1
|
Yoo D, Kim SR, Jun E, Park Y, Kwak BJ, Lee W, Lee JH, Hwang DW, Kim SC, Song KB. Clinical implication of the geometric location (fundal end versus cystic ductal end) of gallbladder cancer. ANZ J Surg 2024; 94:867-875. [PMID: 38251805 DOI: 10.1111/ans.18869] [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: 06/23/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Management of early-stage gallbladder cancer is becoming more important as the rate of early detection is increasing. Although there have been many studies about the clinical implication of the invasion depth or peritoneal/hepatic location of gallbladder cancers, there is no study on the clinical implication of the geometric location of cancer along the longitudinal length of the gallbladder. METHODS The location of gallbladder cancer was defined as the geometric center of the primary site of a tumour, which lies on the longitudinal diameter of the surgical specimens. We compared the oncologic outcomes following surgery between gallbladder cancers located on the fundal end and those located on the cystic ductal end. We also analysed patients with stage 1 gallbladder cancer who recurred after surgery. RESULTS A total of 575 patients with gallbladder cancer were included in this study. Patients with gallbladder cancer on the cystic ductal end had significantly lower rates of recurrence-free survival (P = 0.016) and overall survival (P = 0.023) compared to those with gallbladder cancer on the fundal end. Among 90 patients with stage 1 gallbladder cancer, three patients had a recurrence, all of whom had cystic ductal end gallbladder cancer and showed cystic duct invasion or concomitant xanthogranulomatous cholecystitis in permanent pathology. CONCLUSIONS Gallbladder cancers on the cystic ductal end had worse postoperative oncologic outcomes compared with those on the fundal end.
Collapse
Affiliation(s)
- Daegwang Yoo
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Seoul Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Seong-Ryong Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Seoul, South Korea
| | - Eunsung Jun
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yejong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bong Jun Kwak
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woohyung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
2
|
Ji Z, Ren L, Liu F, Liu L, Song J, Zhu J, Ji G, Huang G. Effect of different surgical options on the long-term survival of stage I gallbladder cancer: a retrospective study based on SEER database and Chinese Multi-institutional Registry. J Cancer Res Clin Oncol 2023; 149:12297-12313. [PMID: 37432456 DOI: 10.1007/s00432-023-05116-z] [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: 06/06/2023] [Accepted: 07/04/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Gallbladder cancer (GC) is a uncommon and highly malignant tumor. This study compared the effects of simple cholecystectomy (SC) and extended cholecystectomy (EC) on the long-term survival of stage I GC. METHODS Patients with stage I GC between 2004 and 2015 in the SEER database were selected. Meanwhile, this study collected the clinical information of patients with stage I GC admitted to five medical centers in China between 2012 and 2022. Using clinical data from patients in the SEER database as a training set to construct a nomogram, which was validated in Chinese multicenter patients. Long-term survival between SC and EC were distinguished using propensity score matching (PSM). RESULTS A total of 956 patients from the SEER database and 82 patients from five Chinese hospitals were included in this study. The independent prognostic factors were age, sex, histology, tumor size, T stage, grade, chemotherapy and surgical approach by multivariate Cox regression analysis. We developed a nomogram based on these variables. The nomogram has been proved to have good accuracy and discrimination in internal and external validation. The cancer-specific survival (CSS) and overall survival of patients receiving EC were better than those of SC before and after the propensity score match. The interaction test showed that EC was associated with better survival in patients aged ≥ 67 years (P = 0.015) and in patients with T1b and T1NOS (P < 0.001). CONCLUSION A novel nomogram to predict CSS in patients with stage I GC after SC or EC. Compared with SC, EC for stage I GC had higher OS and CSS, especially in specific subgroups (T1b, T1NOS, and age ≥ 67 years).
Collapse
Affiliation(s)
- Zuhong Ji
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210046, China
| | - Ling Ren
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210046, China
- Department of Gastroenterology, Lianyungang No 1 People's Hospital, Lianyungang, China
| | - Fang Liu
- Pathological Diagnosis Center, XuZhou Central Hospital, Xuzhou, China
| | - Lei Liu
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210046, China
- Department of Gastroenterology, The Affiliated Yixing Hospital of Jiangsu University, Yixing, Jiangsu, China
| | - Jing Song
- Department of Endocrinology, The Affiliated Huaian No.1 People's Hospital of Nanjing Medical University, Huai'an, China
| | - Juntao Zhu
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210046, China
| | - Guozhong Ji
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210046, China.
| | - Guangming Huang
- Medical Centre for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, 121 Jiangjiayuan Road, Nanjing, 210046, China.
| |
Collapse
|
3
|
Takala S, Lassen K, Søreide K, Sparrelid E, Angelsen JH, Bringeland EA, Eilard MS, Hemmingsson O, Isaksson B, Karjula H, Lammi JP, Larsen PN, Lavonius M, Lindell G, Mortensen FV, Mortensen K, Nordin A, Pless T, Sandström P, Sandvik O, Vaalavuo Y, Villard C, Sallinen V. Practice patterns in diagnostics, staging, and management strategies of gallbladder cancer among Nordic tertiary centers. Scand J Surg 2023; 112:147-156. [PMID: 37377127 DOI: 10.1177/14574969231181228] [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] [Indexed: 06/29/2023]
Abstract
BACKGROUND AND OBJECTIVE Gallbladder cancer (GBC) is a rare malignancy in the Nordic countries and no common Nordic treatment guidelines exist. This study aimed to characterize the current diagnostic and treatment strategies in the Nordic countries and disclose differences in these strategies. METHODS This was a survey study with a cross-sectional questionnaire of all 19 university hospitals providing curative-intent surgery for GBC in Sweden, Norway, Denmark, and Finland. RESULTS In all Nordic countries except Sweden, neoadjuvant/downstaging chemotherapy was used in GBC patients. In T1b and T2, majority of the centers (15-18/19) performed extended cholecystectomy. In T3, majority of the centers (13/19) performed cholecystectomy with resection of segments 4b and 5. In T4, majority of the centers (12-14/19) chose palliative/oncological care. The centers in Sweden extended lymphadenectomy beyond the hepatoduodenal ligament, whereas all other Nordic centers usually limited lymphadenectomy to the hepatoduodenal ligament. All Nordic centers except those in Norway used adjuvant chemotherapy routinely for GBC. There were no major differences between the Nordic centers in diagnostics and follow-up. CONCLUSIONS The surgical and oncological treatment strategies of GBC vary considerably between the Nordic centers and countries.
Collapse
Affiliation(s)
- Sini Takala
- Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kristoffer Lassen
- Department of HPB Surgery, University Hospital of Oslo at Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Kjetil Søreide
- HPB Unit, Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ernesto Sparrelid
- Division of Surgery, Department of Clinical Science, Intervention, and Technology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jon-Helge Angelsen
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - Erling A Bringeland
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Malin S Eilard
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Transplantation Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Hemmingsson
- Department of Surgical and Perioperative Sciences/Surgery, Umeå University, Umeå, Sweden; Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Bengt Isaksson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Heikki Karjula
- Department of Surgery, Oulu University Hospital, Oulu, Finland
| | | | - Peter N Larsen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maija Lavonius
- Department of Digestive Surgery, Turku University Hospital and University of Turku, Turku, Finland
| | - Gert Lindell
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | | | - Kim Mortensen
- Department of Gastrointestinal Surgery, University Hospital North Norway, Tromsø, Norway
| | - Arno Nordin
- Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Torsten Pless
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Per Sandström
- Department of Surgery and Biomedical and Clinical Sciences, University Hospital of Linköping, Linköping, Sweden
| | - Oddvar Sandvik
- HPB Unit, Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Yrjö Vaalavuo
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Christina Villard
- Department of Medicine, Karolinska Institute, Stockholm, Sweden; Department of Transplantation, Karolinska University Hospital, Stockholm, Sweden
| | - Ville Sallinen
- Department of Abdominal Surgery Transplantation and Liver Surgery University of Helsinki and Helsinki University Hospital Haartmaninkatu 4 Helsinki 00029 Finland
- Gastroenterological Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
4
|
Vega EA, Newhook TE, Mellado S, Ruzzenente A, Okuno M, De Bellis M, Panettieri E, Ahmad MU, Merlo I, Rojas J, De Rose AM, Nishino H, Sinnamon AJ, Donadon M, Hauger MS, Guevara OA, Munoz C, Denbo JW, Chun YS, Tran Cao HS, Sanchez Claria R, Tzeng CWD, De Aretxabala X, Vivanco M, Brudvik KW, Seo S, Pekolj J, Poultsides GA, Torzilli G, Giuliante F, Anaya DA, Guglielmi A, Vinuela E, Vauthey JN. Benchmarks and Geographic Differences in Gallbladder Cancer Surgery: An International Multicenter Study. Ann Surg Oncol 2023; 30:4904-4911. [PMID: 37149547 DOI: 10.1245/s10434-023-13531-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/05/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND High-quality surgery plays a central role in the delivery of excellent oncologic care. Benchmark values indicate the best achievable results. We aimed to define benchmark values for gallbladder cancer (GBC) surgery across an international population. PATIENTS AND METHODS This study included consecutive patients with GBC who underwent curative-intent surgery during 2000-2021 at 13 centers, across seven countries and four continents. Patients operated on at high-volume centers without the need for vascular and/or bile duct reconstruction and without significant comorbidities were chosen as the benchmark group. RESULTS Of 906 patients who underwent curative-intent GBC surgery during the study period, 245 (27%) were included in the benchmark group. These were predominantly women (n = 174, 71%) and had a median age of 64 years (interquartile range 57-70 years). In the benchmark group, 50 patients (20%) experienced complications within 90 days after surgery, with 20 patients (8%) developing major complications (Clavien-Dindo grade ≥ IIIa). Median length of postoperative hospital stay was 6 days (interquartile range 4-8 days). Benchmark values included ≥ 4 lymph nodes retrieved, estimated intraoperative blood loss ≤ 350 mL, perioperative blood transfusion rate ≤ 13%, operative time ≤ 332 min, length of hospital stay ≤ 8 days, R1 margin rate ≤ 7%, complication rate ≤ 22%, and rate of grade ≥ IIIa complications ≤ 11%. CONCLUSIONS Surgery for GBC remains associated with significant morbidity. The availability of benchmark values may facilitate comparisons in future analyses among GBC patients, GBC surgical approaches, and centers performing GBC surgery.
