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Rahul R, Haldenia K, Singh A, Kapoor V, Singh RK, Saxena R. Does Timing of Completion Radical Cholecystectomy Determine the Survival Outcome in Incidental Carcinoma Gallbladder: A Single-Center Retrospective Analysis. Cureus 2022; 14:e26653. [PMID: 35949769 PMCID: PMC9357255 DOI: 10.7759/cureus.26653] [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] [Accepted: 07/08/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Incidental discovery of gallbladder cancer (GBC) on postoperative histopathology or intra-operative suspicion is becoming increasingly frequent since laparoscopic cholecystectomy became the standard of care for gallstone disease. Incidental GBC (IGBC) portends a better survival than primarily detected GBC. Various factors affect the outcome of re-resection with the timing of re-intervention an important determinant of survival. Methods All patients of IGBC who underwent curative resection from January 2009 to December 2018 were considered for analysis. Details of demographic profile, index surgery, and operative findings on re-resection, histopathology and follow-up were retrieved from the prospectively maintained database. Patients were evaluated in three groups based on the interval between index cholecystectomy and re-resection: Early (<4 weeks), Intermediate (4-12 weeks) and Late (>12 weeks), using appropriate statistical tests. Results Ninety-one patients were admitted with IGBC during the study period of which 48 underwent re-resection with curative intent. The median age of presentation was 55 years (31-77 years). The median duration of follow-up was 40.6 months (Range: 1.2-130.6 months). Overall and disease-free survival among the above-mentioned three groups was the best in the early group (104 and 102 months) as compared to the intermediate (84 and 83 months) and late groups (75 and 73 months), though the difference failed to achieve statistical significance (p=0.588 and 0.581). On univariate analysis, factors associated with poor outcome were node metastasis, need for common bile duct (CBD) excision and high-grade tumor. However, on multivariate analysis, poor differentiation was the only independent factor affecting survival. Conclusion Early surgery, preferably within four weeks, possibly entails better survival in incidentally detected GBC. The grade of a tumor, however, is the most important determinant of survival in IGBC.
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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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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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de Aretxabala X, Castillo F, Hepp J, Muñoz S, Vivanco M, Burgos L, Solano N, Rencoret G, Roa I. Gallbladder cancer who is really cured? HPB (Oxford) 2021; 23:1253-1258. [PMID: 33468412 DOI: 10.1016/j.hpb.2020.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although gallbladder cancer (GBCA) is characterized by a dismal prognosis, there is a proportion of patients who are cured. The aim of this study was to analyze the profile of these patients. METHODS A database was queried for patients who underwent curative resection with a follow-up of at least 5 years. Patients were prospectively treated and registered by the same surgical team. A multivariate regression analysis was used to identify factors associated with long-term survival. RESULTS From 1988 to 2013, 461 patients were evaluated and 112 who underwent resection were analyzed. Among the patients, five year survival was 57% while lymph node and liver compromise were the only independent factors associated with survival. On the other hand, the elapsed time between the cholecystectomy and the resection, the differentiation grade and the level of wall invasion did not have an independent effect on the prognosis. CONCLUSION Despite its poor prognosis, a subset of patients can be cured of GBCA. R0 resection of patients without lymph and liver infiltration are key to GBCA survival.
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Affiliation(s)
- Xabier de Aretxabala
- Department of Surgery, Clinica Alemana, Santiago, Chile; Department of Surgery, Hospital Fuerza Aérea de Chile, Santiago, Chile.
| | - Felipe Castillo
- Department of Surgery, Hospital Barros Luco, Santiago, Chile
| | - Juan Hepp
- Department of Surgery, Clinica Alemana, Santiago, Chile
| | - Sergio Muñoz
- Epidemiology Department, Universidad de la Frontera, Temuco, Chile
| | | | - Luis Burgos
- Department of Surgery, Universidad de la Frontera, Temuco, Chile
| | | | | | - Ivan Roa
- Creative Bioscience, Santiago, Chile
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Peng H, Fan K, Zan R, Gong ZJ, Sun W, Sun Y, Wang W, Jiang H, lou J, Ni J, Suo T, Zhang X. Degradable magnesium implants inhibit gallbladder cancer. Acta Biomater 2021; 128:514-522. [PMID: 33964481 DOI: 10.1016/j.actbio.2021.04.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/11/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
Gallbladder cancer can be difficult to detect in its early stages and is prone to metastasize, causing bile duct obstruction, which is usually treated by stent implantation in clinic. However, the commonly used biliary stents are non-degradable, which not only prone to secondary blockage, but also need to be removed by secondary surgery. Biodegradable magnesium (Mg) is expected to one of the promising candidates for degradable biliary stents due to its excellent physicochemical property and biocompatibility. In this work, we studied the influence of high-purity Mg wires on gallbladder cancer through in vitro and in vivo experiments and revealed that the degradation products of Mg could significantly inhibit the growth of gallbladder cancer cells and promote their apoptosis. Our findings indicate that Mg biliary stent possesses the function of draining bile and treating gallbladder cancer, suggesting that Mg has good application prospects in biliary surgery. STATEMENT OF SIGNIFICANCE: Current research and development of biomedical magnesium are mainly concentrated in the cardiovascular and orthopedics field. Degradable magnesium bile duct stents have great application prospects in the treatment of bile duct blockage caused by bile duct-related cancers. At present, the effect of magnesium implants on gallbladder cancer is not clear. Our work verified the effectiveness of magnesium wire implants in inhibiting gallbladder cancer through in vivo and in vitro experiments, and studied the effect of magnesium degradation products on gallbladder cancer cells from the perspective of cell proliferation, apoptosis and cycle. This study provided new understanding for the application of magnesium in biliary surgery.
