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Muszynska C, Lundgren L, Jacobsson H, Sandström P, Andersson B. Preoperatively suspected gallbladder cancer improves survival compared with incidental gallbladder cancer in pT3 patients. Scand J Surg 2024:14574969241263539. [PMID: 39066517 DOI: 10.1177/14574969241263539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND The aim was to compare survival for incidental gallbladder cancer (IGBC), respectively, preoperatively suspected gallbladder cancer (GBC), subjected to surgery for different pathological tumour (pT) stages and in different treatment groups in a national cohort. METHODS Data were collected and crosslinked from two national quality registers, SweLiv (2009-2019) and GallRiks (2009-2016). Survival was estimated using Kaplan-Meier analysis. The log-rank test and Cox regression analyses were used to compare groups. RESULTS In total, 466 IGBC patients, including 225 who only underwent simple cholecystectomy (SC), and 477 GBC patients were included. Most patients were female, with small differences in mean age between groups. In all IGBC patients compared with GBC patients, an improved 5-year overall survival in pT3 GBC undergoing surgery (GBC 13% vs all IGBC 8%, p < 0.001), was seen. GBC was shown to be an independent predictor for improved survival in pT3 patients (hazard ratio (HR): 0.6; 95% confidence interval (CI): 0.4-0.8, p < 0.001). In addition, in GBC with curative reresection compared with IGBC SC and IGBC with curative resection, an improved 5-year overall survival in pT3 GBC was shown (GBC 20% vs all IGBC 10%, p < 0.001). GBC was an independent predictor for improved survival in pT3 patients with curative resection (HR: 0.4; 95% CI: 0.3-0.7, p < 0.001). CONCLUSIONS GBC was shown to be an independent predictor for improved survival in pT3 patients, and patients with GBC may benefit from one-stage resection. It is, therefore, reasonable to recommend that radiological suspicion of malignancy should be evaluated at a liver tumour centre to optimize patient outcomes.
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Affiliation(s)
- Carolina Muszynska
- Carolina Muszynska Department of Surgery Skåne University Hospital Department of Clinical Sciences Lund University Lund SE-221 85 Sweden
| | - Linda Lundgren
- Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden
- Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Helene Jacobsson
- Unit for Medical Statistics and Epidemiology, Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden
| | - Per Sandström
- Department of Surgery, County Council of Östergötland, Linköping University, Linköping, Sweden
- Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Bodil Andersson
- Department of Surgery, Skåne University Hospital and Department of Clinical Sciences, Lund University, Lund, Sweden
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Kamata M, Fusegi A, Kurihara N, Abe A, Nomura H, Kanao H. Effects of tumor spillage prevention in laparoscopic radical hysterectomy for early-stage cervical cancer: a propensity score-matched analysis. J Gynecol Oncol 2024; 36:36.e22. [PMID: 39028154 DOI: 10.3802/jgo.2025.36.e22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 06/08/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
OBJECTIVE Minimally invasive radical hysterectomy has a worse prognosis than open surgery, but the reasons for the poor prognosis remain unclear. Tumor spillage occurs when the tumor is exposed to the surgical field and has been suggested to be related to a poor prognosis. This study aimed to compare the prognostic value of tumor spillage in laparoscopic radical hysterectomy and evaluate whether tumor spillage prevention improves oncological safety. METHODS We compared the prognosis of patients who underwent laparoscopic radical hysterectomy between December 2014 and November 2021 with or without tumor spillage prevention, including surgeries without prevention and those with failed prevention. Prevention consisted of vaginal cuff formation or closure of the vaginal canal with clips to prevent tumor exposure at the time of colpotomy. The primary endpoint was disease-free survival, which was adjusted using propensity scores to compare patients. RESULTS In total, 165 patients received tumor spillage prevention, and 61 did not or failed to receive such prevention. The median follow-up was 4.4 years. Patients who did not undergo prevention or failed prevention had significantly shorter disease-free survival than those who did (hazard ratio [HR]=3.54; 95% confidence interval [CI]=1.23-10.23). The same trend was observed after adjusting for propensity score matching. Patients who did not or failed to receive prevention were more likely to experience local recurrence (HR=4.01; 95% CI=1.13-14.24). CONCLUSION Tumor spillage prevention was associated with longer disease-free survival in laparoscopic radical hysterectomy.
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Affiliation(s)
- Mayumi Kamata
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Atsushi Fusegi
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Nozomi Kurihara
- Department of Clinical Planning and Strategy, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akiko Abe
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Japanese Foundation for Cancer Research, Tokyo, Japan
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Sugumar K, De Mond J, Vijay A, Paramesh AS, Jeon H, Pointer DT, Corsetti RL. Bile Spillage as a Prognostic Factor for Gall Bladder Cancer: A Systematic Review and Meta-Analysis. J Surg Res 2024; 299:94-102. [PMID: 38718689 DOI: 10.1016/j.jss.2024.04.004] [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: 12/05/2023] [Revised: 02/22/2024] [Accepted: 04/07/2024] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Biliary spillage (BS) is a common complication following initial cholecystectomy for gall bladder cancer (GBC). Few studies have explored the importance of BS as a long-term prognostic factor. We perform a meta-analysis of the association between BS and survival in GBC. METHODS A systematic literature search was performed in February 2023. Studies evaluating the incidence of BS and its association with long-term outcomes in patients undergoing initial laparoscopic or open cholecystectomy for either incidental or resectable GBC were included. Overall survival (OS), disease-free survival (DFS), and rate of peritoneal carcinomatosis (RPC) were the primary end points. Forest plot analyses were used to calculate the pooled hazard ratios (HRs) of OS, DFS, and RPC. Metaregression was used to evaluate study-level association between BS and perioperative risk factors. RESULTS Of 181 published articles, 11 met inclusion criteria with a sample size of 1116 patients. The rate of BS ranged between 9% and 67%. On pooled analysis, BS was associated with worse OS (HR = 1.68, 95% confidence interval [CI] = 1.32-2.14), DFS (pooled HR= 2.19, 95% CI = 1.30-3.68), and higher RPC (odds ratio = 9.37, 95% CI = 3.49-25.2). The rate of BS was not associated with higher T stage, lymph node metastasis, higher grade, positive margin status, reresection, or conversion rates. CONCLUSIONS Our meta-analysis shows that BS is a predictor of higher peritoneal recurrence and poor survival in GBC. BS was not associated with tumor characteristics or conversion rates. Further research is needed to identify other potential risk factors for BS and investigate the ideal treatment schedule to improve survival.