Collapse
Affiliation(s)
- Eduardo A Vega
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Surgery, Saint Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | - Timothy E Newhook
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sebastian Mellado
- Department of Surgery, Saint Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
- Tuft University School of Medicine, Boston, MA, USA
| | - Andrea Ruzzenente
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - Masayuki Okuno
- Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mario De Bellis
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Usman Ahmad
- Department of Surgery, Stanford University, Stanford, CA, USA
| | - Ignacio Merlo
- General Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jesus Rojas
- UGI & HPB Surgery Unit, Hospital Regional de Talca, Universidad Catolica del Maule, Talca, Chile
| | - Agostino M De Rose
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Hiroto Nishino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Andrew J Sinnamon
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Matteo Donadon
- Division of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marit S Hauger
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Oscar A Guevara
- Department of Surgery, Instituto Nacional de Cancerologia, Bogota, Colombia
| | - Cesar Munoz
- UGI & HPB Surgery Unit, Hospital Regional de Talca, Universidad Catolica del Maule, Talca, Chile
| | - Jason W Denbo
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Hop S Tran Cao
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rodrigo Sanchez Claria
- General Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xabier De Aretxabala
- Gallbladder Consortium Chile, Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Sotero del Rio Hospital and Clinica Alemana de Santiago, Santiago, Chile
| | - Marcelo Vivanco
- Gallbladder Consortium Chile, Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Sotero del Rio Hospital and Clinica Alemana de Santiago, Santiago, Chile
| | - Kristoffer W Brudvik
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Oslo, Norway
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Juan Pekolj
- General Surgery and Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniel A Anaya
- Section of Hepatobiliary Tumors, Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Alfredo Guglielmi
- Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - Eduardo Vinuela
- Gallbladder Consortium Chile, Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Sotero del Rio Hospital and Clinica Alemana de Santiago, Santiago, Chile
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| |
Collapse
|
5
|
Chen Z, Yu J, Cao J, Lin C, Hu J, Zhang B, Shen J, Feng X, Topatana W, Chen M, Fang H. Wedge resection versus segment IVb and V resection of the liver for T2 gallbladder cancer: a systematic review and meta-analysis. Front Oncol 2023; 13:1186378. [PMID: 37469411 PMCID: PMC10352769 DOI: 10.3389/fonc.2023.1186378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/16/2023] [Indexed: 07/21/2023] Open
Abstract
Objectives Although guidelines recommend extended cholecystectomy for T2 gallbladder cancer (GBC), the optimal hepatectomy strategy remains controversial. The study aims to compare the prognosis of T2 GBC patients who underwent wedge resection (WR) versus segment IVb and V resection (SR) of the liver. Methods A specific search of online databases was performed from May 2001 to February 2023. The postoperative efficacy outcomes were synthesized and meta-analyses were conducted. Results A total of 9 studies involving 2,086 (SR = 627, WR = 1,459) patients were included in the study. The primary outcomes included disease-free survival (DFS) and overall survival (OS). For DFS, the 1-year DFS was statistically higher in patients undergoing SR than WR [risk ratio (RR) = 1.07, 95% confidence interval (CI) = 1.02-1.13, P = 0.007]. The 3-year DFS (P = 0.95), 5-year DFS (P = 0.77), and hazard ratio (HR) of DFS (P = 0.72) were similar between the two groups. However, the 3-year OS was significantly lower in patients who underwent SR than WR [RR = 0.90, 95% CI = 0.82-0.99, P = 0.03]. Moreover, SR had a higher hazard HR of OS [HR = 1.33, 95% CI = 1.01-1.75, P = 0.04]. No significant difference was found in 1-year (P = 0.32) and 5-year (P = 0.9) OS. For secondary outcomes, patients who received SR tended to develop postoperative complications (POC) [RR = 1.90, 95% CI = 1.00-3.60, P = 0.05]. In addition, no significant differences in intrahepatic recurrence (P = 0.12) were observed. Conclusions In conclusion, SR can improve the prognosis of T2 GBC patients in DFS. In contrast to WR, the high HR and complications associated with SR cannot be neglected. Therefore, surgeons should evaluate the condition of the patients and take their surgical skills into account when selecting SR. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier, CRD42022362974.
Collapse
Affiliation(s)
- Zhehan Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiayu Yu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chenping Lin
- Department of General Surgery, Second People’s Hospital of Linhai, Linhai, Zhejiang, China
| | - Jiahao Hu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bin Zhang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiliang Shen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xu Feng
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Win Topatana
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haixing Fang
- Department of Hepatobiliary Surgery, The First People’s Hospital of Fuyang, Fuyang First Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| |
Collapse
|
6
|
Huang F, Shamavonian R, Morris DL. Cytoreductive Surgery and HIPEC for Regionally Advanced Gallbladder Cancer: a Case Report. Indian J Surg Oncol 2023; 14:127-130. [PMID: 37359942 PMCID: PMC10284756 DOI: 10.1007/s13193-022-01634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/23/2022] [Indexed: 02/07/2023] Open
Abstract
Gallbladder cancer is a rare cancer, associated with an extremely poor prognosis. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is not commonly performed in gallbladder cancer; however, case series have shown prolonged survival time with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in gallbladder cancer and no increase in morbidity compared to cytoreductive surgery without hyperthermic intraperitoneal chemotherapy. We present a case of gallbladder cancer with peritoneal metastases in a 60-year-old male who was successfully treated with complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and survived for 4 years following diagnosis.
Collapse
Affiliation(s)
- Fay Huang
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, University of New South Wales, Level 3, Clinical Sciences (Pitney) Building, Kogarah, NSW 2217 Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Raphael Shamavonian
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, University of New South Wales, Level 3, Clinical Sciences (Pitney) Building, Kogarah, NSW 2217 Australia
- School of Medicine, University of Notre Dame, Sydney, NSW Australia
| | - David L. Morris
- Hepatobilliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, University of New South Wales, Level 3, Clinical Sciences (Pitney) Building, Kogarah, NSW 2217 Australia
- St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW Australia
| |
Collapse
|
7
|
Zhang W, Ouyang DL, Che X. Short- and long-term outcomes of laparoscopic vs open surgery for T2 gallbladder cancer: A systematic review and meta-analysis. World J Gastrointest Surg 2022; 14:1387-1396. [PMID: 36632125 PMCID: PMC9827575 DOI: 10.4240/wjgs.v14.i12.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 10/28/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND With the development of laparoscopic techniques, gallbladder cancer (GBC) is no longer a contraindication to laparoscopic surgery (LS). Although LS is recommended for stage T1 GBC, the value of LS for stage T2 GBC is still controversial.
AIM To evaluate the short- and long-term outcomes of LS in comparison to those of open surgery (OS) for stage T2 GBC.
METHODS We searched the PubMed, Embase, Cochrane Library, Ovid, Google Scholar, and Web of Science databases for published studies comparing the efficacy of LS and OS in the treatment of stage T2 GBC, with a cutoff date of September 2022. The Stata 15 statistical software was used for analysis. Relative risk (RR) and weighted mean difference (WMD) were calculated to assess binary and continuous outcome indicators, respectively. Begg’s test and Egger’s test were used for detecting publication bias.
RESULTS A total of five studies were included, with a total of 297 patients, 153 in the LS group and 144 in the OS group. Meta-analysis results showed that the LS group was better than the OS group in terms of operative time [WMD = -41.29, 95% confidence interval (CI): -75.66 to -6.92, P = 0.02], estimated blood loss (WMD = -261.96, 95%CI: -472.60 to -51.31, P = 0.01), and hospital stay (WMD = -5.67, 95%CI: -8.53 to -2.81, P = 0.0001), whereas there was no significant difference between the two groups in terms of blood transfusion (RR = 0.60, 95%CI: 0.31-1.15, P = 0.13), complications (RR = 0.72, 95%CI: 0.39-1.33, P = 0.29), number of lymph nodes retrieved (WMD = –1.71, 95%CI: -4.27 to -0.84, P = 0.19), recurrence (RR = 0.41, 95%CI: 0.06-2.84, P = 0.36), 3-year and 5-year overall survival (RR = 0.99, 95%CI: 0.82-1.18, P = 0.89 and RR = 1.02, 95%CI: 0.68-1.53, P = 0.92; respectively), and 3-year and 5-year disease-free survival (RR = 1.01, 95%CI: 0.84-1.21, P = 0.93 and RR = 1.15, 95%CI: 0.90-1.46, P = 0.26; respectively).
CONCLUSION The long-term outcomes of LS for T2 GBC are similar to those of OS, but LS is superior to OS in terms of operative time, intraoperative bleeding, and postoperative hospital stay. Nevertheless, these findings should be validated via high-quality randomized controlled trials and longer follow-ups.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
| | - De-Liang Ouyang
- Department of General Surgery, The Third Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang 421900, Hunan Province, China
| | - Xu Che
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, Guangdong Province, China
| |
Collapse
|
8
|
Uzun MA, Tilki M, Alkan Kayaoğlu S, Çiçek Okuyan G, Kılıçoğlu ZG, Gönültaş A. Long-term results and prognostic factors after surgical treatment for gallbladder cancer. Turk J Surg 2022; 38:334-344. [PMID: 36875276 PMCID: PMC9979551 DOI: 10.47717/turkjsurg.2022.5861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/10/2022] [Indexed: 01/12/2023]
Abstract
Objectives Gallbladder cancer is relatively rare and traditionally regarded as having poor prognosis. There is controversy about the effects of clinicopathological features and different surgical techniques on prognosis. The aim of this study was to investigate the effects of clinicopathological characteristics of the patients with surgically treated gallbladder cancer on long-term survival. Material and Methods We retrospectively analyzed the database of gallbladder cancer patients treated at our clinic between January 2003 and March 2021. Results Of 101 evaluated cases, 37 were inoperable. Twelve patients were determined unresectable based on surgical findings. Resection with curative intent was performed in 52 patients. The one-, three-, five-, and 10-year survival rates were 68.9%, 51.9%, 43.6%, and 43.6%, respectively. Median survival was 36.6 months. On univariate analysis, poor prognostic factors were determined as advanced age; high carbohydrate antigen 19-9 and carcinoembryonic antigen levels; non-incidental diagnosis; intraoperative incidental diagnosis; jaundice; adjacent organ/structure resection; grade 3 tumors; lymphovascular invasion; and high T, N1 or N2, M1, and high AJCC stages. Sex, IVb/V segmentectomy instead of wedge resection, perineural invasion, tumor location, number of resected lymph nodes, and extended lymphadenectomy did not significantly affect overall survival. On multivariate analysis, only high AJCC stages, grade 3 tumors, high carcinoembryonic antigen levels, and advanced age were independent predictors of poor prognosis. Conclusion Treatment planning and clinical decision-making for gallbladder cancer requires individualized prognostic assessment along with standard anatomical staging and other confirmed prognostic factors.
Collapse
Affiliation(s)
- Mehmet Ali Uzun
- Clinic of General Surgery, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye.,Clinic of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Metin Tilki
- Clinic of General Surgery, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Sevcan Alkan Kayaoğlu
- Clinic of General Surgery, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Gülten Çiçek Okuyan
- Clinic of General Surgery, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Zeynep Gamze Kılıçoğlu
- Clinic of Radiology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| | - Aylin Gönültaş
- Clinic of Pathology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, İstanbul, Türkiye
| |
Collapse
|
9
|
Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
Collapse
Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Cassese G, Han HS, Yoon YS, Lee JS, Cho JY, Lee HW, Lee B, Troisi RI. Preoperative Assessment and Perioperative Management of Resectable Gallbladder Cancer in the Era of Precision Medicine and Novel Technologies: State of the Art and Future Perspectives. Diagnostics (Basel) 2022; 12:1630. [PMID: 35885535 PMCID: PMC9320561 DOI: 10.3390/diagnostics12071630] [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: 05/07/2022] [Revised: 07/01/2022] [Accepted: 07/02/2022] [Indexed: 12/07/2022] Open
Abstract
Gallbladder carcinoma (GBC) is a rare malignancy, with an estimated 5-year survival rate of less than 5% in the case of advanced disease. Surgery is the only radical treatment for early stages, but its application and effectiveness depend on the depth of tumoral invasion. The extent of resection is usually determined according to the T-stage. Therefore, an early and correct preoperative assessment is important for the prognosis, as well as for the selection of the most appropriate surgical procedure, to avoid unnecessary morbid surgeries and to reach the best outcomes. Several modalities can be used to investigate the depth of invasion, from ultrasounds to CT scans and MRI, but an ideal method still does not exist. Thus, different protocols are proposed according to different recommendations and institutions. In this scenario, the indications for laparoscopic and robotic surgery are still debated, as well as the role of new technologies such as next-generation sequencing and liquid biopsies. The aim of this article is to summarize the state of the art current modalities and future perspectives for assessing the depth of invasion in GBC and to clarify their role in perioperative management accordingly.