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Regmi P, Hu HJ, Chang-Hao Y, Liu F, Ma WJ, Ran CD, Wang JK, Paudyal A, Cheng NS, Li FY. Laparoscopic surgery for oncologic extended resection of T1b and T2 incidental gallbladder carcinoma at a high-volume center: a single-center experience in China. Surg Endosc 2020; 35:6505-6512. [PMID: 33174099 DOI: 10.1007/s00464-020-08146-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 10/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical treatment is still the most effective treatment for gallbladder cancer. For the patients with stage T1b and above, the current guidelines recommend the extended radical operation, and oncologic extended resection can benefit the survival of the patients. The laparoscopic approach is still in the early phase, and its safety and oncological outcomes are not well known. OBJECTIVE To evaluate the technical feasibility and oncological outcomes of laparoscopic surgery for oncologic extended resection of early-stage incidental gallbladder carcinoma. RESULTS This study included 18 male and 32 female patients. Twenty patients underwent laparoscopic oncologic extended resection and 30 patients underwent open oncologic extended resection. All of the patients had R0 resection. A laparoscopic approach was associated with less intraoperative blood loss (242 ± 108.5 vs 401 ± 130.3; p < 0.01) and shorter duration of postoperative hospital stay (6.2 ± 2.4 vs 8.6 ± 2.3; p < 0.01). There was no statistically significant difference between two groups for lymph nodes yield (5.4 ± 3.5 vs 5.8 ± 2.1; p > 0.05), incidence of lymphatic metastasis (15% vs 16.67%; p > 0.05), residual disease (20% vs 23.3%; p > 0.05), and postoperative morbidity (15% vs 20%; p > 0.05). During follow-up time of median 20.95 (12-29.5) months, no significant difference was found between the two groups for early tumor recurrence (10% vs 13.33%; p > 0.05) and disease-free survival (p > 0.05). CONCLUSION Laparoscopic surgery may offer similar intraoperative, perioperative, and short-term oncological outcomes as an open oncologic extended resection for incidental gallbladder carcinoma.
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Affiliation(s)
- Parbatraj Regmi
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yin Chang-Hao
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Cong-Dun Ran
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jun-Ke Wang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Aliza Paudyal
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Nan-Sheng Cheng
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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de Savornin Lohman E, de Bitter T, Verhoeven R, van der Geest L, Hagendoorn J, Haj Mohammad N, Daams F, Klümpen HJ, van Gulik T, Erdmann J, de Boer M, Hoogwater F, Koerkamp BG, Braat A, Verheij J, Nagtegaal I, van Laarhoven C, van den Boezem P, van der Post R, de Reuver P. Trends in Treatment and Survival of Gallbladder Cancer in the Netherlands; Identifying Gaps and Opportunities from a Nation-Wide Cohort. Cancers (Basel) 2020; 12:cancers12040918. [PMID: 32283627 PMCID: PMC7226578 DOI: 10.3390/cancers12040918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/31/2020] [Accepted: 04/03/2020] [Indexed: 12/29/2022] Open
Abstract
Gallbladder cancer (GBC) is rare in Western populations and data about treatment and outcomes are scarce. This study aims to analyze survival and identify opportunities for improvement using population-based data from a low-incidence country. GBC patients diagnosed between 2005 and 2016 with GBC were identified from the Netherlands Cancer Registry. Patients were grouped according to time period (2005–2009/2010–2016) and disease stage. Trends in treatment and overall survival (OS) were analyzed. In total 1834 patients were included: 661 (36%) patients with resected, 278 (15%) with non-resected non-metastatic, and 895 (49%) with metastatic GBC. Use of radical versus simple cholecystectomy (12% vs. 26%, p < 0.001) in early (pT1b/T2) GBC increased. More patients with metastatic GBC received chemotherapy (11% vs. 29%, p < 0.001). OS improved from 4.8 months (2005–2009) to 6.1 months (2010–2016) (p = 0.012). Median OS increased over time (2005–2009 vs. 2010–2016) in resected (19.4 to 26.8 months, p = 0.038) and metastatic (2.3 vs. 3.4 months, p = 0.001) GBC but not in unresected, non-metastatic GBC. In early GBC, patients with radical cholecystectomy had a median OS of 76.7 compared to 18.4 months for simple cholecystectomy (p < 0.001). Palliative chemotherapy showed superior (p < 0.001) survival in metastatic (7.3 versus 2.1 months) and non-resected non-metastatic (7.7 versus 3.5 months) GBC. In conclusion, survival of GBC remains poor. Radical surgery and palliative chemotherapy appear to improve prognosis but remain under-utilized.
