant chemoradiation (NACRT). The present randomised phase III trial is designed to compare NACRT with NACT alone and will test the superiority of chemoradiation in terms of tumour downstaging and improvement in OS. METHODS AND ANALYSIS Patients with biopsy-proven locally advanced GBC (T3-4) with predefined clinical-radiological features will be randomised to the gemcitabine-based chemotherapy-alone arm or the chemoradiation arm. Patients with resectable disease or with distant metastases will be excluded. The primary end point of the study is to compare OS between the two arms. The secondary end point was to compare PFS, R0 resection rates, acute and late toxicity, postoperative complications and quality of life between the two study arms. The trial is designed to detect an improvement in median OS by 5.5 months in the study arm (11 months in the control group, HR of 0.7) with 80.0% power at a 0.05 significance level. The resultant sample size to achieve this aim is 314 (157 in each arm) over a duration of 5 years with a 10% attrition rate. ETHICS AND DISSEMINATION The institutional ethics committee has approved this trial and will be routinely monitoring the trial at frequent intervals. The results of the study will be disseminated via peer-reviewed scientific journals, conference presentations and submission to regulatory authorities. REGISTRATION The trial is registered with Clinical Trials Registry India (CTRI/2016/08/007199) and ClinicalTrials.gov (NCT02867865). This trial aims to assess the superiority of NACRT over NACT in locally advanced GBCs in terms of improvement in OS. The results of this study will define the optimal neoadjuvant approach in locally advanced GBC. TRIAL REGISTRATION NUMBER NCT02867865; Pre-results.
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Affiliation(s)
- Reena Engineer
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shraddha Patkar
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Ashutosh Das Sharma
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Nitin Shetty
- Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Vikas Ostwal
- Department of Medical Oncology, Gastrointestinal Disease Management Group, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Gastrointestinal Disease Management Group, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prachi Patil
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Shaesta Mehta
- Department of Digestive Diseases and Clinical Nutrition, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Mahesh Goel
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Chen M, Cao J, Zhang B, Pan L, Cai X. A Nomogram for Prediction of Overall Survival in Patients with Node-negative Gallbladder Cancer. J Cancer 2019; 10:3246-3252. [PMID: 31289596 PMCID: PMC6603372 DOI: 10.7150/jca.30046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 04/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background & Aims: According to the stage of tumor, it's hard suitable to predict the prognosis for gallbladder cancer, especially for node-negative gallbladder cancer. Therefore, we aimed to create a nomogram based on demographic and clinicopathologic characteristics to estimate individualized potential impacts on postoperative overall survival. Methods: 789 patients with node-negative gallbladder cancer were selected from the Surveillance, Epidemiology, and End Results and randomly divided into training and internal validation group. Univariate and multivariate survival analysis were used to identify prognostic factors. The nomogram was constructed using Cox proportional hazards models. We evaluated the performance of the nomogram with Harrell's concordance index and calibration curve. The nomogram was externally validated in 115 patients with node-negative gallbladder cancer from the Sir Run Run Shaw hospital. Results: The nomogram for overall survival was built on the basis of five independent factors, such as age, sex, histology, T-stage, and number of examined lymph nodes. The C-index of nomogram for overall survival in the internal and external validation group was up to 0.724 and 0.716, respectively. Both of those calibration curves showed good agreement between predicted and observed outcomes in the 1-, 3-, 5-year overall survival. Compared to the 7th edition AJCC stage, the nomogram had a better difference in predicting overall survival, even could further classify patients into four risk subgroups in each stage. Conclusion: This nomogram can be used as a decision model to predict the outcomes of postoperative overall survival for node-negative gallbladder cancer, and may give useful guidance to clinicians for next treatment.
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Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China.,Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China.,Engineering Research Center of Cognitive Healthcare of Zhejiang Province, 310003, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
| | - Bin Zhang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
| | - Long Pan
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China.,Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China.,Engineering Research Center of Cognitive Healthcare of Zhejiang Province, 310003, China
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Søreide K, Harrison EM, Wigmore SJ. Research gaps and unanswered questions in gallbladder cancer. HPB (Oxford) 2018; 20:685-686. [PMID: 29784604 DOI: 10.1016/j.hpb.2018.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/17/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Kjetil Søreide
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK; Clinical Medicine, University of Bergen, Norway; Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway.
| | - Ewen M Harrison
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK
| | - Stephen J Wigmore
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK
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Kishi Y, Nara S, Esaki M, Hiraoka N, Shimada K. Extent of lymph node dissection in patients with gallbladder cancer. Br J Surg 2018; 105:1658-1664. [DOI: 10.1002/bjs.10913] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/06/2018] [Accepted: 05/17/2018] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Definitions of regional lymph nodes for gallbladder cancer differ according to staging system. Hence, the appropriate extent of lymph node dissection has not yet been standardized.