Collapse
Affiliation(s)
- Gianluca Cassese
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, 80131 Naples, Italy
| | - Ho-Seong Han
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Jun Suh Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Jai Young Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Hae-Won Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Boram Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
| | - Roberto Ivan Troisi
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea; (G.C.); (Y.-S.Y.); (J.S.L.); (J.Y.C.); (H.-W.L.); (B.L.); (R.I.T.)
- Department of Clinical Medicine and Surgery, Division of Minimally Invasive and Robotic HPB Surgery, Federico II University Hospital, 80131 Naples, Italy
| |
Collapse
|
11
|
Pericleous S, Doran SLF, Wotherspoon A, Terlizzo M, Riddell A, Brown G, Shur J, Chua S, Hujairi N, Middleton N, Cunningham D, Kumar S, Bhogal RH. The Diagnostic Accuracy of 18 F-FGD-PET/CT for Cancer of the Gallbladder: A Retrospective Study. World J Nucl Med 2022; 21:112-119. [PMID: 35865160 PMCID: PMC9296241 DOI: 10.1055/s-0042-1750332] [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] [Indexed: 12/24/2022] Open
Abstract
Background Gallbladder cancer has a poor prognosis and imaging can have variable diagnostic accuracy. We assessed the ability of preoperative 18 F-fluorodeoxyglucose positron emission tomography computed tomography ( 18 F-FDG-PET/CT) imaging to predict a postoperative histological diagnosis of gallbladder cancer. Method A retrospective analysis was undertaken in a cohort of patients, who had suspected gallbladder cancer on cross-sectional imaging and that underwent preoperative FDG-PET/CT scan. The discriminatory power of FDG-PET/CT was determined in receiver operator characteristic (ROC) analysis and diagnostic accuracy parameters were estimated at different thresholds of maximum standard unit value (SUV max ) . Results Twenty-two patients were included in the study; 7 had malignant and 15 benign diagnoses. There was no statistically significant difference between the measured SUV max between the two groups ( p = 0.71). With an area under the curve of 0.486, the ROC curve did not indicate any discriminatory power of FDG-PET/CT at any potential threshold of SUV max. Conclusion This study indicates that the diagnosis of primary gallbladder cancer cannot be accurately confirmed with FDG PET/CT scanning.
Collapse
Affiliation(s)
- Stephanos Pericleous
- Department of HPB Surgery, Academic Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Sophie L. F. Doran
- Department of HPB Surgery, Academic Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Andrew Wotherspoon
- Department of Histopathology, Royal Marsden Hospital, London, United Kingdom
| | - Monica Terlizzo
- Department of Histopathology, Royal Marsden Hospital, London, United Kingdom
| | - Angela Riddell
- Department of Radiology and Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Gina Brown
- Department of Radiology and Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Joshua Shur
- Department of Radiology and Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Sue Chua
- Department of Radiology and Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Nabil Hujairi
- Department of Radiology and Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Nicos Middleton
- School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - David Cunningham
- Department of Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Sacheen Kumar
- Department of Surgery, Academic Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Ricky H. Bhogal
- Department of HPB Surgery, Academic Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| |
Collapse
|
12
|
Salehi O, Vega EA, Mellado S, Core MJ, Li M, Kozyreva O, Kutlu OC, Freeman R, Conrad C. High-Quality Surgery for Gallbladder Carcinoma: Rare, Associated with Disparity, and Not Substitutable by Chemotherapy. J Gastrointest Surg 2022; 26:1241-1251. [PMID: 35396641 DOI: 10.1007/s11605-022-05290-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/26/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Oncologic surgery for T1b-T3 gallbladder carcinoma (GBC) consists of gallbladder fossa resection or bisegmentectomy IVb/V with negative margins and portal/retropancreatic lymphadenectomy. Frequency of high quality oncologic surgery, factors associated with its use, and the ability of chemotherapy to rescue low-quality surgery (LQS) remain unknown. METHODS The NCDB was queried for patients diagnosed with stage I-III (T1b-T3) GBC undergoing curative-intent surgery from 2004 to 2016. These patients were divided into two groups based on receiving high quality surgery (HQS) or not; HQS was defined as cholecystectomy with partial hepatectomy, lymph node harvest ≥ 6, and negative margins. Logistic regression and Kaplan-Meier survival analyses were performed. RESULTS A total of 3796 patients met inclusion criteria; only 364 (9.6%) met HQS criteria, and 3432 (90.4%) did not achieve HQS and were deemed low-quality surgery (LQS). HQS was associated with improved median overall survival (55.1 vs. 25.5 months, P < .001). Adjuvant chemotherapy (AC) was not able to rescue LQS with poorer survival compared to HQS without AC (27.9 vs 55.1 months, P < .001). Factors associated with HQS included private insurance (OR 1.809, P < .001), higher income (OR 1.380, P = .038), urban/rural residence (vs metropolitan) (OR 1.641, P = .001), higher education (OR 1.342, P = .031), Medicaid expansion states (OR 1.405, P = .005), stage 3 GBC (OR 1.642, P = .020), and reresection (OR 2.685, P < .001). Factors associated with LQS included older age (OR 0.974, P < .001), comorbidities (OR 0.701, P = .004), and laparoscopic approach (0.579, P < .001). Facility type incrementally improved HQS rate (integrated cancer network vs. comprehensive community, 9.8% vs. 6.1%, OR 1.694, P = .003; academic/research center vs. integrated cancer network, 14.9% vs. 9.8%, OR 1.599, P = .003). CONCLUSION While HQS for GBC strongly improves survival, it is infrequently practiced. The newly identified factors that improve survival for GBC, such as centralization, open approach, and insurance coverage, are modifiable and, therefore, should be considered to achieve optimal outcomes.
Collapse
Affiliation(s)
- Omid Salehi
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, 11 Nevins St., Suite 201, Brighton, Boston, MA, 02135, USA
| | - Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, 11 Nevins St., Suite 201, Brighton, Boston, MA, 02135, USA
| | | | - Michael J Core
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, 11 Nevins St., Suite 201, Brighton, Boston, MA, 02135, USA
| | - Mu Li
- Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Harvard Medical School, Boston, MA, USA
| | - Olga Kozyreva
- Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Harvard Medical School, Boston, MA, USA
| | - Onur C Kutlu
- Department of Surgery, University of Miami Health System, Miller School of Medicine, Miami, FL, USA
| | - Richard Freeman
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, 11 Nevins St., Suite 201, Brighton, Boston, MA, 02135, USA
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, 11 Nevins St., Suite 201, Brighton, Boston, MA, 02135, USA.
| |
Collapse
|
13
|
Hemminki K, Försti A, Hemminki O, Liska V, Hemminki A. Long-term incidence and survival trends in cancer of the gallbladder and extrahepatic bile ducts in Denmark, Finland, Norway and Sweden with etiological implications related to Thorotrast. Int J Cancer 2022; 151:200-208. [PMID: 35213036 DOI: 10.1002/ijc.33980] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/06/2022]
Abstract
Cancers of the gallbladder and extrahepatic bile ducts (called here 'GBC' because gallbladder cancer is the main component) are rare in Europe, including the Nordic countries. Their incidence has varied for unknown reasons and we hypothesize that Thorotrast, a previously used carcinogenic radiographic contrast medium, has contributed to the incidence trends. We obtained incidence and survival data from the NORDCAN database, which includes cancer registry data from Denmark (DK), Finland (FI), Norway (NO) and Sweden (SE), which are globally the oldest national cancer databases, starting from 1943 in DK, 1953 in FI and NO and 1960 in SE, and extending to 2016. The incidence trend for GBC showed a broad maximum around 1980 in men (close to 3/100,000) and women (4/100,000), except for NO, where this phenomenon was not seen. In 1955, FI and NO incidence rates were equal but FI rates peaked and later declined similar to DK and SE rates. By 2010, the incidence was similar in all Nordic countries, for both men and women, at close to 2.0/100,000. Birth cohort analysis showed strong effects for countries other than NO. Relative 1-year survival increased for men from 20% to about 50% and similarly for women although at a 5 percentage points lower level. Survival in NO was better than in other countries in the 1980s. Thorotrast, causing a high risk of GBC, was extensively used in the Nordic countries between 1930 and end of 1940s, with the exception of NO, where these was no documented use. These data suggest that Thorotrast influenced GBC epidemiology and probably worsened survival in certain periods. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Kari Hemminki
- Biomedical Center, Faculty of Medicine, Charles University in Pilsen, Pilsen, Czech Republic.,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, Heidelberg, Germany
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Otto Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Finland.,Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Vaclav Liska
- Department of Surgery, University Hospital, School of Medicine in Pilsen, Pilsen, Czech Republic.,Biomedical Center, Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Finland.,Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
14
|
Prieto-Ortiz RG, Borráez-Segura BA, Prieto-Ortiz JE, Guevara-Cruz ÓA. Cáncer de vesícula biliar, una visión actual. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El diagnóstico de cáncer de vesícula biliar se realiza generalmente de forma incidental durante el estudio de las piezas quirúrgicas o cuando la enfermedad está avanzada y se expresa por su diseminación. Muy pocas veces se diagnostica de forma preoperatoria. Corresponde a la neoplasia más común de las vías biliares y su incidencia varía de acuerdo a la región geográfica. La región andina en Latinoamérica presenta una de las mayores incidencias a nivel mundial.
Métodos. Se realizó una revisión narrativa de la literatura, para presentar una información actualizada en lo referente a los factores de riesgo (incluyendo las alteraciones genéticas y moleculares), al diagnóstico y al tratamiento de esta patología. Basados en los datos actuales, presentamos algunas recomendaciones dirigidas al diagnóstico temprano, que permita un manejo más adecuado de nuestros pacientes.
Resultados. Se han implicado nuevos factores de riesgo relacionados con la etiología del cáncer de vesícula biliar, como la obesidad, factores genéticos y moleculares. A pesar de la disponibilidad de los métodos diagnósticos imagenológicos, no ha ocurrido una importante variación porcentual en cuanto al estadio al momento del diagnóstico.