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Affiliation(s)
- Kavin Sugumar
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
| | - Jeff De Mond
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Adarsh Vijay
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Anil S Paramesh
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Hoonbae Jeon
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - David T Pointer
- Department of Surgical Oncology, Ochsner Health, New Orleans, Louisiana
| | - Ralph L Corsetti
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Marino R, Ratti F, Casadei-Gardini A, Rimini M, Pedica F, Clocchiatti L, Aldrighetti L. The oncologic burden of residual disease in incidental gallbladder cancer: An elastic net regression model to profile high-risk features. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108397. [PMID: 38815335 DOI: 10.1016/j.ejso.2024.108397] [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: 02/10/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Incidental Gallbladder Cancer (IGBC) following cholecystectomy constitutes a significant portion of gallbladder cancer diagnoses. Re-exploration is advocated to optimize disease clearance and enhance survival rates. The consistent association of residual disease (RD) with inferior oncologic outcomes prompts a critical examination of re-resection's role as a modifying factor in the natural history of IGBC. METHODS All patients diagnosed with gallbladder cancer between 2012 and 2022 were included. An elastic net regularized regression model was employed to profile high-risk predictors of RD within the IGBC group. Survival outcomes were assessed based on resection margins and RD. RESULTS Among the 181 patients undergoing re-exploration for IGBC, 133 (73.5 %) harbored RD, while 48 (26.5 %) showed no evidence. The elastic net model, utilizing a selected λ = 0.029, identified six coefficients associated with the risk of RD: aspiration from cholecystectomy (0.141), hepatic tumor origin (1.852), time to re-exploration >8 weeks (1.879), positive margin status (2.575), higher T stage (1.473), and poorly differentiated tumors (2.241). Furthermore, the study revealed a median overall survival of 44 months (CI 38-60) for IGBC patients with no evidence of RD, compared to 31 months (23-42) for those with RD (p < 0.001). CONCLUSION Re-resection revealed a high incidence of RD (73.5 %), significantly correlating with poorer survival outcomes. The preoperative identification of high-risk features provides a reliable biological disease profile. This aids in strategic preselection of patients who may benefit from re-resection, underscoring the need to consolidate outcomes with tailored chemotherapy for those with unfavorable characteristics.
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Affiliation(s)
- Rebecca Marino
- IRCCS San Raffaele Hospital, Hepatobiliary Surgery Division, 20132, Milan, Italy
| | - Francesca Ratti
- IRCCS San Raffaele Hospital, Hepatobiliary Surgery Division, 20132, Milan, Italy; University Vita-Salute San Raffaele, 20132, Milan, Italy.
| | | | - Margherita Rimini
- Department of Medical Oncology, IRCCS San Raffaele Hospital, 20132, Milan, Italy
| | - Federica Pedica
- Department of Experimental Oncology, Pathology Unit, San Raffaele Hospital, 20132, Milan, Italy
| | - Lucrezia Clocchiatti
- IRCCS San Raffaele Hospital, Hepatobiliary Surgery Division, 20132, Milan, Italy
| | - Luca Aldrighetti
- IRCCS San Raffaele Hospital, Hepatobiliary Surgery Division, 20132, Milan, Italy; University Vita-Salute San Raffaele, 20132, Milan, Italy
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Huang CK, Lu RH, Chen CC, Chen PC, Hsu WC, Tsai MJ, Ting CT. Spilled gallstone mimicking intra-abdominal seeding of gallbladder adenocarcinoma: A case report. World J Gastrointest Surg 2024; 16:622-627. [PMID: 38463373 PMCID: PMC10921212 DOI: 10.4240/wjgs.v16.i2.622] [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: 11/14/2023] [Revised: 12/08/2023] [Accepted: 01/08/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Gallbladder rupture is common in laparoscopic cholecystectomy because the gallbladder is usually in acute or chronic inflammation status. The gallstones may sometime be spilled into the peritoneal cavity, resulting in intra-abdominal abscess if the gallstones were not retrieved. The diagnosis of intra-abdominal abscess caused by unretrieved gallstone can usually be correctly identified in the routine imaging studies, such as abdominal ultrasonography or computed tomography (CT). Here we present a case of abscess formation from unretrieved gallstone following laparoscopic cholecystectomy, which mimics the imaging findings of metastatic gallbladder adenocarcinoma. CASE SUMMARY This case described a 78-year-old man who received laparoscopic cholecystectomy and gallbladder adenocarcinoma was diagnosed after surgery. After adjuvant chemotherapy, the following up abdominal CT showed several small nodules at right upper abdomen and peritoneal carcinomatosis is considered. Repeated laparoscopic surgery for the excision of seeding tumor was conducted and the pathological diagnosis of the nodules and mass was inflammatory tissues and gallbladder stone. CONCLUSION Spilled gallstones are a common complication during laparoscopic cholecystectomy and some gallstones fail to be retrieved due to the size or the restricted view of laparoscopic surgery. For spilled gall bladder stones, surgeons may consider regular computerized tomography follow-up, and if necessary, laparoscopic examination can be used as a means of confirming the diagnostic and treatment.
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Affiliation(s)
- Cheng-Ken Huang
- Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei 106, Taiwan
| | - Ruey-Hwa Lu
- Division of General Surgery, Department of Surgery, Zhongxing Branch, Taipei City Hospital, Taipei 103, Taiwan
| | - Chien-Cheng Chen
- Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei 106, Taiwan
| | - Po-Chun Chen
- Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei 106, Taiwan
| | - Wen-Chang Hsu
- Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei 106, Taiwan
| | - Meng-Jui Tsai
- Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei 106, Taiwan
| | - Chin-Tsung Ting
- Division of Gastrointestinal Surgery, Department of Surgery, Ren-Ai Branch, Taipei City Hospital, Taipei 106, Taiwan
- School of Medicine, Institute of Traditional Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Department of Health and Welfare, University of Taipe, Taipe 104, Taiwan
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Zhang W, Wang Q, Liang K, Lin H, Wu D, Han Y, Yu H, Du K, Zhang H, Hong J, Zhong X, Zhou L, Shi Y, Wu J, Pang T, Yu J, Cao L. Deep learning nomogram for preoperative distinction between Xanthogranulomatous cholecystitis and gallbladder carcinoma: A novel approach for surgical decision. Comput Biol Med 2024; 168:107786. [PMID: 38048662 DOI: 10.1016/j.compbiomed.2023.107786] [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: 07/13/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023]
Abstract
The distinction between Xanthogranulomatous Cholecystitis (XGC) and Gallbladder Carcinoma (GBC) is challenging due to their similar imaging features. This study aimed to differentiate between XGC and GBC using a deep learning nomogram model built from contrast enhanced computed tomography (CT) scans. 297 patients were included with confirmed XGC (94) and GBC (203) as the training and internal validation cohort from 2017 to 2021. The deep learning model Resnet-18 with Fourier transformation named FCovResnet18, shows most impressive potential in distinguishing XGC from GBC using 3-phase merged images. The accuracy, precision and area under the curve (AUC) of the model were then calculated. An additional cohort of 74 patients consisting of 22 XGC and 52 GBC patients was enrolled from two subsidiary hospitals as the external validation cohort. The accuracy, precision and AUC achieve 0.98, 0.99, 1.00 in the internal validation cohort and 0.89, 0.92, 0.92 in external validation cohort. A nomogram model combining clinical characteristics and deep learning prediction score showed improved predicting value. Altogether, FCovResnet18 nomogram has demonstrated its ability to effectively differentiate XGC from GBC preoperatively, which significantly aid surgeons in making informed and accurate surgical decisions for XGC and GBC patients.