Methods
Pathological stages and disease-specific survival (DSS) of patients who had undergone surgical resection of gallbladder cancer between 1990 and 2016 were reviewed. Patients with nodal metastases limited to the hepatoduodenal ligament or common hepatic artery, extending to the posterosuperior pancreatic head lymph nodes (PSPLNs), or in nodes along the coeliac axis or superior mesenteric vessels were grouped as having Na, Nb and Nc disease respectively. Metastases beyond these regions were defined as distant metastases (M1). Absence of distant metastasis was expressed as M0.
Results
A total of 259 patients were evaluated. There were 74, 31 and nine patients respectively in the Na, Nb and Nc groups. Twenty-five, nine and four patients in the respective groups had M1 disease (P = 0·682). The 5-year DSS rate was comparable between patients with Na M0 and those with Nb M0 disease (36 versus 34 per cent respectively; P = 0·950), whereas the rate in patients with Nc M0 status (0 per cent) was worse than that of patients with Nb M0 (P = 0·017) and comparable to that of patients with M1 disease (14 per cent; P = 0·590). Among 22 patients with Nb M0 disease, the 5-year DSS rate did not differ between those who had undergone pancreatoduodenectomy and those who had had dissection of PSPLNs without pancreatoduodenectomy (50 versus 30 per cent respectively; P = 0·499).
Conclusion
PSPLNs and nodes along the hepatoduodenal ligament and hepatic artery should be considered regional nodes for gallbladder cancer, and should be resected.
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Affiliation(s)
- Y Kishi
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital, Tokyo, Japan
| | - S Nara
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital, Tokyo, Japan
| | - M Esaki
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital, Tokyo, Japan
| | - N Hiraoka
- Division of Molecular Pathology, National Cancer Centre Research Institute, Tokyo, Japan
| | - K Shimada
- Hepatobiliary and Pancreatic Surgery Division, National Cancer Centre Hospital, Tokyo, Japan
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Incidental Gallbladder Carcinoma Discovered after Laparoscopic Cholecystectomy: Identifying Patients Who will Benefit from Reoperation. J Gastrointest Surg 2018; 22:606-614. [PMID: 29274001 DOI: 10.1007/s11605-017-3655-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/08/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite an early radical reoperation, recurrence and poor survival are observed in up to 40% of patients with an incidentally discovered gallbladder carcinoma (I-GBC) after undergoing a laparoscopic cholecystectomy (LC). This study seeks to identify prognostic factors after re-I-GBC resection. METHODS A retrospective review of a prospectively maintained patient database with patients who were undergoing resection for I-GBC from January 1995 to March 2017 was performed. Prognostic factors for survival were assessed by multivariate Cox analysis. RESULTS There were 50 consecutive patients (median age 64 years; range 38-82) undergoing reoperation 45 ± 30 days after LC. Re-resection entailed a major hepatectomy in five patients (10%) and lymphadenectomy in all patients. Ninety-day morbidity and mortality were 22 and 2%, respectively. Lymph node (LN) involvement was present in 24 (48%) patients with a mean of 5.79 ± 14.4 LN+. Median overall survival was 40 months with 1-, 3-, 5- and 10-year survival rates of 80, 50, 41 and 36%, respectively. Independent risk factors for overall survival were T3 tumours (HR = 7.58; 95% confidence intervals (CI), 2.41-23.83.) and LN involvement (HR = 3.66; 95% CI, 1.42-9.45). Patients presenting with zero, one and two risk factors had 3-year survival rates of 85, 31 and 0%, respectively, and median overall survival of 80, 22 and 13 months, respectively (p < 0.0001). CONCLUSIONS After I-GBC discovery following an LC, T3 tumours and tumours with LN+ are characterised by poor prognosis. The presence and the identification of these prognostic factors help identify patients in need of alternative perioperative treatments.