Conclusiones. El manejo quirúrgico del cáncer de vesícula biliar está indicado en los estadios más tempranos de la enfermedad y es importante evaluar las opciones terapéuticas en pacientes con enfermedad avanzada. Se considera de suma importancia el estudio anatomopatológico de la pieza quirúrgica y la revisión del informe por parte del cirujano
Collapse
|
15
|
Yan J, Dai P, Qin X, He Y, Zhang Y. HMGA2 promotes the migration and invasion of gallbladder cancer cells and HMGA2 knockdown inhibits angiogenesis via targeting VEGFA. Mol Med Rep 2021; 25:54. [PMID: 34913073 PMCID: PMC8711027 DOI: 10.3892/mmr.2021.12570] [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: 03/29/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022] Open
Abstract
The high mobility group AT-hook 2 (HMGA2) protein has been found to be upregulated in the majority of tumor types and is associated with a poor prognosis. Previous studies have suggested the oncogenic role of HMGA2 in gallbladder cancer (GBC). The present study aimed to investigate the effects of HMGA2 on the invasion, migration and angiogenesis of GBC cells. To achieve this aim, HMGA2 was overexpressed or silenced in the GBC cell line, EH-GB1, and then the proliferation, migration, invasion and epithelial-mesenchymal transition (EMT) abilities of EH-GB1 cells were investigated using Cell Counting Kit-8, wound healing, Transwell and western blotting assays. In addition, the expression levels of VEGFA were determined in EH-GB1 cells using western blotting and reverse transcription-quantitative PCR following HMGA2 overexpression or silencing. Furthermore, HMGA2-silenced EH-GB1 cells were transfected with VEGFA overexpression plasmids to evaluate the tube formation ability of HUVECs using tube formation assay. The results demonstrated that HMGA2 silencing inhibited GBC cell proliferation, migration, invasion and EMT, as evidenced by the downregulated expression of Ki67, proliferating cell nuclear antigen, MMP2, MMP9, N-cadherin, snail family transcriptional repressor 2 and zinc finger E-box-binding homeobox 1, and attenuated cell migration and invasion. However, the opposite results were obtained following HMGA2 overexpression. Moreover, HMGA2 knockdown and overexpression downregulated and upregulated VEGFA expression, respectively. In addition, the tube formation ability of HUVECs and the expression levels of CD31, VEGFR1 and VEGFR2 were downregulated following HMGA2 silencing. However, these effects were partially rescued by simultaneous VEGFA overexpression. In conclusion, the findings of the present study revealed that HMGA2 may promote GBC cell migration, invasion, EMT and angiogenesis. Therefore, inhibiting HMGA2 expression could be considered as a possible therapeutic approach for GBC.
Collapse
Affiliation(s)
- Jun Yan
- Department of General Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, P.R. China
| | - Peng Dai
- Department of General Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, P.R. China
| | - Xueliang Qin
- Department of General Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, P.R. China
| | - Yanping He
- Department of General Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, P.R. China
| | - Yu Zhang
- Department of General Surgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi 030012, P.R. China
| |
Collapse
|
16
|
Kar I, Qayum K, Sofi J. Indications and Complications of Hepatic Resection Patients at Sher-I-Kashmir Institute of Medical Sciences: An Observational Study. Cureus 2021; 13:e19713. [PMID: 34934577 PMCID: PMC8684362 DOI: 10.7759/cureus.19713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/05/2022] Open
Abstract
Aim: This study aimed to determine the indications and demographic profile of hepatic resection at Sher-I-Kashmir Institute of Medical Sciences (SKIMS), the performed types of hepatic resection, as well as assess the details of the operation and perioperative complications of hepatic resection. Methods: This is a prospective, retrospective observational study. The retrospective study period was from January 2005 to August 2015 and the prospective study period was from 2015 till 2017. Prospective patients were clinically evaluated by medical history and clinical examination and also underwent various investigations. The patients were scored on Child-Pugh and American Society of Anesthesiology (ASA) scores for risk stratification and prepared for surgery, which included segmentectomy to major liver resection. The retrospective data were obtained from the Medical Records Department (MRD). Statistical analysis was done on SPSS software 25.0 version (Armonk, NY: IBM Corp.). Results: This study included 122 patients with a male to female ratio of 1:1.59. The patients' age was between 1 and 73 years. The patients' most common complaint was right upper quadrant abdominal pain. The main established clinical diagnosis was oriental cholangiohepatitis (OCH) (36.9%) followed by carcinoma of gallbladder (CaGB) which accounted for 37 cases (30.4%). Liver metastases including solitary masses and multiple lesions were 10 cases (8.2%). Fifty-five patients underwent left lateral segmentectomy (45.1%) and mostly for OCH. Standard wedge resection was done in 30.7% of cases and for all cases of CaGB. The mean blood loss was 146.5 ml. A total of 37 patients had complications. Wound infection was the most common complication, occurring in 10 patients (8.2%). Conclusion: Patients with hepatobiliary pathology, necessitating liver resection are now routinely admitted to the Department of Surgical Gastroenterology in SKIMS, Srinagar. Patients are carefully evaluated and operated with a confirmed definitive diagnosis. The overall surgical outcome does not differ from India's best centers.
Collapse
|
17
|
Toyonaga H, Hayashi T, Katanuma A. Response to the letter. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:e58. [PMID: 34382348 DOI: 10.1002/jhbp.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/26/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Haruka Toyonaga
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| |
Collapse
|
18
|
Toyonaga H, Hayashi T, Ueki H, Chikugo K, Ishii T, Nasuno H, Kin T, Takahashi K, Takada M, Ambo Y, Shinohara T, Yamazaki H, Katanuma A. An intact boundary between the tumor and inner hypoechoic layer discriminates T1 lesions among sessile elevated gallbladder cancers. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:1121-1129. [PMID: 33826798 DOI: 10.1002/jhbp.961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/06/2021] [Accepted: 03/21/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The depth of invasion determines the surgical method for treating gallbladder cancer (GBC). However, the preoperative correct diagnosis of invasion depth, especially discrimination of T1 lesions among sessile elevated GBCs, is difficult. We investigated the utility of preoperative endoscopic ultrasound (EUS) findings for diagnosing the invasion depth. METHODS We studied a sessile elevated GBC specimen diagnosed as a T1 lesion before developing our study protocol. EUS evidenced an intact boundary between the tumor and the inner hypoechoic layer (the intact boundary sign). To evaluate the potential of using this sign to diagnose T1 GBC as a primary outcome indicator, we retrospectively analyzed patients who underwent surgical resection of sessile elevated GBCs between April 2009 and March 2020. RESULTS Of the 26 surgically resected sessile elevated GBC specimens, 20 were included and six were excluded due to difficulty in evaluating the overall tumor or layer structure. The Kappa coefficient for interobserver agreement regarding the intact boundary sign was 0.733. The sensitivity and specificity of the sign for diagnosing T1 lesions were 0.857 and 1.000, respectively. CONCLUSION This new EUS finding could guide the accurate diagnosis of T1 lesions in patients with sessile elevated GBC.
Collapse
Affiliation(s)
- Haruka Toyonaga
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tsuyoshi Hayashi
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hidetaro Ueki
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kouki Chikugo
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tatsuya Ishii
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hiroshi Nasuno
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Toshifumi Kin
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | | | - Minoru Takada
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yoshiyasu Ambo
- Department of Surgery, Teine Keijinkai Hospital, Sapporo, Japan
| | | | - Hajime Yamazaki
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan.,Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| |
Collapse
|
19
|
Björk D, Bartholomä W, Hasselgren K, Edholm D, Björnsson B, Lundgren L. Malignancy in elective cholecystectomy due to gallbladder polyps or thickened gallbladder wall: a single-centre experience. Scand J Gastroenterol 2021; 56:458-462. [PMID: 33590795 DOI: 10.1080/00365521.2021.1884895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Gallbladder cancer is a rare but aggressive malignancy. Surgical resection is recommended for gallbladder polyps ≥10 mm. For gallbladder wall thickening, resection is recommended if malignancy cannot be excluded. The incidence of gallbladder malignancy after cholecystectomy with indications of polyps or wall thickening in the Swedish population is not known. MATERIAL/METHODS A retrospective study was performed at Linköping University Hospital and included patients who underwent cholecystectomy 2010 - 2018. All cholecystectomies performed due to gallbladder polyps or gallbladder wall thickening without other preoperative malignant signs were identified. Preoperative radiological examinations were re-analysed by a single radiologist. Medical records and histopathology reports were analysed. RESULTS In all, 102 patients were included, of whom 65 were diagnosed with gallbladder polyps and 37 with gallbladder wall thickening. In each group, one patient (1.5% and 2.7% in each group) had gallbladder malignancy ≥ pT1b.Two (3.1%) and three (8.1%) patients with gallbladder malignancy < T1b were identified in each group. DISCUSSION/CONCLUSION This study indicates that the incidence of malignancy is low without other malignant signs beyond gallbladder polyps and/or gallbladder wall thickening. We propose that these patients should be discussed at a multidisciplinary tumour board. If the polyp is 10-15 mm or if the gallbladder wall is thickened but no other malignant signs are observed, cholecystectomy can be safely performed by an experienced general surgeon at a general surgery unit. If the histopathology indicates ≥ pT1b, the patient should be referred immediately to a hepatobiliary centre for liver and lymph node resection.
Collapse
Affiliation(s)
- Dennis Björk
- Department of Surgery, Linköping University, Linköping, Sweden
| | - Wolf Bartholomä
- Department of Radiology in Linköping, Linköping University, Linköping, Sweden
| | | | - David Edholm
- Department of Surgery, Linköping University, Linköping, Sweden
| | | | - Linda Lundgren
- Department of Surgery, Linköping University, Linköping, Sweden
| |
Collapse
|
20
|
Tidjane A, Boudjenan N, Bengueddach A, Kadri A, Ikhlef N, Benmaarouf N, Tabeti B. Pure large cell neuroendocrine carcinoma of the gallbladder, is surgical relentlessness beneficial? A case report and literature review. Int Cancer Conf J 2021; 10:127-133. [PMID: 33425643 PMCID: PMC7778705 DOI: 10.1007/s13691-020-00461-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/17/2020] [Indexed: 01/04/2023] Open
Abstract
Pure large cell neuroendocrine carcinoma of the gallbladder is a rare disease. However, the prognosis of this aggressive tumor is poor with short survival after diagnosis. We are describing in this manuscript a case of pure large cell neuroendocrine carcinoma in which survival exceeded 26 months, after performing two curative surgeries. We are reporting the case of a 68-year-old woman with a history of recovered right breast carcinoma and operated 6 years later for a completely asymptomatic gallbladder tumor of 31 mm. In this case, curative surgery was performed allowing monobloc resection of the gallbladder and the hepatic segments IVb and V, a lymph node dissection was performed to. The histological examination of the specimen and immunohistochemistry confirms that the tumor was a grade 3 pure large cell neuroendocrine carcinoma of gallbladder with lymph node invasion, the hepatic and biliary surgical margins were free. Postoperative adjuvant chemotherapy was administered and the evolution was eventless until the discovery at 20 months of a lymph node considered being metastatic recurrence. A second surgery was performed allowing removal of three lymph nodes. This time, a different protocol of chemotherapy was administered to our patient who remains alive and without recurrence at 26 months from her first surgery. Surgical relentlessness with free margins resections associated with appropriate chemotherapy probably improves the survival of patients suffering from this rare and aggressive tumor.