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Affiliation(s)
- Weichen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qing Wang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Kewei Liang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China.
| | - Haihao Lin
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Dongyan Wu
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuzhe Han
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Hanxi Yu
- International Institutes of Medicine, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Keyi Du
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Haitao Zhang
- Polytechnic Institute, Zhejiang University, Hangzhou, China
| | - Jiawei Hong
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Xun Zhong
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingfeng Zhou
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuhong Shi
- Polytechnic Institute, Zhejiang University, Hangzhou, China
| | - Jian Wu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Tianxiao Pang
- School of Mathematical Sciences, Zhejiang University, Hangzhou, China
| | - Jun Yu
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Linping Cao
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Lee CE, Lee SJ, Moon JI, Choi IS, Yoon DS, Choi WJ, Lee SE, Sung NS, Kwon SU, Bae IE, Roh SJ, Kim SG. Acute cholecystitis in old adults: the impact of advanced age on the clinical characteristics of the disease and on the surgical outcomes of laparoscopic cholecystectomy. BMC Gastroenterol 2023; 23:328. [PMID: 37749524 PMCID: PMC10521416 DOI: 10.1186/s12876-023-02954-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 09/10/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Impact of advanced age on disease characteristics of acute cholecystitis (AC), and surgical outcomes after laparoscopic cholecystectomy (LC) has not been established. METHODS This single-center retrospective study included patients who underwent LC for AC between April 2010 and December 2020. We analyzed the disease characteristics and surgical outcomes according to age: Group 1 (age < 60 years), Group 2 (60 ≤ age < 80 years), and Group 3 (age ≥ 80 years). Risk factors for complications were assessed using logistic regression analysis. RESULTS Of the 1,876 patients (809 [43.1%] women), 723 were in Group 1, 867 in Group 2, and 286 in Group 3. With increasing age, the severity of AC and combined common bile duct stones increased. Group 3 demonstrated significantly worse surgical outcomes when compared to Group 1 and 2 for overall (4.0 vs. 9.1 vs. 18.9%, p < 0.001) and serious complications (1.2 vs. 4.2 vs. 8.0%, p < 0.001), length of hospital stay (2.78 vs. 3.72 vs. 5.87 days, p < 0.001), and open conversion (0.1 vs. 1.0 vs. 2.1%, p = 0.007). Incidental gallbladder cancer was also the most common in Group 3 (0.3 vs. 1.5 vs. 3.1%, p = 0.001). In the multivariate analysis, body mass index < 18.5, moderate/severe AC, and albumin < 2.5 g/dL were significant risk factors for serious complications in Group 3. CONCLUSION Advanced age was associated with severe AC, worse surgical outcomes, and a higher rate of incidental gallbladder cancer following LC. Therefore, in patients over 80 years of age with AC, especially those with poor nutritional status and high severity grading, urgent surgery should be avoided, and surgery should be performed after sufficient supportive care to restore nutritional status before LC.
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Affiliation(s)
- Cho Eun Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Seung Jae Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea.
| | - Ju Ik Moon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - In Seok Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Dae Sung Yoon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Won Jun Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Sang Eok Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Nak Song Sung
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Seong Uk Kwon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - In Eui Bae
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Seung Jae Roh
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
| | - Sung Gon Kim
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, 35365, Daejeon, South Korea
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Yasukawa K, Shimizu A, Kubota K, Notake T, Hayashi H, Tomida H, Kuroiwa Y, Nakamura K, Hongo Y, Soejima Y. For safe and fast surgery: Utilization of the SAND balloon catheter for acute cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:1141-1151. [PMID: 37548128 DOI: 10.1002/jhbp.1346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/07/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The utility of the SAND balloon catheter in laparoscopic cholecystectomy for acute cholecystitis (AC) remains unclear. METHODS A retrospective cohort study of patients who underwent emergency cholecystectomy at Shinshu University was performed to evaluate the efficacy of the SAND balloon catheter in cases of AC (SAND balloon utilization: Group S, n = 44; non-utilization: Group non-S, n = 47). RESULTS The duration of surgery was significantly shorter in Group S than in Group non-S (p = .031). Despite comparable incidences of blood transfusions in the two groups, intraoperative blood loss was significantly less in Group S than in Group non-S (p = .013). The incidence of postoperative intraperitoneal infection tended to be higher in Group non-S (p = .076). Within Group non-S, bile spillage during operation was found in 16 (34.0%) patients. The multivariate analysis revealed that gangrenous AC was the strongest independent risk factor for bile spillage during operation (odds ratio [OR]: 19.1; 95% confidence interval [CI]: 2.84-78.4; p = .002), followed by surgeons with ≤10 years of experience (OR: 11.3; 95% CI: 1.81-70.6; p < .010). CONCLUSIONS Implementation of the SAND balloon catheter in patients with AC is a safe and efficacious surgical option. This catheter is recommended in cases of gangrenous cholecystitis and for surgeons with limited experience.