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Cong LL, Cai ZQ, Guo P, Chen C, Liu DC, Li WZ, Wang L, Zhao Y, Si SB, Geng ZM. Decision of surgical approach for advanced gallbladder adenocarcinoma based on a Bayesian network. J Surg Oncol 2017; 116:1123-1131. [PMID: 28876457 DOI: 10.1002/jso.24797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/13/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES To determine whether radical resection can benefit patients with advanced gallbladder adenocarcinoma using a Bayesian network (BN) with clinical data. METHODS In total, 362 patients who had undergone surgical treatment of gallbladder adenocarcinoma at a tertiary institute were evaluated to establish two BN models using a tree-augmented naïve Bayes algorithm. We then chose 250 patients with T3-4N0-2M0 stage gallbladder adenocarcinoma to test the posterior probability after the surgical type was taken into account. RESULTS In total, 170 patients (≤7 months) and 137 patients (>7 months) were correctly classified in the median survival time model (accuracy, 84.81%), and 204 patients (≤12 months), 15 patients (12-36 months), 17 patients (36-60 months), and 34 patients (>60 months) were correctly classified in the 1-, 3-, and 5-year survival model (accuracy, 74.59%), respectively. Every posterior probability in the two models upregulated the ratio of the longer survival time and suggested a better prognosis for gallbladder adenocarcinoma that can be improved by R0 resection. CONCLUSIONS These BN models indicate that stages T4 and N2 gallbladder adenocarcinoma are not contraindications for surgery and that R0 resection can improve survival in patients with advanced gallbladder adenocarcinoma.
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Affiliation(s)
- Long-Long Cong
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhi-Qiang Cai
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, Shaanxi, China
| | - Peng Guo
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, Shaanxi, China
| | - Chen Chen
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - De-Chun Liu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wen-Zhi Li
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lin Wang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yaling Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University, Health Science Center, Xi'an, Shaanxi, China
| | - Shu-Bin Si
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, Shaanxi, China
| | - Zhi-Min Geng
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Sternby Eilard M, Lundgren L, Cahlin C, Strandell A, Svanberg T, Sandström P. Surgical treatment for gallbladder cancer - a systematic literature review. Scand J Gastroenterol 2017; 52:505-514. [PMID: 28270039 DOI: 10.1080/00365521.2017.1284895] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate existing evidence regarding surgical treatments for gallbladder cancer in a Health Technology Assessment. A specific aim was to evaluate whether extended surgery regarding liver, lymph nodes, bile duct, and adjacent organs compared with cholecystectomy alone in the adult patient with gallbladder cancer in early and late stages implies improved survival. METHODS In April 2015 and updated in June 2016, a systematic literature search was conducted in PubMed, Embase, and the Cochrane Library. Two authors independently screened titles, abstracts, and full-text articles. The certainty of evidence was evaluated according to GRADE. MAIN RESULTS Forty-four observational studies (non-randomised, controlled studies) and seven case series were included. Radical resection, including liver and lymph node resection, compared with cholecystectomy alone showed significantly better survival for patients with stages T1b and above. All studies had serious study limitations and the certainty of evidence was very low (GRADE ⊕○○○). A survival benefit seen in patients with stage T1b or higher with lymph node resection, was most evident in stage T2, but the certainty of evidence was low (GRADE ⊕⊕○○). It is uncertain whether routine bile duct resections improve overall survival in patients with gallbladder cancer stage T2-T4 (GRADE ⊕○○○). CONCLUSION Data indicate that prognosis can be improved if liver resection and lymph node resection is performed in patients with tumour stage T1b or higher. There is no evidence supporting resection of the bile duct or adjacent organs if it is not necessary in order to achieve radicality.
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Affiliation(s)
- Malin Sternby Eilard
- a Department of Transplantation and Liver Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Linda Lundgren
- b Department of Surgery , Ryhov Hospital , Jönköping , Sweden
| | - Christian Cahlin
- a Department of Transplantation and Liver Surgery , Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Annika Strandell
- c HTA-Centrum of Region Västra Götaland, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Therese Svanberg
- d Medical Library, Sahlgrenska University Hospital , Gothenburg , Sweden
| | - Per Sandström
- e Department of Surgery , Institute of Clinical and Experimental Medicine, University Hospital of Linkoping , Linköping , Sweden
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Masior Ł, Krasnodębski M, Kobryń K, Grąt M, Krawczyk M. Surgical treatment of gall-bladder cancer. POLISH JOURNAL OF SURGERY 2017; 87:324-30. [PMID: 26247506 DOI: 10.1515/pjs-2015-0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Indexed: 11/15/2022]
Abstract
Despite the aggressive nature and poor prognosis of gall-bladder cancer there is a group of patients who can achieve significant benefits from a radical surgical treatment. The possibility of obtaining long-term survival, even in case of patients with locally advanced cancer and metastases to regional lymph nodes, prompts to verify nihilistic approach to the treatment of this disease. Obviously such therapy can and should be performed only in centers specializing in hepatobiliary surgery. Due to the high recurrence rate, most of which are systemic, the hope of improving treatment outcomes should be sought in the use of combination therapy, based on a new chemotherapy and chemoradiotherapy regimens with the addition of targeted therapy. Unfortunately, the current application of these methods did not bring the expected benefits.