Collapse
Affiliation(s)
- Anisse Tidjane
- Department of Hepatobiliary Surgery and Liver Transplantation, EHU-1st November 1954, Department of Medicine, University of Oran 1, B.P 1510 El Menaouer, 31000 Oran, Algeria
| | - Nabil Boudjenan
- Department of Hepatobiliary Surgery and Liver Transplantation, EHU-1st November 1954, Department of Medicine, University of Oran 1, B.P 1510 El Menaouer, 31000 Oran, Algeria
| | - Aicha Bengueddach
- Department of Oncology, EHU-1st November 1954, Department of Medicine, University of Oran 1, Oran, Algeria
| | - Amin Kadri
- Laboratoire d’Anatomie Pathologique Dr. Kadri, Oran, Algeria
| | - Nacim Ikhlef
- Department of Hepatobiliary Surgery and Liver Transplantation, EHU-1st November 1954, Department of Medicine, University of Oran 1, B.P 1510 El Menaouer, 31000 Oran, Algeria
| | - Noureddine Benmaarouf
- Department of Hepatobiliary Surgery and Liver Transplantation, EHU-1st November 1954, Department of Medicine, University of Oran 1, B.P 1510 El Menaouer, 31000 Oran, Algeria
| | - Benali Tabeti
- Department of Hepatobiliary Surgery and Liver Transplantation, EHU-1st November 1954, Department of Medicine, University of Oran 1, B.P 1510 El Menaouer, 31000 Oran, Algeria
| |
Collapse
|
21
|
Giudicelli X, Rode A, Bancel B, Nguyen AT, Mabrut JY. Xanthogranulomatous cholecystitis: Diagnosis and management. J Visc Surg 2021; 158:326-336. [PMID: 33741306 DOI: 10.1016/j.jviscsurg.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Xanthogranulomatous cholecystitis (XGC) is a rare form of cholecystitis, characterized by the presence of xanthogranuloma, prominent yellow structures within the gallbladder wall that is very often lithiasic. When XGC presents in its pseudo-tumoral form with occasional adjacent organ involvement, it can mimic gallbladder carcinoma (GBC). The etiopathogenesis of XGC is inflammatory destruction of Rokitansky-Aschoff sinuses containing biliary and cholesterol pigments within the gallbladder wall; this leads to a florid granulomatous histiocytic inflammatory reaction. The prevalence ranges from 1.3% to 8.8% of all cholecystectomies and varies from country to country; XGC occurs predominantly in patients over 50 years of age, and is equally distributed between males and females. Its association with GBC remains a topic of debate in the literature (between 0 and 20%). Symptoms are non-specific and generally similar to those of acute or chronic cholecystitis. XGC, when associated with altered health status, leads to the suspicion of GBC. XGC can also come to light due to an acute complication of cholecystolithiasis, in particular, gallstone migration. Imaging by sonography and CT scan is suggestive, but magnetic resonance imaging is more specific. In difficult cases, biopsy may be necessary to eliminate the diagnosis of tumor. In case of pre- or intra-operative diagnostic doubt, the opinion of a hepatobiliary specialty center can be of help. When diagnosis of GBC has been eliminated, laparoscopic cholecystectomy is recommended, although with a high risk of conversion to laparotomy and complications.
Collapse
Affiliation(s)
- X Giudicelli
- Department of Viscera, Oncologic and Bariatric Surgery, University Hospital Center Felix-Guyon, Allée des Topazes, 97400 Saint-Denis, La Réunion, France.
| | - A Rode
- Radiology department, University Hospital Center Croix Rousse, Hospices Civils de Lyon, university Claude-Bernard Lyon-1, 69004 Lyon, France
| | - B Bancel
- Department of anatomy and pathological cytology, Groupement Hospitalier Est, 69677 Lyon, France
| | - A-T Nguyen
- Department of anatomy and pathological cytology, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - J-Y Mabrut
- Department of digestive surgery and liver transplantation, University Hospital Center Croix Rousse, Hospices Civils de Lyon, Claude-Bernard-Lyon-1, 69004 Lyon, France
| |
Collapse
|
22
|
Wietsma MFT, Molloy C, Bhimani N, de Savornin Lohman EAJ, Gill AJ, Andrici J, Samra J, de Reuver PR, Hugh TJ. Gallbladder carcinoma outcomes in an Australian tertiary referral hospital. ANZ J Surg 2021; 91:603-608. [PMID: 33604992 DOI: 10.1111/ans.16663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aimed to examine the presentation, treatment, and long-term outcomes of patients with gallbladder carcinoma (GBC) managed in a surgical unit of an Australian tertiary referral hospital of a 19-year period. METHODS A retrospective review of prospectively collected data of patients with GBC managed in the Royal North Shore Upper GI Surgical department from October 1999 to March 2018. RESULTS A total of 104 patients with GBC were identified: 36 patients underwent palliative treatment, 61 patients with gallbladder adenocarcinoma underwent resection with curative intent. Seven patients were excluded. 'Simple cholecystectomy' was undertaken in eight patients, 'standard radical cholecystectomy' in 37 and 'extended radical resection' in 16. The median survival in these patients was 35 months (95% confidence interval (CI) 21.29-55.10), with a median follow up of 60 months (95% CI 38.18-78.39). This compares with an overall median survival of only 4.00 months (95% CI 2.79-6.24) in patients who did not undergo a potentially curative resection. Independent predictors of poor long-term survival included an elevated preoperative serum tumour marker, advanced tumour stage (T3/T4) or node positive disease (N1/N2). CONCLUSION The biology and stage of GBC at presentation are major factors in determining patient outcome. There is a need for better pre- and post-operative predictors to improve risk stratification, and these are likely to be in the form of molecular markers. Although the focus of surgery should be to ensure an R0 resection, patients with advanced stage disease need to be carefully selected for surgical intervention, and ideally should be managed by a multidisciplinary team in a specialist centre.
Collapse
Affiliation(s)
| | - Charles Molloy
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nazim Bhimani
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Anthony J Gill
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Juliana Andrici
- Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jaswinder Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Thomas J Hugh
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
23
|
Lundgren L, Henriksson M, Andersson B, Sandström P. Cost-effectiveness of gallbladder histopathology after cholecystectomy for benign disease. BJS Open 2020; 4:1125-1136. [PMID: 33136336 PMCID: PMC7709377 DOI: 10.1002/bjs5.50325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background The prevalence of incidental gallbladder cancer is low when performing cholecystectomy for benign disease. The performance of routine or selective histological examination of the gallbladder is still a subject for discussion. The aim of this study was to assess the cost‐effectiveness of these different approaches. Methods Four management strategies were evaluated using decision‐analytical modelling: no histology, current selective histology as practised in Sweden, macroscopic selective histology, and routine histology. Healthcare costs and life‐years were estimated for a lifetime perspective and combined into incremental cost‐effectiveness ratios (ICERs) to assess the additional cost of achieving an additional life‐year for each management strategy. Results In the analysis of the four strategies, current selective histology was ruled out due to a higher ICER compared with macroscopic selective histology, which showed better health outcomes (extended dominance). Comparison of routine histology with macroscopic selective histology resulted in a gain of 12 life‐years and an incremental healthcare cost of approximately €1 000 000 in a cohort of 10 000 patients, yielding an estimated ICER of €76 508. When comparing a macroscopic selective strategy with no
histological assessment, 50 life‐years would be saved and
the ICER was estimated to be €20 708 in a cohort of 10 000
patients undergoing cholecystectomy. Conclusion A macroscopic selective strategy appears to be the most cost‐effective approach.
Collapse
Affiliation(s)
- L Lundgren
- Department of Surgery, County Council of Östergötland, Linköping, Sweden.,Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping, Sweden
| | - M Henriksson
- Centre for Medical Technology Assessment, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - B Andersson
- Department of Surgery, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Surgery, Lund University, Lund, Sweden
| | - P Sandström
- Department of Surgery, County Council of Östergötland, Linköping, Sweden.,Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping, Sweden
| |
Collapse
|
24
|
Kamada Y, Hori T, Yamamoto H, Harada H, Yamamoto M, Yamada M, Yazawa T, Tani M, Sato A, Tani R, Aoyama R, Sasaki Y, Zaima M. Surgical treatment of gallbladder cancer: An eight-year experience in a single center. World J Hepatol 2020; 12:641-660. [PMID: 33033570 PMCID: PMC7522563 DOI: 10.4254/wjh.v12.i9.641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/10/2020] [Accepted: 07/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gallbladder cancer (GBC) is the most common biliary malignancy and has the worst prognosis, but aggressive surgeries [e.g., resection of the extrahepatic bile duct (EHBD), major hepatectomy and lymph node (LN) dissection] may improve long-term survival. GBC may be suspected preoperatively, identified intraoperatively, or discovered incidentally on histopathology.
AIM To present our data together with a discussion of the therapeutic strategies for GBC.
METHODS We retrospectively investigated nineteen GBC patients who underwent surgical treatment.
RESULTS Nearly all symptomatic patients had poor outcomes, while suspicious or incidental GBCs at early stages showed excellent outcomes without the need for two-stage surgery. Lymph nodes around the cystic duct were reliable sentinel nodes in suspicious/incidental GBCs. Intentional LN dissection and EHBD resection prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic LNs or invasion of the nerve plexus. All patients with positive surgical margins (e.g., the biliary cut surface) showed poor outcomes. Hepatectomies were performed in sixteen patients, nearly all of which were minor hepatectomies. Metastases were observed in the left-sided liver but not in the caudate lobe. We may need to reconsider the indications for major hepatectomy, minimizing its use except when it is required to accomplish negative bile duct margins. Only a few patients received neoadjuvant or adjuvant chemoradiation. There were significant differences in overall and disease-free survival between patients with stages ≤ IIB and ≥ IIIA disease. The median overall survival and disease-free survival were 1.66 and 0.79 years, respectively.
CONCLUSION Outcomes for GBC patients remain unacceptable, and improved therapeutic strategies, including neoadjuvant chemotherapy, optimal surgery and adjuvant chemotherapy, should be considered for patients with advanced GBCs.
Collapse
Affiliation(s)
- Yasuyuki Kamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Hideki Harada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Michihiro Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masahiro Yamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Takefumi Yazawa
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masaki Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Asahi Sato
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ryotaro Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Ryuhei Aoyama
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Yudai Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
| |
Collapse
|
25
|
Yang Y, Tu Z, Cai H, Hu B, Ye C, Tu J. A predictive nomogram for lymph node metastasis of incidental gallbladder cancer: a SEER population-based study. BMC Cancer 2020; 20:828. [PMID: 32867722 PMCID: PMC7461264 DOI: 10.1186/s12885-020-07341-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Existing imaging techniques have a low ability to detect lymph node metastasis (LNM) of gallbladder cancer (GBC). Gallbladder removal by laparoscopic cholecystectomy can provide pathological information regarding the tumor itself for incidental gallbladder cancer (IGBC). The purpose of this study was to identify the risk factors associated with LNM of IGBC and to establish a nomogram to improve the ability to predict the risk of LNM for IGBC. METHODS A total of 796 patients diagnosed with stage T1/2 GBC between 2004 and 2015 who underwent surgery and lymph node evaluation were enrolled in this study. We randomly divided the dataset into a training set (70%) and a validation set (30%). A logistic regression model was used to construct the nomogram in the training set and then was verified in the validation set. Nomogram performance was quantified with respect to discrimination and calibration. RESULTS The rates of LNM in T1a, T1b and T2 patients were 7, 11.1 and 44.3%, respectively. Tumor diameter, T stage, and tumor differentiation were independent factors affecting LNM. The C-index and AUC of the training set were 0.718 (95% CI, 0.676-0.760) and 0.702 (95% CI, 0.659-0.702), respectively, demonstrating good prediction performance. The calibration curves showed perfect agreement between the nomogram predictions and actual observations. Decision curve analysis showed that the LNM nomogram was clinically useful when the risk was decided at a possibility threshold of 2-63%. The C-index and AUC of the validation set were 0.73 (95% CI: 0.665-0.795) and 0.692 (95% CI: 0.625-0.759), respectively. CONCLUSION The nomogram established in this study has good prediction ability. For patients with IGBC requiring re-resection, the model can effectively predict the risk of LNM and make up for the inaccuracy of imaging.