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Affiliation(s)
- Koya Yasukawa
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Shimizu
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koji Kubota
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tsuyoshi Notake
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hikaru Hayashi
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hidenori Tomida
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yudai Kuroiwa
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kenya Nakamura
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuta Hongo
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Soejima
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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9
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Kihara Y, Yokomizo H, Murotani K. Impact of acute cholecystitis comorbidity on prognosis after surgery for gallbladder cancer: a propensity score analysis. World J Surg Oncol 2023; 21:109. [PMID: 36973745 PMCID: PMC10045850 DOI: 10.1186/s12957-023-03001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Cholecystitis can represent a comorbidity during gallbladder cancer surgery; nonetheless, the prognostic impact of acute cholecystitis comorbidity remains unclear. This study aimed to evaluate the impact of acute cholecystitis comorbidity on prognosis after gallbladder cancer surgery, with adjustment for background factors using propensity score analysis. METHODS A total of 218 patients who underwent gallbladder cancer surgery at our institute between 1986 and 2022 were retrospectively included in the analysis. Patients were divided into two groups according to the presence or absence of acute cholecystitis at the time of surgery. Background factors were adjusted by including intraoperative bile leakage as a covariate in propensity score calculation. Overall survival and recurrence-free survival were compared between the two groups using one-to-one propensity score matching and inverse probability weighting. RESULTS Of the 218 patients, 37 had coexisting acute cholecystitis. In one-to-one propensity score matching, the overall survival time in the acute cholecystitis group tended to be shorter than that in the non-acute cholecystitis group, although not significantly (hazard ratio, 2.41; 95% confidence interval, 0.96-6.06). Other analyses using inverse probability weighting showed significantly poor overall survival in the acute cholecystitis group. Regarding recurrence-free survival in propensity score matching, the acute cholecystitis group showed a significantly shorter duration than the non-acute cholecystitis group (hazard ratio, 6.69; 95% confidence interval, 1.46-30.6). The inverse probability weighting-adjusted analysis also indicated a significantly higher risk of recurrence in the acute cholecystitis group. CONCLUSIONS Acute cholecystitis comorbidity at the time of gallbladder cancer surgery may have a negative impact on gallbladder cancer prognosis.
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Affiliation(s)
- Yasuhiro Kihara
- Division of General Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, 861-8520, Japan.
- Graduate School of Medicine, Kurume University, Fukuoka, Japan.
| | - Hiroshi Yokomizo
- Division of General Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, 861-8520, Japan
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10
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The diagnostic value of staging laparoscopy in gallbladder cancer: a nationwide cohort study. World J Surg Oncol 2023; 21:6. [PMID: 36641472 PMCID: PMC9840315 DOI: 10.1186/s12957-022-02880-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/17/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Disseminated disease (DD) is often found at (re-)exploration in gallbladder cancer (GBC) patients. We aimed to assess the yield of staging laparoscopy (SL) and identify predictors for DD. METHODS This retrospective study included patients from all Dutch academic centres with primary GBC (pGBC) and incidentally diagnosed GBC (iGBC) planned for (re-)resection. The yield of SL was determined. In iGBC, predictive factors for DD were assessed. RESULTS In total, 290 patients were included. Of 183 included pGBC patients, 143 underwent laparotomy without SL, and 42 (29%) showed DD perioperatively. SL, conducted in 40 patients, identified DD in eight. DD was found in nine of 32 patients who underwent laparotomy after SL. Of 107 included iGBC patients, 100 underwent laparotomy without SL, and 19 showed DD perioperatively. SL, conducted in seven patients, identified DD in one. Cholecystitis (OR = 4.25; 95% CI 1.51-11.91) and primary R1/R2 resection (OR = 3.94; 95% CI 1.39-11.19) were independent predictive factors for DD. CONCLUSIONS In pGBC patients, SL may identify DD in up to 20% of patients and should be part of standard management. In iGBC patients, SL is indicated after primary resection for cholecystitis and after initial R1/R2 resection due to the association of these factors with DD.
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11
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Silva DAGDA, Veloso OLL, Valadares MSP, Costa RSDA, Silveira MG, Carvalho FCDE, Sousa MG. Incidental gallbladder cancer: what is the prevalence and how do we perform cholecystectomy for presumably benign biliary disease? Rev Col Bras Cir 2023; 49:e20223417. [PMID: 36629721 PMCID: PMC10578791 DOI: 10.1590/0100-6991e-20223417-en] [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: 07/11/2022] [Accepted: 09/05/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE to determine the prevalence of incidental gallbladder cancer (IGBC) in cholecystectomies performed in a tertiary public hospital and to describe technical and epidemiological aspects of performing cholecystectomies for presumably benign disease. METHOD descriptive, retrospective observational study, based on analysis of medical records of patients undergoing cholecystectomy with preoperative hypothesis of benign disease between January 2018 and January 2022. RESULTS prevalence of gallbladder adenocarcinoma in our sample was 0.16%, similar to data in the literature. Technical aspects during cholecystectomy were also described with a frequency similar to that found in the literature. CONCLUSION despite a rare disease, IGBC is relevant in the routine of the General Surgeon. Its diagnosis, staging and treatment directly affect the prognosis. Technical aspects during cholecystectomy are not always remembered by surgeons and can interfere with the prognosis and subsequent treatment of the patient.
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Affiliation(s)
- Diego Arley Gomes DA Silva
- - Universidade Federal da Paraíba, Departamento de Cirurgia - João Pessoa - PB - Brasil
- - Instituto do Coração do Hospital das Clínicas da FMUSP, Disciplina de Cirurgia Torácica - São Paulo - SP - Brasil
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12
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Vega EA, Mellado S, Salehi O, Freeman R, Conrad C. Treatment of Resectable Gallbladder Cancer. Cancers (Basel) 2022; 14:1413. [PMID: 35326566 PMCID: PMC8945892 DOI: 10.3390/cancers14061413] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/18/2022] [Accepted: 03/06/2022] [Indexed: 02/04/2023] Open
Abstract
Gallbladder cancer (GBC) is the most common biliary tract cancer worldwide and its incidence has significant geographic variation. A unique combination of predisposing factors includes genetic predisposition, geographic distribution, female gender, chronic inflammation, and congenital developmental abnormalities. Today, incidental GBC is the most common presentation of resectable gallbladder cancer, and surgery (minimally invasive or open) remains the only curative treatment available. Encouragingly, there is an important emerging role for systemic treatment for patients who have R1 resection or present with stage III-IV. In this article, we describe the pathogenesis, surgical and systemic treatment, and prognosis.
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Affiliation(s)
- Eduardo A. Vega
- Department of Surgery, St. Elizabeth’s Medical Center, Boston University School of Medicine, Boston, MA 02135, USA; (E.A.V.); (O.S.); (R.F.)
| | | | - Omid Salehi
- Department of Surgery, St. Elizabeth’s Medical Center, Boston University School of Medicine, Boston, MA 02135, USA; (E.A.V.); (O.S.); (R.F.)
| | - Richard Freeman
- Department of Surgery, St. Elizabeth’s Medical Center, Boston University School of Medicine, Boston, MA 02135, USA; (E.A.V.); (O.S.); (R.F.)