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Chen C, Wang L, Cong LL, Liu DC, Geng ZM. Lymphatic metastasis of gallbladder cancer: Present and future. Shijie Huaren Xiaohua Zazhi 2016; 24:4634-4643. [DOI: 10.11569/wcjd.v24.i35.4634] [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
Lymphatic metastasis is the most common way of metastasis in gallbladder cancer (GBC), and it is also one of the important factors influencing prognosis. Therefore, it is important to elucidate the lymphatic drainage pathways, group the metastatic lymph nodes, assess the extent of lymphadenectomy, and identify relevant predictors of lymphatic metastasis. The development of lymph node tracer technique has greatly improved the surgical procedure, and exploration of the molecular mechanisms of lymphatic metastases may provide new therapeutic targets. In the current review, we discuss the lymphatic drainage pathways as well as the substation, predictors, tracers and mechanisms of lymphatic metastasis of GBC.
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35
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Squadroni M, Tondulli L, Gatta G, Mosconi S, Beretta G, Labianca R. Cholangiocarcinoma. Crit Rev Oncol Hematol 2016; 116:11-31. [PMID: 28693792 DOI: 10.1016/j.critrevonc.2016.11.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 11/07/2016] [Accepted: 11/22/2016] [Indexed: 12/15/2022] Open
Abstract
Biliary tract cancer accounts for <1% of all cancers and affects chiefly an elderly population, with predominance in men. We distinguish cholangiocarcinoma (intrahepatic, hilar and distal) and gallbladder cancer, with different pathogenesis and prognosis. The treatment is based on surgery (whenever possible), radiotherapy in selected cases, and chemotherapy. The standard cytotoxic treatment for advanced/metastatic disease is represented by the combination of gemcitabine and cisplatin, whereas fluoropyrimidines are generally administered in second line setting. At the present time, no biologic drug demonstrated a clear efficacy in this cancer, although the molecular characterisation could provide a promising basis for experimental treatments. A good supportive care and an early palliative care are warranted in most patients and should be delivered as a part of a global approach.
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Affiliation(s)
| | - Luca Tondulli
- Medical Oncology Unit, Borgo Roma Hospital, Verona, Italy
| | - Gemma Gatta
- Italian National Cancer Institute, Milan, Italy
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Long-Term Outcomes and Prognostic Factors in Advanced Gallbladder Cancer: Focus on the Advanced T Stage. PLoS One 2016; 11:e0166361. [PMID: 27846279 PMCID: PMC5112857 DOI: 10.1371/journal.pone.0166361] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/27/2016] [Indexed: 12/22/2022] Open
Abstract
Background Radical resection is an effective therapeutic method to increase the survival rate of patients with gallbladder cancer (GBC). In addition to the surgical approach, the relationships between various clinicopathologic factors and the outcome of patients with GBC remain controversial. Methods Clinical and laboratory examination characteristics, pathological and surgical data, and post-operative survival time of 338 patients with advanced GBC who received treatment at the First Affiliated Hospital of Xi'an Jiaotong University, China from January 2008 to December 2012 were analyzed retrospectively. Factors influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analysis. Results The overall survival rates for curative resection patients were significantly greater than those for non-curative resection patients (1-,3-,5-year survival rate and mean-survival time: 59.0%, 47.3%, 44.3% and 22.0 months vs. 12.7%, 8.3%, 7.7% and 3.0 months) (P < 0.001). For the curative resection patients, positive margin, lymph node metastasis, poorly pathological differentiation and the presence of ascites were all independent risk factors for poor prognosis. For patients with T3 stage, neither segmentectomy of IVb and V nor common bile duct resection improved the prognosis (P = 0.867 and P = 0.948). For patients with T4 stage, aggressive curative resection improved the prognosis (P = 0.007). Conclusions An advanced T stage does not preclude curative resection. Positive margin, lymph node metastasis, poorly pathological differentiation and the presence of ascites are all independent risk factors for poor prognosis in the curative intent resection patients. The range of liver resection and whether common bile duct resection is performed do not influence the prognosis as long as R0 resection is achieved.