Collapse
Affiliation(s)
- Yingnan Yang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China
| | - Zhuolong Tu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China
| | - Huajie Cai
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China
| | - Bingren Hu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China
| | - Chentao Ye
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China
| | - Jinfu Tu
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang street, Ouhai district, Wenzhou, Zhejiang Province, China.
| |
Collapse
|
26
|
Jin LM, Zhang YH, Zhang CW, Wu WD, Wu J, Dou CW, Wei FQ, Wang ZF, Hu ZM, Zheng SS. Is laparoscopic radical cholecystectomy an effective and safe approach for advanced gallbladder cancer? Hepatobiliary Pancreat Dis Int 2020; 19:203-204. [PMID: 32386988 DOI: 10.1016/j.hbpd.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/01/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Li-Ming Jin
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Yu-Hua Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Cheng-Wu Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Wei-Ding Wu
- Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Jia Wu
- Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Chang-Wei Dou
- Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Fang-Qiang Wei
- Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Zhi-Fei Wang
- Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Zhi-Ming Hu
- Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou 310014, China
| | - Shu-Sen Zheng
- Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Department of Hepatobiliary and Pancreatic Surgery, Department of Liver Transplantation, Shulan (Hangzhou) Hospital, Zhejiang Shuren University School of Medicine, Hangzhou 310022, China.
| |
Collapse
|
27
|
Pinheiro RN, Fontoura RP, Rodrigues LLP, Netto JDS, Sarmento BJQ. Incidental finding of adenocarcinoma in a gallbladder lumen with no wall involvement. J Surg Case Rep 2020; 2020:rjaa107. [PMID: 32582429 PMCID: PMC7299606 DOI: 10.1093/jscr/rjaa107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/29/2020] [Accepted: 03/31/2020] [Indexed: 11/14/2022] Open
Abstract
Gallbladder cancer (GBC) is a rare disease characterized by its aggressiveness. Resection with free tumour margins is the sole curative treatment and, in incidental findings, surgical reapproach is recommended for segmentectomy IVb and V or wedge resection of the gallbladder fossa and lymphadenectomy. Here we report a case of gallbladder adenocarcinoma as an incidental finding in a fragment in its lumen with no wall involvement evidentiated. The patient was reoperated for resection of the gallbladder bed with hepatic hilum and cystic duct lymphadenectomy, later evidentiated as free of residual disease. The normality of the bile ducts evidenced by imaging studies, in addition to signs of chronic cholecystitis corroborate to GBC diagnosis. We suspect that the fragment was detached gallbladder polypoid neoplastic lesion. Despite the lack of clinical manifestations, the fast surgical interventions and the histopathological analysis of the material was probably a prognostic determinant for the patient.
Collapse
Affiliation(s)
| | - Renata P Fontoura
- Academic League of Oncology, Base Hospital Institute, Brasilia, Federal District, Brazil
| | - Letícia L P Rodrigues
- Academic League of Oncology, Base Hospital Institute, Brasilia, Federal District, Brazil
| | - José Donato S Netto
- Academic League of Oncology, Base Hospital Institute, Brasilia, Federal District, Brazil
| | | |
Collapse
|
28
|
Navarro JG, Kang I, Hwang HK, Yoon DS, Lee WJ, Kang CM. Oncologic safety of laparoscopic radical cholecystectomy in pT2 gallbladder cancer: A propensity score matching analysis compared to open approach. Medicine (Baltimore) 2020; 99:e20039. [PMID: 32443308 PMCID: PMC7253605 DOI: 10.1097/md.0000000000020039] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The role of laparoscopic radical cholecystectomy (LRC) in the surgical management of T2 gallbladder carcinoma (GBC) is still controversial.The medical records of patients with T2 GBC treated with radical cholecystectomy were retrospectively reviewed. In this study, we compare the short- and long-term oncologic outcomes, using propensity score matching analysis, of patients with T2 GBC who underwent LRC and open radical cholecystectomy (ORC).Among 183 patients, 86 were selected by propensity score matching (LRC = 43 and ORC = 43). The ORC group underwent more extensive surgery (liver resections and extended lymph node dissections [ELND]) than the LRC group. The LRC group had less operative blood loss, shorter length of hospital stay, fewer complications, and had the earlier start of adjuvant chemotherapy. There was no significant difference between the laparoscopic and open surgery groups in terms of 5-year overall survival rate (64.6% vs 80.4%, P = .214) and disease-free survival rate (77.1% vs 82.2%, P = .641). A subgroup analyses showed that liver resection and ELND had no survival advantage compared to no liver resection and regional lymph node dissection, respectively.Our LRC approach is safe and effective, with long-term survival comparable to that of ORC.
Collapse
Affiliation(s)
- Jonathan Geograpo Navarro
- Division of Surgical Oncology, Department of Surgery, Vicente Sotto Memorial Medical Center, Cebu, Philippines
| | - Incheon Kang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Ho Kyoung Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Dong Sup Yoon
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Woo Jung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| | - Chang Moo Kang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea
| |
Collapse
|
29
|
Shi Z, Xiao Z, Li L, Hu L, Gao Y, Zhao J, Liu Y, Huang D, Xu Q. Application of nomogram containing log odds of metastatic lymph node in gallbladder cancer patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:655. [PMID: 32566592 PMCID: PMC7290604 DOI: 10.21037/atm-2020-91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Zhan Shi
- Graduate Department, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310014, China.,Department of Hepatic-biliary-pancreatic Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310014, China
| | - Zunqiang Xiao
- Graduate Department, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310014, China.,Department of Hepatic-biliary-pancreatic Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310014, China
| | - Lijie Li
- Department of Obstetrics and Gynecology, Zhejiang Hospital, Hangzhou 310012, China
| | - Linjun Hu
- Graduate Department, 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
- Graduate Department, The Medical College of Qingdao University, Qingdao 266071, 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
| | - 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
| |
Collapse
|
30
|
Chong JU, Lee WJ. Oncologic Outcomes of Extended Lymphadenectomy without Liver Resection for T1/T2 Gallbladder Cancer. Yonsei Med J 2019; 60:1138-1145. [PMID: 31769244 PMCID: PMC6881702 DOI: 10.3349/ymj.2019.60.12.1138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 10/15/2019] [Accepted: 10/22/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This study provides a standardized operative strategical algorithm that can be applied to patients with T1/T2 gallbladder cancer (GBC). Our aim was to determine the oncologic outcome of radical cholecystectomy with para-aortic lymph node dissection without liver resection in T1/T2 GBC. MATERIALS AND METHODS From January 2005 to December 2017, 164 patients with GBC underwent operations by a single surgeon at Severance Hospital. A retrospective review was performed for 113 of these patients, who were pathologically determined to be in stages T1 and T2 according to American Joint Committee on Cancer 7th guidelines. RESULTS Of the 113 patients, 109 underwent curative resection for T1/T2 GBC; four patients who underwent palliative operations without radical cholecystectomies were excluded from further analyses. For all T1b and T2 lesions, radical cholecystectomy with para-aortic lymph node dissection was performed without liver resection. There were four GBC-related mortalities, and 5-year disease-specific survival was 97.0%. The median follow-up was 50 months (range: 5-145 months). In all T stages, the median was not reached for survival analysis. Five-year disease-specific survival for T1a, T1b, and T2 were 100%, 94.1%, and 97.1%, respectively. Five-year disease-free survival for T1a, T1b, and T2 were 100%, 87.0%, and 91.8%, respectively. CONCLUSION Our results suggest that the current operative protocol can be applied to minimal invasive operations for GBC with similar oncologic outcomes as open approach. For T1/T2 GBC, radical cholecystectomy, including para-aortic lymph node dissection, can be performed safely with favorable oncologic outcomes.
Collapse
Affiliation(s)
- Jae Uk Chong
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Woo Jung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
- Pancreatobiliary Cancer Center, Yonsei Cancer Center, Severance Hospital, Seoul, Korea.
| |
Collapse
|
31
|
Sandstrom P, Bjornsson B. Bile spillage should be avoided in elective cholecystectomy. Hepatobiliary Surg Nutr 2019; 8:640-642. [PMID: 31929995 DOI: 10.21037/hbsn.2019.07.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Per Sandstrom
- Department of Surgery, University Hospital of Linkoping, Linkoping, Sweden.,Department of Clinical and Experimental Medicine, University Hospital of Linkoping, Linkoping, Sweden
| | - Bergthor Bjornsson
- Department of Surgery, University Hospital of Linkoping, Linkoping, Sweden.,Department of Clinical and Experimental Medicine, University Hospital of Linkoping, Linkoping, Sweden
| |
Collapse
|
32
|
Torén W, Ansari D, Søreide K, Andersson R. Re-resection for incidentally detected gallbladder cancer: Weighing in on the options. Eur J Surg Oncol 2019; 46:495-497. [PMID: 31669144 DOI: 10.1016/j.ejso.2019.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 12/30/2022] Open
Affiliation(s)
- William Torén
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Daniel Ansari
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden
| | - Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Roland Andersson
- Department of Surgery, Clinical Sciences Lund, Lund University and Skåne University Hospital, Lund, Sweden.
| |
Collapse
|
33
|
Lee W, Jeong CY, Kim YH, Roh YH, Yoon MH, Seo HI, Park JI, Jung BH, Shin DH, Choi YI, Ryu JH, Yang KH, Choi CS, Park YH, Nah YW, Hong SC. Validation of the prognostic performance in various nodal staging systems for gallbladder cancer: results of a multicenter study. Langenbecks Arch Surg 2019; 404:581-588. [PMID: 31414179 DOI: 10.1007/s00423-019-01807-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 07/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although the current nodal staging system for gallbladder cancer (GBC) was changed based on the number of positive lymph nodes (PLN), it needs to be evaluated in various situations. METHODS We reviewed the clinical data for 398 patients with resected GBC and compared nodal staging systems based on the number of PLNs, the positive/retrieved LN ratio (LNR), and the log odds of positive LN (LODDS). Prognostic performance was evaluated using the C-index. RESULTS Subgroups were formed on the basis of an restricted cubic spline plot as follows: PLN 3 (PLN = 0, 1-2, ≥ 3); PLN 4 (PLN = 0, 1-3, ≥ 4); LNR (LNR = 0, 0-0.269, ≥ 0.27); and LODDS (LODDS < - 0.8, - 0.8-0, ≥ 0). The oncological outcome differed significantly between subgroups in each system. In all patients with GBC, PLN 4 (C-index 0.730) and PLN 3 (C-index 0.734) were the best prognostic discriminators of survival and recurrence, respectively. However, for retrieved LN (RLN) ≥ 6, LODDS was the best discriminator for survival (C-index 0.852). CONCLUSION The nodal staging system based on PLN was the optimal prognostic discriminator in patients with RLN < 6, whereas the LODDS system is adequate for RLN ≥ 6. The following nodal staging system considers applying different systems according to the RLN.