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth’s Medical Center, Boston University School of Medicine, Boston, MA 02135, USA; (E.A.V.); (O.S.); (R.F.)
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Feo CF, Ginesu GC, Fancellu A, Perra T, Ninniri C, Deiana G, Scanu AM, Porcu A. Current management of incidental gallbladder cancer: A review. Int J Surg 2022; 98:106234. [PMID: 35074510 DOI: 10.1016/j.ijsu.2022.106234] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 02/05/2023]
Abstract
Early-stage gallbladder cancer (GBC) is mostly discovered incidentally by the pathologist after cholecystectomy for a presumed benign disease. It is the most common malignancy of the biliary tract with a variable incidence rate all over the World. The majority of patients with GBC remain asymptomatic for a long time and diagnosis is usually late when the disease is at an advanced stage. Radical surgery consisting in resection of the gallbladder liver bed and regional lymph nodes seems to be the best treatment option for incidental GBC. However, recurrence rates after salvage surgery are still high and the addition of neoadjuvant/adjuvant chemotherapy may improve outcomes. The aim of the present review is to evaluate current literature for advances in management of incidental GBC, with particular focus on staging techniques and surgical options.
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Affiliation(s)
- Claudio F Feo
- Unit of General Surgery 2, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100, Sassari, Italy
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14
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SILVA DIEGOARLEYGOMESDA, VELOSO OLGALANUSALEITE, VALADARES MATHEUSSOUTOPERAZZO, COSTA RODRIGOSOARESDA, SILVEIRA MARIANAGALINDO, CARVALHO FERNANDACOSTADE, SOUSA MARCELOGONÇALVES. Câncer incidental de vesícula biliar: qual a prevalência e como operamos a colecistectomia por doença presumidamente benigna? Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
RESUMO Objetivos: determinar a prevalência de câncer incidental de vesícula biliar (CIVB) em colecistectomias realizadas em um hospital público terciário e descrever aspectos técnicos e epidemiológicos na realização de colecistectomias por doença presumidamente benigna. Método: estudo observacional descritivo, retrospectivo, a partir da análise de prontuários de pacientes submetidos à colecistectomia com hipótese pré-operatória de doença benigna entre janeiro de 2018 e janeiro de 2022. Resultados: a prevalência de adenocarcinoma de vesícula biliar na amostra avaliada foi de 0,16%, semelhante aos dados da literatura mundial. Os aspectos técnicos durante a realização da colecistectomia também foram descritos com frequência semelhante ao encontrado na literatura. Conclusão: o CIVB é uma doença rara mas de importância relevante na rotina do Cirurgião Geral. Seu diagnóstico, estadiamento e tratamento implicam diretamente no prognóstico. Aspectos técnicos durante a realização da colecistectomia nem sempre são lembrados pelos cirurgiões e podem interferir no prognóstico e tratamento subsequente do paciente.
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15
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Rahul, Haldeniya K, Singh A, Bhatt N, Mishra P, Singh RK, Saxena R. Determinants of curative resection in incidental gallbladder carcinoma with special reference to timing of referral. Ann Hepatobiliary Pancreat Surg 2021; 25:492-499. [PMID: 34845121 PMCID: PMC8639303 DOI: 10.14701/ahbps.2021.25.4.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022] Open
Abstract
Backgrounds/Aims Re-resection of incidental gallbladder carcinoma (IGBC) is possible in a select group of patients. However, the optimal timing for re-intervention lacks consensus. Methods A retrospective analysis was performed for a prospective database of 91 patients with IGBC managed from 2009 to 2018. Patients were divided into three groups based on the duration between the index cholecystectomy and re-operation or final staging: Early (E), < 4 weeks; Intermediate (I), > 4 weeks and < 12 weeks; and Late (L), > 12 weeks. Demographic data, tumor characteristics, and operative details of patients were analyzed to determine factors affecting the re-resectability of IGBC. Results Twenty-two patients in ‘E’, 48 in ‘I’, and 21 in ‘L’ groups were evenly matched. Nearly two thirds were asymptomatic. Curative resection was possible in 48 (52.7%) patients. Metastasis was detected during staging laparoscopy (SL)/laparotomy in 26 (28.6%) patients. The yield of SL was more in the ‘L’ group (30.8%) than in the ‘I’ (11.1%) or ‘E’ (nil) group, avoiding unnecessary laparotomy in 13.6%. Only 28.5% of patients in the ‘L’ group could undergo curative resection (R0/R1 resection), significantly less than that in the ‘E’ (50.0%) or ‘I’ group (64.6%) (both p < 0.001). On multivariate analysis, presentation in intermediate period and tumor differentiation increased the chance of curative resection (p < 0.05). Conclusions Asymptomatic patients in the ‘I’ group with well differentiated IGBC have the best chance of obtaining a curative resection.
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Affiliation(s)
- Rahul
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kulbhushan Haldeniya
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ashish Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Neha Bhatt
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Prabhakar Mishra
- Department of Biostatistics & Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajneesh Kumar Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajan Saxena
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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16
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Sutton TL, Walker BS, Radu S, Dewey EN, Enestvedt CK, Maynard E, Orloff SL, Nabavizadeh N, Sheppard BC, Lopez CD, Billingsley KG, Mayo SC. Degree of biliary tract violation during treatment of gallbladder adenocarcinoma is independently associated with development of peritoneal carcinomatosis. J Surg Oncol 2021; 124:581-588. [PMID: 34115368 DOI: 10.1002/jso.26569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/10/2021] [Accepted: 06/01/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is often incidentally diagnosed after cholecystectomy. Intra-operative biliary tract violations (BTV) have been recently associated with development of peritoneal disease (PD). The degree of BTV may be associated with PD risk, but has not been previously investigated. METHODS We reviewed patients with initially non-metastatic GBC treated at our institution from 2003 to 2018. Patients were grouped based on degree of BTV during their treatment: major (e.g., cholecystotomy with bile spillage, n = 27, 29%), minor (e.g., intra-operative cholangiogram, n = 18, 19%), and no violations (n = 48, 55%). Overall survival (OS) and peritoneal disease-free survival (PDFS) were evaluated with Kaplan-Meier and Cox proportional hazards modeling. RESULTS Ninety-three patients were identified; the median age was 64 years (range 31-87 years). Seventy-six (82%) were incidentally diagnosed. The median follow-up was 23 months; 20 (22%) patients developed PD. The 3-year PDFS for patients with major, minor, and no BTV was 52%, 83%, and 98%, respectively (major vs. none: p < 0.001; minor vs. none: p < 0.01). BTV was not associated with 5-year OS (HR 1.53, p = 0.16). CONCLUSION Increasing degree of BTV is associated with higher risk of peritoneal carcinomatosis in patients with GBC and should be considered during preoperative risk stratification. Reporting biliary tract violations during cholecystectomy is encouraged.