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37
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Engineer R, Goel M, Chopra S, Patil P, Purandare N, Rangarajan V, Ph R, Bal M, Shrikhande S, Shrivastava SK, Mehta S. Neoadjuvant Chemoradiation Followed by Surgery for Locally Advanced Gallbladder Cancers: A New Paradigm. Ann Surg Oncol 2016; 23:3009-15. [DOI: 10.1245/s10434-016-5197-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Indexed: 12/29/2022]
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38
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Tran TB, Dua MM, Spain DA, Visser BC, Norton JA, Poultsides GA. Hepato-pancreatectomy: how morbid? Results from the national surgical quality improvement project. HPB (Oxford) 2015; 17:763-9. [PMID: 26058463 PMCID: PMC4557649 DOI: 10.1111/hpb.12426] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 04/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Simultaneous resection of both the liver and the pancreas carries significant complexity. The objective of this study was to investigate peri-operative outcomes after a synchronous hepatectomy and pancreatectomy (SHP). METHODS The American College of Surgeons National Surgical Quality Improvement Project database was queried to identify patients who underwent SHP. Resections were categorized as '< hemihepatectomy', '≥ hemihepatectomy' (hemihepatectomy and trisectionectomy), 'PD' (pancreaticoduodenectomy and total pancreatectomy) and 'distal' (distal pancreatectomy and enucleation). RESULTS From 2005 to 2013, 480 patients underwent SHP. Patients were stratified based on the extent of resection: '< hemihepatectomy + distal (n = 224)', '≥ hemihepatectomy + distal' (n = 49), '< hemihepatectomy + PD' (n = 83) and '≥ hemihepatectomy + PD' (n = 24). Although the first three groups had a reasonable and comparable safety profile (morbidity 33-51% and mortality 0-6.6%), the '≥ hemihepatectomy + PD' group was associated with an 87.5% morbidity (organ space infection 58.3%, re-intubation 12.5%, reoperation 25% and septic shock 25%), 8.3% 30-day mortality and 18.2% in-hospital mortality. CONCLUSIONS A synchronous hemihepatectomy (or trisectionectomy) with PD remains a highly morbid combination and should be reserved for patients who have undergone extremely cautious selection.
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Affiliation(s)
- Thuy B Tran
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Monica M Dua
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - David A Spain
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Brendan C Visser
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - Jeffrey A Norton
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
| | - George A Poultsides
- Department of Surgery, Stanford Cancer Institute, Stanford University, Stanford, CA, USA
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Garg PK, Pandey D. Gallbladder cancer: Nihilism abates, optimism prevails. Eur J Surg Oncol 2015; 41:1443. [PMID: 26233821 DOI: 10.1016/j.ejso.2014.10.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- P K Garg
- Department of Surgical Oncology, All India Institute of Medical Sciences, Delhi, 110029, India; Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, 110095, India
| | - D Pandey
- Department of Surgical Oncology, All India Institute of Medical Sciences, Delhi, 110029, India.
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Viganò L, Birnbaum DJ. Reply to: "Gallbladder cancer: Nihilism abates, optimism prevails". Eur J Surg Oncol 2015; 41:1444-5. [PMID: 26233820 DOI: 10.1016/j.ejso.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/03/2015] [Indexed: 11/15/2022] Open
Affiliation(s)
- L Viganò
- Department of Hepatobiliary & General Surgery, Humanitas Clinical and Research Center, Humanitas University, Rozzano, MI, Italy.