Collapse
Affiliation(s)
- Woohyung Lee
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University, College of Medicine, 79 Gangnam-ro, Jinju, 660-702, Republic of Korea
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Chi-Young Jeong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University, College of Medicine, 79 Gangnam-ro, Jinju, 660-702, Republic of Korea
| | - Young Hoon Kim
- Department of Surgery, Dong-A University Hospital, Dong-A University, College of Medicine, Busan, Republic of Korea
| | - Young Hoon Roh
- Department of Surgery, Dong-A University Hospital, Dong-A University, College of Medicine, Busan, Republic of Korea
| | - Myung Hee Yoon
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University, College of Medicine, Busan, Republic of Korea
| | - Hyung Il Seo
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University, College of Medicine, Busan, Republic of Korea
| | - Jeong-Ik Park
- Department of Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Bo-Hyun Jung
- Department of Surgery, Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea
| | - Dong Hoon Shin
- Department of Surgery, Kosin University Gospel Hospital, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Young Il Choi
- Department of Surgery, Kosin University Gospel Hospital, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Je Ho Ryu
- Department of Surgery, Pusan University Yangsan Hospital, Pusan University, College of Medicine, Busan, Republic of Korea
| | - Kwang Ho Yang
- Department of Surgery, Pusan University Yangsan Hospital, Pusan University, College of Medicine, Busan, Republic of Korea
| | - Chang Soo Choi
- Department of Surgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea
| | - Yo-Han Park
- Department of Surgery, College of Medicine, Inje University, Busan Paik Hospital, Busan, Republic of Korea
| | - Yang Won Nah
- Department of Surgery, Ulsan University Hospital, Ulsan University, College of Medicine, Ulsan, Republic of Korea
| | - Soon-Chan Hong
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University, College of Medicine, 79 Gangnam-ro, Jinju, 660-702, Republic of Korea.
| |
Collapse
|
34
|
Roos E, Soer E, Klompmaker S, Meijer L, Besselink M, Giovannetti E, Heger M, Kazemier G, Klümpen H, Takkenberg R, Wilmink H, Würdinger T, Dijk F, van Gulik T, Verheij J, van de Vijver M. Crossing borders: A systematic review with quantitative analysis of genetic mutations of carcinomas of the biliary tract. Crit Rev Oncol Hematol 2019; 140:8-16. [PMID: 31158800 DOI: 10.1016/j.critrevonc.2019.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/21/2019] [Indexed: 12/11/2022] Open
|
35
|
Lundgren L, Muszynska C, Ros A, Persson G, Gimm O, Andersson B, Sandström P. Management of incidental gallbladder cancer in a national cohort. Br J Surg 2019; 106:1216-1227. [DOI: 10.1002/bjs.11205] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/19/2019] [Accepted: 03/14/2019] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Incidental gallbladder cancer is a rare event, and its prognosis is largely affected by the tumour stage and treatment. The aim of this study was to analyse the management, treatment and survival of patients with incidental gallbladder cancer in a national cohort over a decade.
Methods
Patients were identified through the Swedish Registry of Gallstone Surgery (GallRiks). Data were cross-linked to the national registry for liver surgery (SweLiv) and the Cancer Registry. Medical records were collected if registry data were missing. Survival was measured as disease-specific survival. The study was divided into two intervals (2007–2011 and 2012–2016) to evaluate changes over time.
Results
In total, 249 patients were identified with incidental gallbladder cancer, of whom 92 (36·9 per cent) underwent re-resection with curative intent. For patients with pT2 and pT3 disease, median disease-specific survival improved after re-resection (12·4 versus 44·1 months for pT2, and 9·7 versus 23·0 months for pT3). Residual disease was present in 53 per cent of patients with pT2 tumours who underwent re-resection; these patients had a median disease-specific survival of 32·2 months, whereas the median was not reached in patients without residual disease. Median survival increased by 11 months for all patients between the early and late periods (P = 0·030).
Conclusion
Re-resection of pT2 and pT3 incidental gallbladder cancer was associated with improved survival, but survival was impaired when residual disease was present. A higher re-resection rate and more R0 resections in the later time period may have been associated with improved survival.
Collapse
Affiliation(s)
- L Lundgren
- Department of Surgery, County Council of Östergötland and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - C Muszynska
- Department of Surgery, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - A Ros
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - G Persson
- Department of Surgery, Ryhov Hospital, Jönköping, Sweden
| | - O Gimm
- Department of Surgery, County Council of Östergötland and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - B Andersson
- Department of Surgery, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden
| | - P Sandström
- Department of Surgery, County Council of Östergötland and Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
36
|
Zhou D, Wang J, Quan Z, Yang Y, Ma F. Improvement in the diagnosis and treatment of T2 gallbladder carcinoma is pivotal to improvement in the overall prognosis for this disease. Biosci Trends 2019; 13:1-9. [PMID: 30867371 DOI: 10.5582/bst.2019.01039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Since the American Joint Committee on Cancer (AJCC) subdivided the T2 stage of gallbladder carcinoma (GBC) into T2a and T2b, the diagnosis and treatment of those stages have been a subject of heated discussion and controversy. T2 is a stage of GBC that might be treatable. Based on the extent of lymph node metastasis and distant metastasis, T2 GBC can be classified into various pathological stages such as IIA, IIB, IIIB, and IVB, leading to controversy in clinical settings. This review aims to discuss the effectiveness of and controversies concerning S4b+5 resection, the acceptable extent of lymph node dissection, the timing for treatment of incidental gallbladder cancer, and adjuvant therapy. This review also aims to suggest directions for and recommendations regarding clinical research in the future.
Collapse
Affiliation(s)
- Di Zhou
- Department of General Surgery, XinHua Hospital, Shanghai Jiao Tong University
| | - Jiandong Wang
- Department of General Surgery, XinHua Hospital, Shanghai Jiao Tong University
| | - Zhiwei Quan
- Department of General Surgery, XinHua Hospital, Shanghai Jiao Tong University
| | - Yong Yang
- Department of General Surgery, XinHua Hospital, Shanghai Jiao Tong University
| | - Fei Ma
- Department of Oncology, XinHua Hospital, Shanghai Jiao Tong University
| |
Collapse
|
37
|
Søreide K, Guest RV, Harrison EM, Kendall TJ, Garden OJ, Wigmore SJ. Systematic review of management of incidental gallbladder cancer after cholecystectomy. Br J Surg 2019; 106:32-45. [PMID: 30582640 DOI: 10.1002/bjs.11035] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/16/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer. METHODS A systematic PubMed search of the English literature to May 2018 was conducted. RESULTS The search identified 12 systematic reviews and meta-analyses, in addition to several consensus reports, multi-institutional series and national audits. Some 0·25-0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one-third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5-year survival rates of up to 100 per cent after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent and timing of reresection remain controversial. Observation time may be used for new cross-sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of disease dissemination. Gallbladder cancers are PET-avid, and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. The incidence of port-site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. CONCLUSION Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.
Collapse
Affiliation(s)
- K Søreide
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R V Guest
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - E M Harrison
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - T J Kendall
- Division of Pathology, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - O J Garden
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - S J Wigmore
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| |
Collapse
|
38
|
Justo I, Marcacuzco A, Nutu OA, Manrique A, Calvo J, Caso Ó, Cambra F, García-Sesma Á, Jiménez-Romero LC. A retrospective analysis of patients with gallbladder cancer: surgical treatment and survival according to tumor stage. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:485-492. [PMID: 29685046 DOI: 10.17235/reed.2018.5435/2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION gallbladder cancer is the most common biliary neoplasm and the sixth most common tumor of the digestive system. The disease has an ominous prognosis, with a 5-year survival rate of approximately 5%. It is usually diagnosed late and surgical resection is the only potential cure. METHODS a retrospective study was carried out in 92 patients with a pathological diagnosis of gallbladder cancer from January 2000 to January 2016. RESULTS the mean age of cases was 72 ± 11 years; 64 subjects were females and 28 were males. Symptoms at admission included abdominal pain (78%), anorexia (77%), nausea (76%) and jaundice (45%). Surgery was indicated in 92 (100%) patients and 59 (64%) underwent a curative/intent resection. The initial surgical procedures included simple cholecystectomy in 69 (75%) cases and extended cholecystectomy in eleven (11%) subjects. Rescue surgery was performed in 15 patients with tumor tissue in the cholecystectomy specimen; ten individuals underwent an R0 curative resection. Adjuvant therapy was administered in 30 (33%) patients. The median survival in our series was 12.5 months, with survival rates of 57%, 30% and 20% at one, three and five years, respectively. CONCLUSION to conclude, surgical treatment with a complete tumor resection should be considered for all patients, provided that their clinical status allows it.
Collapse
Affiliation(s)
- Iago Justo
- Cirugia general, Hospital Universitario 12 de Octubre
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Ibrahim F, Sandström P, Björnsson B, Larsson AL, Drott J. 'I want to know why and need to be involved in my own care…': a qualitative interview study with liver, bile duct or pancreatic cancer patients about their experiences with involvement in care. Support Care Cancer 2018; 27:2561-2567. [PMID: 30430301 PMCID: PMC6541569 DOI: 10.1007/s00520-018-4548-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/08/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Patients' involvement in their own care is important for those with upper abdominal tumours. Care is often conducted according to standardized fast-track care programs (FTCP), and a shorter hospital stay is one of the goals. However, there is no research providing an in-depth perspective on patients' experiences of involvement in care. In this qualitative study, we explored experiences of involvement among patients who had surgery for upper abdominal tumours and were cared for according to an FTCP. METHODS Qualitative in-depth face-to-face interviews about patient involvement in care were conducted with 20 patients who had surgery for the liver, bile duct, or pancreatic cancer using an open-interview guide. RESULTS The most important findings are that customized information and active dialogue about care decisions stimulate patient involvement. We identified three themes from the analysed data: involvement depended on the quality of information, communication and involvement during the care period, and safety at discharge. CONCLUSIONS Individualized care and continuous information about treatment and care goals in the FTCP during the care process create trust between patients and healthcare professionals and increase patient experiences of involvement.
Collapse
Affiliation(s)
- Farzana Ibrahim
- Department of Clinical and Experimental Medicine, Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden.,Department of Medicine and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden
| | - Per Sandström
- Department of Clinical and Experimental Medicine, Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Bergthor Björnsson
- Department of Clinical and Experimental Medicine, Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Anna Lindhoff Larsson
- Department of Clinical and Experimental Medicine, Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden
| | - Jenny Drott
- Department of Clinical and Experimental Medicine, Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden. .,Department of Medicine and Health Sciences, Division of Nursing Science, Linköping University, Linköping, Sweden. .,Faculty of Medicine and Health Sciences, Linköping University, 581 83, Linköping, Sweden.
| |
Collapse
|
40
|
Lindnér P, Holmberg E, Hafström L. Gallbladder cancer - no improvement in survival over time in a Swedish population. Acta Oncol 2018; 57:1482-1489. [PMID: 29932778 DOI: 10.1080/0284186x.2018.1478124] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) has an extremely poor outcome. The aim of this study was to examine trends in GBC incidence, treatment and overall survival in a complete population of affected persons in a well-defined region in Sweden in 2000-2014. MATERIAL AND METHODS Altogether 546 individuals with GBC were identified at Sweden's Regional Cancer Centre West. Subjects were grouped into three 5-year periods (Period A: 2000-2004, Period B: 2005-2009 and Period C: 2010-2014) and the survival, diagnosis, staging, grading and treatment for each period were investigated. Patients dead at date of diagnosis (n = 39) and patients with not invasive cancer (n = 25) were not included in the analysis. RESULTS The incidence was unchanged over the study period. The survival curves for the time periods were not significantly separated. Median survival was 4.7 months in Period A, 4.8 months in Period B and 6.1 months in Period C. Stage migration to more M1 in Periods B and C occurred and survival was improved for these cohorts. More individuals were diagnosed using only diagnostic imaging (p = .02). There were 177 curatively aiming operative procedures carried out on 482 persons (37%). The survival after surgery for the three periods improved over time (p = .02). Individuals who underwent a liver bed resection after a cholecystectomy had better survival than individuals who had cholecystectomy combined with liver resection. More persons were treated with chemotherapy, but no significant impact was found on survival in the total GBC population. CONCLUSIONS Although there were signs of improved diagnosis of GBC, the survival rate did not improve over time. There was a significant stage migration to more M1 in Periods B and C. Therapeutics able to downsize a cancer and increase the effectiveness of surgery with curative intent are warranted.