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Affiliation(s)
- Thomas L Sutton
- Department of Surgery, Oregon Health & Science University (OHSU), Division of General Surgery, Portland, Oregon, USA
| | - Brett S Walker
- Department of Surgery, Oregon Health & Science University (OHSU), Division of General Surgery, Portland, Oregon, USA
| | | | - Elizabeth N Dewey
- Department of Surgery, Oregon Health & Science University (OHSU), Division of General Surgery, Portland, Oregon, USA
| | - C Kristian Enestvedt
- OHSU Department of Surgery, Division of Abdominal Transplant Surgery, Portland, Oregon, USA
| | - Erin Maynard
- OHSU Department of Surgery, Division of Abdominal Transplant Surgery, Portland, Oregon, USA
| | - Susan L Orloff
- OHSU Department of Surgery, Division of Abdominal Transplant Surgery, Portland, Oregon, USA
| | | | - Brett C Sheppard
- Department of Surgery, Oregon Health & Science University (OHSU), Division of General Surgery, Portland, Oregon, USA
| | - Charles D Lopez
- OHSU Department of Medicine, Division of Hematology/Oncology, Portland, Oregon, USA.,The Knight Cancer Institute at OHSU, Portland, Oregon, USA
| | | | - Skye C Mayo
- The Knight Cancer Institute at OHSU, Portland, Oregon, USA.,OHSU Department of Surgery, Division of Surgical Oncology, Portland, Oregon, USA
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17
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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.
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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
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Matsuyama R, Yabusita Y, Homma Y, Kumamoto T, Endo I. Essential updates 2019/2020: Surgical treatment of gallbladder cancer. Ann Gastroenterol Surg 2021; 5:152-161. [PMID: 33860135 PMCID: PMC8034687 DOI: 10.1002/ags3.12434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/31/2020] [Indexed: 12/20/2022] Open
Abstract
Gallbladder cancer is a biliary tract cancer that originates in the gallbladder and cystic ducts and is recognized worldwide as a refractory cancer with early involvement of the surrounding area because of its anatomical characteristics. Although the number of cases is increasing steadily worldwide, the frequency of this disease remains low, making it difficult to plan large-scale clinical studies, and there is still much discussion about the indications for surgical resection and the introduction of multidisciplinary treatment. Articles published between 2019 and 2020 were reviewed, focusing mainly on the indications for surgical resection for each tumor stage, the treatment of incidental gallbladder cancer, and current trends in minimally invasive surgery for gallbladder cancer.
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Affiliation(s)
- Ryusei Matsuyama
- Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan
| | - Yasuhiro Yabusita
- Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan
| | - Yuki Homma
- Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan
| | - Takafumi Kumamoto
- Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan
| | - Itaru Endo
- Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan
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19
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Lee SM, Lim JH. Comparison of outcomes of single incision robotic cholecystectomy and single incision laparoscopic cholecystectomy. Ann Hepatobiliary Pancreat Surg 2021; 25:78-83. [PMID: 33649258 PMCID: PMC7952663 DOI: 10.14701/ahbps.2021.25.1.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 12/14/2022] Open
Abstract
Backgrounds/Aims Multiport laparoscopic cholecystectomy is the standard surgical procedure for symptomatic gallbladder diseases. However, as a result of the ongoing trend toward minimally invasive laparoscopy, single-incision laparoscopic cholecystectomy (SILC) has evolved. Single-incision robotic cholecystectomy (SIRC) can overcome several limitations of manual SILC. The purpose of this study is to evaluate and compare the safety and feasibility of SIRC and SILC. Methods This study retrospectively reviewed data for all patients who underwent SIRC or SILC from March 2018 to July 2019 in a single institution. The following variables were analyzed: age, sex, body mass index, pain scale, length of stay, and complications. The data were analyzed using the Independent two sample t-test or the Fisher’s exact test. Results A total of 343 patients underwent SIRC or SILC during the study period. After excluding patients with acute cholecystitis, 197 SIRC and 103 SILC patients were analyzed in this study. The surgery time and postoperative hospital stay did not differ between SIRC and SILC. However, the SIRC patients experienced less bile spillage during the surgery than did the SILC patients (SIRC vs. SILC: 24 (23.3%) vs. 11 (5.6%) cases, respectively; p<0.001). Although there was no difference in the incidence of postoperative complications between procedures, additional pain control was administered more frequently in SILC patients (SILC 1.08±0.893, SIRC 0.58±0.795; p<0.001). Conclusions While both SILC and SIRC are effective for single-incision cholecystectomy, SIRC was superior to SILC in terms of technical stability. Moreover, it has the advantage of postoperative pain control.
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Affiliation(s)
- Sun Min Lee
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Hong Lim
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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20
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He S, Yu T, Khadaroo PA, Cai L, Chu Y, Wei F, Liang X. A Comparison Between the Prognosis of Simultaneous and Salvage Radical Resection in Incidental Gallbladder Cancer. Cancer Manag Res 2020; 12:13469-13478. [PMID: 33408519 PMCID: PMC7779289 DOI: 10.2147/cmar.s286292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/08/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Incidental gallbladder cancer (IGBC) is defined as gallbladder cancer (GBC) that is accidentally discovered during cholecystectomy to treat benign lesions. We aimed to compare the prognosis of IGBC patients who underwent simultaneous radical resection (SIR) vs salvage radical resection (SAR). Patients and Methods We retrospectively reviewed data for IGBC patients admitted to Sir Run Run Shaw Hospital from January 2000 to May 2016. Survival analysis was performed using Kaplan–Meier (univariate) and COX regression (multivariate) analyses. Results Eighty-four patients with IGBC underwent radical resection; 43/84 underwent SIR, and 41/84 underwent SAR. Compared with SIR, the SAR group was more likely to receive comprehensive preoperative radiographic evaluation, port-site excision, and have more lymph nodes excised (all P < 0.05). Kaplan–Meier analysis indicated that the prognosis in the SAR group was better than that in SIR (overall survival: P = 0.050, recurrence-free survival: P = 0.028). Regression analysis indicated that the type of radical resection (SIR/SAR) was not an independent prognostic factor (overall survival: P = 0.737, recurrence-free survival: P = 0.957). Conclusion Patients undergoing SAR had non-inferior survival compared with SIR. It is possible that patients in SAR underwent preoperative radiographical evaluations more comprehensively and the surgical operations were more well performed.