| | - D J Birnbaum
- AP-HM, Hôpital Nord, Department of Digestive Surgery, Marseille, France
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Aloia TA, Járufe N, Javle M, Maithel SK, Roa JC, Adsay V, Coimbra FJF, Jarnagin WR. Gallbladder cancer: expert consensus statement. HPB (Oxford) 2015; 17:681-90. [PMID: 26172135 PMCID: PMC4527853 DOI: 10.1111/hpb.12444] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/27/2015] [Indexed: 02/06/2023]
Abstract
An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists was convened on 15 January 2014 to review current evidence on the management of gallbladder carcinoma in order to establish practice guidelines. In summary, within high incidence areas, the assessment of routine gallbladder specimens should include the microscopic evaluation of a minimum of three sections and the cystic duct margin; specimens with dysplasia or proven cancer should be extensively sampled. Provided the patient is medically fit for surgery, data support the resection of all gallbladder polyps of >1.0 cm in diameter and those with imaging evidence of vascular stalks. The minimum staging evaluation of patients with suspected or proven gallbladder cancer includes contrasted cross-sectional imaging and diagnostic laparoscopy. Adequate lymphadenectomy includes assessment of any suspicious regional nodes, evaluation of the aortocaval nodal basin, and a goal recovery of at least six nodes. Patients with confirmed metastases to N2 nodal stations do not benefit from radical resection and should receive systemic and/or palliative treatments. Primary resection of patients with early T-stage (T1b-2) disease should include en bloc resection of adjacent liver parenchyma. Patients with T1b, T2 or T3 disease that is incidentally identified in a cholecystectomy specimen should undergo re-resection unless this is contraindicated by advanced disease or poor performance status. Re-resection should include complete portal lymphadenectomy and bile duct resection only when needed to achieve a negative margin (R0) resection. Patients with preoperatively staged T3 or T4 N1 disease should be considered for clinical trials of neoadjuvant chemotherapy. Following R0 resection of T2-4 disease in N1 gallbladder cancer, patients should be considered for adjuvant systemic chemotherapy and/or chemoradiotherapy.
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Affiliation(s)
- Thomas A Aloia
- Department of Surgical Oncology, University of Texas MD Anderson Cancer CenterHouston, TX, USA,Correspondence Thomas A. Aloia, Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, 1400 Herman Pressler, Unit 1484, Houston, TX 77030, USA. Tel: + 1 713 563 0189. Fax: + 1 713 745 1921. E-mail:
| | - Nicolas Járufe
- Department of Digestive Surgery, School of Medicine, Catholic University of Chile (Pontificia Universidad Católica de Chile)Santiago, Chile
| | - Milind Javle
- Department of GI Medical Oncology, University of Texas MD Anderson Cancer CenterHouston, TX, USA
| | - Shishir K Maithel
- Department of Surgery, Winship Cancer Institute, Emory UniversityAtlanta, GA, USA
| | - Juan C Roa
- Department of Digestive Surgery, School of Medicine, Catholic University of Chile (Pontificia Universidad Catolica de Chile)Santiago, Chile
| | - Volkan Adsay
- Department of Pathology and Laboratory Medicine, Winship Cancer InstituteEmory University, Atlanta, GA, USA
| | - Felipe J F Coimbra
- Department of Abdominal Surgery, AC Camargo Cancer CentreSão Paulo, Brazil
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
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Higuchi R, Ota T, Araida T, Kajiyama H, Yazawa T, Furukawa T, Yoshikawa T, Takasaki K, Yamamoto M. Surgical approaches to advanced gallbladder cancer : a 40-year single-institution study of prognostic factors and resectability. Ann Surg Oncol 2014; 21:4308-16. [PMID: 25023547 DOI: 10.1245/s10434-014-3885-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim was to evaluate prognostic factors and factors associated with the resectability of advanced gallbladder cancer (GBC). METHODS This was a single-institution retrospective review of 274 consecutive surgically-treated cases of advanced GBC (excluding incidental GBC and early GBC). Univariate and multivariate analysis were performed to assess prognostic variables. R0 resection and survival rates were investigated for each local extension factor. RESULTS Long-term survival was uncommon among patients with multiple liver metastases (H2-3: n = 22; 2-year survival, 0 %), dissemination (P1-3: n = 16; 3-year survival, 0 %), invasion through the hepatoduodenal ligament (Binf3: n = 45; 5-year survival, 4.6 %), or group 3 lymph node (LN) metastasis including of the para-aortic LN (N3: n = 52; 13.7 %). Long-term survival rates did not differ significantly between patients who did and did not undergo bile duct resection or pancreaticoduodenectomy. Survival did not differ significantly according to the type of hepatectomy performed. CONCLUSION Surgery may not be indicated for patients with multiple liver metastasis, dissemination, Binf3, or visible para-aortic LN metastasis. Furthermore, it is important to achieve R0 surgery in cases of GBC.
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Affiliation(s)
- Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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