Collapse
Affiliation(s)
- Per Lindnér
- Transplant Institute, Institute of Clinical Sciences Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lo Hafström
- Transplant Institute, Institute of Clinical Sciences Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
41
|
Feng JW, Yang XH, Liu CW, Wu BQ, Sun DL, Chen XM, Jiang Y, Qu Z. Comparison of Laparoscopic and Open Approach in Treating Gallbladder Cancer. J Surg Res 2018; 234:269-276. [PMID: 30527484 DOI: 10.1016/j.jss.2018.09.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/27/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preliminary study on the feasibility and efficacy of laparoscopic cholecystectomy and radical cholecystectomy in stage Tis-T3 gallbladder cancer (GBC). METHODS Retrospective analysis of the clinical data of 102 patients with GBC from August 2008 to August 2017 in the Department of Hepatopancreatobiliary Surgery at the Third Affiliated Hospital of Soochow University. The clinical and pathological data of laparoscopic surgery and open surgery were compared. RESULTS Of 102 patients with GBC, 41 underwent laparoscopic treatment, 12 of whom underwent laparoscopic cholecystectomy, and the others underwent laparoscopic radical cholecystectomy/extended radical cholecystectomy. Sixty-one patients underwent radical cholecystectomy/extended radical cholecystectomy. Based on the individual patient's condition, excision of the extrahepatic biliary tract and cholangioenterostomy were performed. There were no perioperative deaths. There was no significant difference in the operative blood loss (P = 0.732), operative time (P = 0.058), postoperative complications (P = 0.933), R0 margins (P = 0.679), and tumor-related death (P = 0.396) between the laparoscopic group and the laparotomy group. The postoperative activity time (P < 0.001), postoperative eating time (P < 0.001), drainage tube removal time (P < 0.001), and postoperative hospital discharge time (P < 0.001) in the laparoscopic group were all earlier than those in the laparotomy group, and the difference was statistically significant. The number of lymph nodes resected in the laparoscopic group and the laparotomy group was 1-17, average (5 ± 3) and 1-13 average (5 ± 3), respectively, with no statistically significant difference (P = 0.973). The 1-, 3-, and 5-y survival rates in the laparoscopic group were 97.1%, 69.4%, and 51.9%, respectively, and those in the laparotomy group were 94.7%, 64.9%, and 55.7%, respectively; there were no significant difference between the two groups (P = 0.453). In terms of different pathologic T stages, the 5-y survival rates of patients with stage Tis (9 cases), T1a (2 cases), T1b (8 cases), T2 (14 cases), and T3 (8 cases) disease in the laparoscopic group were 100%, 100%, 75%, 48.1%, and 12.5%, respectively, and the 5-y survival rates in patients with stage Tis (4 cases), T1b (9 cases), T2 (32 cases), and T3 (16 cases) disease in the laparotomy group were 100%, 87.5%, 64.7%, and 16%, respectively; there were no significant differences between the two groups. CONCLUSIONS Laparoscopic treatment of stage Tis-T3 GBC is feasible. Laparoscopic treatment of GBC does not increase the incision metastasis rate on the basis of the intact gallbladder wall. The same survival rates can be achieved with laparoscopic treatment as with open treatment of GBC. In terms of postoperative rehabilitation, laparoscopic treatment has more advantages.
Collapse
Affiliation(s)
- Jia-Wei Feng
- Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xing-Hai Yang
- Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Chi-Wen Liu
- Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Bao-Qiang Wu
- Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Dong-Lin Sun
- Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xue-Min Chen
- Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yong Jiang
- Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
| | - Zhen Qu
- Changzhou First People's Hospital, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
| |
Collapse
|
42
|
Incidental Gallbladder Cancer: How Residual Disease Affects Outcome in Two Referral HPB Centers from South America. World J Surg 2018; 43:214-220. [DOI: 10.1007/s00268-018-4762-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
43
|
Sun X, Yan X, Zhuo W, Gu J, Zuo K, Liu W, Liang L, Gan Y, He G, Wan H, Gou X, Shi H, Hu J. PD-L1 Nanobody Competitively Inhibits the Formation of the PD-1/PD-L1 Complex: Comparative Molecular Dynamics Simulations. Int J Mol Sci 2018; 19:E1984. [PMID: 29986511 PMCID: PMC6073277 DOI: 10.3390/ijms19071984] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 12/22/2022] Open
Abstract
The anti-PD-L1 monoclonal antibody (mAb) targeting PD-1/PD-L1 immune checkpoint has achieved outstanding results in clinical application and has become one of the most popular anti-cancer drugs. The mechanism of molecular recognition and inhibition of PD-L1 mAbs is not yet clear, which hinders the subsequent antibody design and modification. In this work, the trajectories of PD-1/PD-L1 and nanobody/PD-L1 complexes were obtained via comparative molecular dynamics simulations. Then, a series of physicochemical parameters including hydrogen bond, dihedral angle distribution, pKa value and binding free energy, and so forth, were all comparatively analyzed to investigate the recognition difference between PD-L1 and PD-1 and nanobody. Both LR113 (the amino acid residues in PD-L1 are represented by the lower left sign of L) and LR125 residues of PD-L1 undergo significant conformational change after association with mAbs, which dominates a strong electrostatic interaction. Solvation effect analysis revealed that solvent-water enhanced molecular recognition between PD-L1 and nanobody. By combining the analyses of the time-dependent root mean squared fluctuation (RMSF), free energy landscape, clustering and energy decomposition, the potential inhibition mechanism was proposed that the nanobody competitively and specifically bound to the β-sheet groups of PD-L1, reduced the PD-L1’s flexibility and finally blocked the formation of PD-1/PD-L1 complex. Based on the simulation results, site-directed mutagenesis of ND99 (the amino acid residues in Nano are displayed by the lower left sign of N) and NQ116 in the nanobody may be beneficial for improving antibody activity. This work offers some structural guidance for the design and modification of anticancer mAbs based on the structure of the PD-1/PD-L1 complex.
Collapse
Affiliation(s)
- Xin Sun
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Antibiotics Research and Re-evaluation Key Laboratory of Sichuan Province, Chengdu University, Chengdu 610106, China.
| | - Xiao Yan
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Antibiotics Research and Re-evaluation Key Laboratory of Sichuan Province, Chengdu University, Chengdu 610106, China.
| | - Wei Zhuo
- Ministry of Education Key Laboratory of Protein Science, Tsinghua-Peking Joint Center for Life Sciences, Beijing Advanced Innovation Center for Structural Biology, School of Life Sciences, Tsinghua University, Beijing 100084, China.
| | - Jinke Gu
- Ministry of Education Key Laboratory of Protein Science, Tsinghua-Peking Joint Center for Life Sciences, Beijing Advanced Innovation Center for Structural Biology, School of Life Sciences, Tsinghua University, Beijing 100084, China.
| | - Ke Zuo
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Antibiotics Research and Re-evaluation Key Laboratory of Sichuan Province, Chengdu University, Chengdu 610106, China.
| | - Wei Liu
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Antibiotics Research and Re-evaluation Key Laboratory of Sichuan Province, Chengdu University, Chengdu 610106, China.
| | - Li Liang
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Antibiotics Research and Re-evaluation Key Laboratory of Sichuan Province, Chengdu University, Chengdu 610106, China.
| | - Ya Gan
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Antibiotics Research and Re-evaluation Key Laboratory of Sichuan Province, Chengdu University, Chengdu 610106, China.
| | - Gang He
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Antibiotics Research and Re-evaluation Key Laboratory of Sichuan Province, Chengdu University, Chengdu 610106, China.
| | - Hua Wan
- College of Mathematics and Informatics, South China Agricultural University, Guangzhou 510642, China.
| | - Xiaojun Gou
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Antibiotics Research and Re-evaluation Key Laboratory of Sichuan Province, Chengdu University, Chengdu 610106, China.
| | - Hubing Shi
- Laboratory of tumor targeted and immune therapy, Clinical Research Center for Breast, State Key Laboratory of Biotherapy, Sichuan University and Collaborative Innovation Center for Biotherapy, Chengdu 610041, China.
| | - Jianping Hu
- College of Pharmacy and Biological Engineering, Sichuan Industrial Institute of Antibiotics, Key Laboratory of Medicinal and Edible Plants Resources Development of Sichuan Education Department, Antibiotics Research and Re-evaluation Key Laboratory of Sichuan Province, Chengdu University, Chengdu 610106, China.
| |
Collapse
|
44
|
Wang J, Liu J, Chang Q, Yang B, Li S, Gu C. The association between preoperative serum interleukin-6 levels and postoperative prognosis in patients with T2 gallbladder cancer. J Surg Oncol 2018; 117:1672-1678. [PMID: 29723410 DOI: 10.1002/jso.25085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/30/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Interleukin-6 (IL-6) is closely associated with tumor progression. Whether it can predict postoperative prognosis of patients with T2 gallbladder cancer (GBC) remains controversial. METHODS We retrospectively collected the medical records of 125 patients with T2 GBC. Then, we analyzed the association between preoperative serum IL-6 levels and postoperative survival by multivariate Cox analyses and Kaplan-Meier curves in exploratory subgroups. RESULTS Predictive effects of serum IL-6 levels on overall survival were similar across most of the evaluated subgroups, except in different tumor location subgroups. The independent odds ratio (OR) of serum IL-6 levels was 2.57 (95%CI 1.73-3.82) in the hepatic side subgroup, while it was 1.15 (95%CI 0.68-1.93) in the peritoneal side subgroup (P = 0.014 for interaction). When we categorized serum IL-6 levels by median value (4.2 pg/mL), the 5-year survival rate of patients with high serum IL-6 levels was significantly higher in the hepatic side subgroup (58.5% vs 14.8%, P < 0.001), but no such difference was found in the peritoneal side subgroup (62.2% vs 67.6%, P = 0.722). CONCLUSIONS Preoperative serum IL-6 is significantly associated with prognostic implications in patients with hepatic side T2 GBC, not in those with peritoneal side tumors.
Collapse
Affiliation(s)
- Jianfa Wang
- Department of General Surgery, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.,Institute of Fudan-MinhangAcademic Healthy System, Minhang Hospital, Fudan university, Shanghai, P.R. China
| | - Jiazhe Liu
- Department of General Surgery, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.,Institute of Fudan-MinhangAcademic Healthy System, Minhang Hospital, Fudan university, Shanghai, P.R. China
| | - Qimeng Chang
- Department of General Surgery, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.,Institute of Fudan-MinhangAcademic Healthy System, Minhang Hospital, Fudan university, Shanghai, P.R. China
| | - Biao Yang
- Department of General Surgery, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.,Institute of Fudan-MinhangAcademic Healthy System, Minhang Hospital, Fudan university, Shanghai, P.R. China
| | - Sen Li
- Department of General Surgery, Minhang Branch, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.,Institute of Fudan-MinhangAcademic Healthy System, Minhang Hospital, Fudan university, Shanghai, P.R. China
| | - Chao Gu
- Department of General Surgery, Jinshan Hospital, Fudan University, Shanghai, P.R. China
| |
Collapse
|