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Affiliation(s)
- Shilin He
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Tunan Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Parikshit Asutosh Khadaroo
- Monash University, School of Medicine, Nursing and Health Sciences, Melbourne, Australia.,School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Liuxin Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Yeyuan Chu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, People's Republic of China
| | - Fangqiang Wei
- Department of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, People's Republic of China
| | - Xiao Liang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People's Republic of China
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21
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Zhang L, Hou C, Chen M, Guo L, Xu Z, Wang L, Ling X, Wang G, Cui L, Xiu D. Tumour radiological appearance evaluated by enhanced CT correlates with tumour progression and survival in curable gallbladder cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2020; 46:2099-2105. [PMID: 32807617 DOI: 10.1016/j.ejso.2020.07.006] [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: 02/18/2020] [Revised: 06/23/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Surgical resection has been proposed for curable gallbladder cancer (GBCA); however, optimal preoperative evaluation and resection planning methods remain unestablished. The aim of this study was to establish the types of CT tumour radiological appearances in GBCA with a focus on its association with clinicopathologic features and its prognostic impact in curable GBCA. METHODS In all, 118 patients surgically treated for GBCA were identified and CT tumour radiological appearances were reviewed. Models were established and internally validated. Clinicopathologic variables and prognostic impact were analysed for correlation with tumour radiological appearance. RESULTS The classification and distribution of tumour radiological appearance in these patients was Type 1 (n = 14), Type 2 (n = 60), Type 3 (n = 21), Type 4 (n = 18), and undetermined (n = 5). Among the 113 patients, a higher tendency of T stage and incidence of lymph node metastasis was observed from Type 1 to Type 4. Most Type 1 patients were T1 stage, they have no lymph node involvement or recurrence. With a median follow-up of 25 months (range, 1-135 months), a clear prognostic difference was observed among the 4 types after surgical treatment (p < 0.001). Type 1 patients showed 100% 5-year survival rate. Among the 66 T2 tumours, both tumour location and tumour radiological appearance effectively stratified patient prognosis (p < 0.001, p = 0.007). Introducing tumour radiological appearance into tumour location enabled further prognostic stratification of the 35 T2h tumours (p < 0.001). CONCLUSIONS Type of CT tumour radiological appearance is a predictor of tumour biology. It may improve preoperative evaluation and resection planning.
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Affiliation(s)
- Lingfu Zhang
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
| | - Chunsheng Hou
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
| | - Ming Chen
- Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
| | - Limei Guo
- Department of Pathology, Peking University Third Hospital and Peking University Health Science Center, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
| | - Zhi Xu
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
| | - Lixin Wang
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
| | - Xiaofeng Ling
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
| | - Gang Wang
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
| | - Long Cui
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
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Incidental Carcinoma after Cholecystectomy for Benign Disease of the Gallbladder: A Meta-Analysis. J Clin Med 2020; 9:jcm9051484. [PMID: 32423156 PMCID: PMC7290945 DOI: 10.3390/jcm9051484] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
This study aimed to determine the incidence and the prognosis of incidental carcinoma of the gallbladder (IGBC) after cholecystectomy through a meta-analysis. This meta-analysis included 51 studies and 436,636 patients with cholecystectomy. The incidence rate of IGBC after cholecystectomy was 0.6% (95% confidence interval (CI) 0.5%-0.8%). The incidence rate of recent studies was not significantly different from those of past studies. The mean age and female ratio of the IGBC subgroup were not significantly different from those of the overall patient group. The estimated rates of IGBC were 13.0%, 34.1%, 39.7%, 22.7%, and 12.5% in the pTis, pT1, pT2, pT3, and pT4 stages, respectively. Patients with IGBC had a favorable overall survival rate compared to patients with non-IGBC (hazard ratio (HR) 0.574, 95% CI 0.445-0.739). However, there was no significant difference of disease-free survival between the IGBC and non-IGBC subgroups (HR 0.931, 95% CI 0.618-1.402). IGBC was found in 0.6% of patients with cholecystectomy. The prognosis of patients with IGBC was favorable compared to those with non-IGBC. In the pathologic examination after cholecystectomy for benign diseases, a sufficient examination for histology should be guaranteed to detect IGBC.
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Abstract
Managing patients with incidental gallbladder cancer requires stratifying patients risk for recurrence and an appreciation for the recurrence patterns characterizing this malignancy. Although standard management includes reresection to remove sites at risk of harboring residual disease and to achieve negative resection margin status, the decision to perform surgery is tempered by an early and frequent distant recurrence, the most common cause of surgical failure. High-risk patients may benefit from neoadjuvant chemotherapy before reresection. The goal of curative-intent reresection is achieving R0 margin status and optimal staging while limiting morbidity and mortality.
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Vega EA, Conrad C. Author response to: Comment on: Comparison of oncological outcomes after open and laparoscopic re-resection of incidental gallbladder cancer. Br J Surg 2020; 107:770-771. [PMID: 32339290 DOI: 10.1002/bjs.11548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 11/07/2022]
Affiliation(s)
- E A Vega
- Department of Surgery, Saint Elizabeth Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - C Conrad
- Department of Surgery, Saint Elizabeth Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
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Zizzo M, Manzini L, Zanelli M, De Marco L, Castro Ruiz C, Manenti A, Annessi V. Prevention of bile spillage during cholecystectomy: current evidences and considerations. Hepatobiliary Surg Nutr 2020; 9:109-111. [PMID: 32140494 DOI: 10.21037/hbsn.2019.11.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Manzini
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy
| | - Loredana De Marco
- Pathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, Italy
| | - Carolina Castro Ruiz
- General Surgery Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Reggio Emilia, Italy
| | - Antonio Manenti
- Department of General Surgery, Azienda Ospedaliero-Universitaria - Policlinico, Modena, Italy
| | - Valerio Annessi
- General Surgery Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Ospedale Civile di Guastalla, Reggio Emilia, Italy
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Ramos E, Lluis N, Llado L, Torras J, Busquets J, Rafecas A, Serrano T, Mils K, Leiva D, Fabregat J. Prognostic value and risk stratification of residual disease in patients with incidental gallbladder cancer. World J Surg Oncol 2020; 18:18. [PMID: 31980034 PMCID: PMC6982379 DOI: 10.1186/s12957-020-1794-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022] Open
Abstract
Background and aim Given their poor prognosis, patients with residual disease (RD) in the re-resection specimen of an incidental gallbladder carcinoma (IGBC) could benefit from a better selection for surgical treatment. The Gallbladder Cancer Risk Score (GBRS) has been proposed to preoperatively identify RD risk more precisely than T-stage alone. The aim of this study was to assess the prognostic value of RD and to validate the GBRS in a retrospective series of patients. Material and methods A prospectively collected database including 59 patients with IGBC diagnosed from December 1996 to November 2015 was retrospectively analyzed. Three locations of RD were established: local, regional, and distant. The effect of RD on overall survival (OS) was analyzed with the Kaplan-Meier method. To identify variables associated with the presence of RD, characteristics of patients with and without RD were compared using Fisher’s exact test. The relative risk of RD associated with clinical and pathologic factors was studied with a univariate logistic regression analysis. Results RD was found in 30 patients (50.8%). The presence of RD in any location was associated with worse OS (29% vs. 74.2%, p = 0.0001), even after an R0 resection (37.7% vs 74.2%, p = 0.003). There was no significant difference in survival between patients without RD and with local RD (74.2% vs 64.3%, p = 0.266), nor between patients with regional RD and distant RD (16.1% vs 20%, p = 0.411). After selecting patients in which R0 resection was achieved (n = 44), 5-year survival rate for patients without RD, local RD, and regional RD was, respectively, 74.2%, 75%, and 13.9% (p = 0.0001). The GBRS could be calculated in 25 cases (42.3%), and its usefulness to predict the presence of regional or distant RD (RDRD) was confirmed (80% in high-risk patients and 30% in intermediate risk p = 0.041). Conclusion RDRD, but not local RD, represents a negative prognostic factor of OS. The GBRS was useful to preoperatively identify patients with high risk of RDRD. An R0 resection did not improve OS of patients with regional RD.
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Affiliation(s)
- Emilio Ramos
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Nuria Lluis
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Llado
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jaume Torras
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juli Busquets
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antoni Rafecas
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Serrano
- Department of Pathology, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Kristel Mils
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
| | - David Leiva
- Department of Radiology, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan Fabregat
- Department of Surgery, IDIBELL, Hospital Universitario de Bellvitge, CIBERehd, Servicio de Cirugía General y Digestiva, Universidad de Barcelona, Av Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain
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Affiliation(s)
- Bita Geramizadeh
- Department of Pathology, Medical School of Shiraz University, Shiraz University of Medical Sciences, Shiraz, Iran.,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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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
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30
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Blakely AM, Wong P, Chu P, Warner SG, Raoof M, Singh G, Fong Y, Melstrom LG. Intraoperative bile spillage is associated with worse survival in gallbladder adenocarcinoma. J Surg Oncol 2019; 120:603-610. [PMID: 31292970 DOI: 10.1002/jso.25617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/21/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Gallbladder adenocarcinoma is often incidentally identified following cholecystectomy. We hypothesized that intraoperative bile spillage would be a negative prognostic factor. METHODS A retrospective review of patients treated at a cancer center with histologically confirmed gallbladder adenocarcinoma, 2009-2017, was performed. Patient, disease, and treatment factors were analyzed in terms of progression-free survival (PFS) and overall survival (OS). RESULTS Sixty-six patients were identified. Tumor stage was T1 (n = 8, 12%), T2 (n = 23, 35%), T3 (n = 35, 53%). Node stage was N0 (n = 22, 33%), N1+ (n = 26, 39%), Nx (n = 18, 27%). Operations included cholecystectomy alone (n = 27, 36%), cholecystectomy and partial hepatectomy (n = 30, 45%), or hepaticojejunostomy (n = 9, 14%). Median PFS was 7 months (interquartile range [IQR], 2-19); median OS was 16 months (IQR, 10-31). Subset multivariate proportional hazards regression of 41 patients who underwent initial cholecystectomy showed decreased PFS was associated with intraoperative spillage (n = 12, 29%; hazard ratio [HR], 5.5; P = .0014); decreased OS was associated with drain placement (n = 21, 51%; HR, 8.1; P = .006). CONCLUSIONS Intraoperative bile spillage and surgical drain placement at initial cholecystectomy are negatively associated with PFS and OS in gallbladder adenocarcinoma. Explicit documentation of spillage and drain placement rationale is critical, possibly indicating locally advanced disease and prompting stronger consideration of systemic therapy before definitive resection.
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Affiliation(s)
- Andrew M Blakely
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Paul Wong
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Peiguo Chu
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Susanne G Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Mustafa Raoof
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Gagandeep Singh
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, California
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Cherkassky L, Jarnagin W. Selecting treatment sequence for patients with incidental gallbladder cancer: a neoadjuvant approach versus upfront surgery. Updates Surg 2019; 71:217-225. [PMID: 31254234 DOI: 10.1007/s13304-019-00670-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 06/22/2019] [Indexed: 02/07/2023]
Abstract
At MSKCC, over 50% of the patients presenting with gallbladder cancer have been diagnosed incidentally following elective cholecystectomy for presumed benign disease. While traditional management of incidental gallbladder cancer (IGBC) dictates re-resection with the ultimate goal of achieving cure, surgical decision-making must take into account that this malignancy is characterized by poor tumor biology with frequent distant recurrence. Since early and frequent distant recurrence is the most common cause of surgical failure, the surgical oncologist's goal should be to selectively re-resect only those patients most likely to benefit from an operation. The astute surgeon recognizes the high-risk patients who likely have micrometastatic disease at the time of diagnosis and alters the treatment sequence, delivering neoadjuvant chemotherapy. This strategy acts as a selection tool, as those progressing at distant sites during therapy are spared the morbidity and mortality of surgery and furthermore has the potential to treat micrometastatic disease. However, a chemotherapy first approach must be applied selectively since a poor response risks local progression to unresectability and a decrease in functional status that comes from the toxicities of dual agent chemotherapy that can impair surgical candidacy. To balance these risks and benefits, two other criteria for a neoadjuvant approach must be met: i) reliable identification of those patients who are at high risk of distant recurrence and who are, therefore, most likely to benefit from a systemic therapy first approach and ii) availability of effective chemotherapy options. In this review, we will outline the data and judgement we use to select a treatment sequence at our institution.
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Affiliation(s)
- Leonid Cherkassky
- Clinical Fellow in Complex General Surgical Oncology, Department of Surgical Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - William Jarnagin
- Leslie Blumgart Chair in Surgery, Department of Surgical Oncology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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