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Affiliation(s)
- Elise de Savornin Lohman
- Department of Surgery, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (E.d.S.L.); (R.V.); (C.v.L.); (P.v.d.B.)
| | - Tessa de Bitter
- Department of Pathology, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (T.d.B.); (I.N.); (R.v.d.P.)
| | - Rob Verhoeven
- Department of Surgery, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (E.d.S.L.); (R.V.); (C.v.L.); (P.v.d.B.)
- Department of Research, Netherlands Comprehensive Cancer Organization, 3501 DB Utrecht, The Netherlands;
| | - Lydia van der Geest
- Department of Research, Netherlands Comprehensive Cancer Organization, 3501 DB Utrecht, The Netherlands;
| | - Jeroen Hagendoorn
- Department of Surgery, Utrecht University Medical Center, 3508 GA Utrecht, The Netherlands;
| | - Nadia Haj Mohammad
- Department of Medical Oncology, Utrecht University Medical Center, Utrecht University, 3508 GA Utrecht, The Netherlands;
| | - Freek Daams
- Department of Surgery, Amsterdam University Medical Centers, VU University, Cancer Center Amsterdam, 1007 MB Amsterdam, The Netherlands;
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, 1100 DD Amsterdam, The Netherlands;
| | - Thomas van Gulik
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, 1100DD Amsterdam, The Netherlands; (T.v.G.); (J.E.)
| | - Joris Erdmann
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, 1100DD Amsterdam, The Netherlands; (T.v.G.); (J.E.)
| | - Marieke de Boer
- Department of Surgery, Section of HPB-Surgery and Liver Transplantation, University Medical Center Groningen, 97700 RB Groningen, The Netherlands; (M.d.B.); (F.H.)
| | - Frederik Hoogwater
- Department of Surgery, Section of HPB-Surgery and Liver Transplantation, University Medical Center Groningen, 97700 RB Groningen, The Netherlands; (M.d.B.); (F.H.)
| | | | - Andries Braat
- Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands;
| | - Joanne Verheij
- Department of Pathology, Amsterdam University Medical Center, 1100 DD Amsterdam, The Netherlands;
| | - Iris Nagtegaal
- Department of Pathology, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (T.d.B.); (I.N.); (R.v.d.P.)
| | - Cornelis van Laarhoven
- Department of Surgery, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (E.d.S.L.); (R.V.); (C.v.L.); (P.v.d.B.)
| | - Peter van den Boezem
- Department of Surgery, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (E.d.S.L.); (R.V.); (C.v.L.); (P.v.d.B.)
| | - Rachel van der Post
- Department of Pathology, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (T.d.B.); (I.N.); (R.v.d.P.)
| | - Philip de Reuver
- Department of Surgery, Radboud University Medical Centre, 6500 HB Nijmegen, The Netherlands; (E.d.S.L.); (R.V.); (C.v.L.); (P.v.d.B.)
- Correspondence: ; Tel./Fax: +31-24-3613983
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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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Creasy JM, Goldman DA, Gonen M, Dudeja V, O’Reilly EM, Abou-Alfa GK, Cercek A, Harding JJ, Balachandran VP, Drebin JA, Allen PJ, Kingham TP, D’Angelica MI, Jarnagin WR. Evolution of surgical management of gallbladder carcinoma and impact on outcome: results from two decades at a single-institution. HPB (Oxford) 2019; 21:1541-1551. [PMID: 31027875 PMCID: PMC6812599 DOI: 10.1016/j.hpb.2019.03.370] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/01/2019] [Accepted: 03/22/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND The surgical approach to gallbladder cancer (GBCA) has evolved in recent years, but the impact on outcomes is unknown. This study describes differences in presentation, surgery, chemotherapy strategy, and survival for patients with GBCA over two decades at a tertiary referral center. METHODS A single-institution database was queried for patients with GBCA who underwent surgical evaluation and exploration and was studied retrospectively. Univariate logistic regression was used to assess the relationship between time and treatment. Univariate Cox proportional hazard regression assessed the association between year of diagnosis and survival. RESULTS From 1992 to 2015, 675 patients with GBCA were evaluated and 437 underwent exploration. Complete resection rates increased over time (p < 0.001). In those submitted to complete resection (n = 255, 58.4%), more recent years were associated with lower likelihood of bile duct resection and major hepatectomy but greater odds of neoadjuvant and adjuvant chemotherapy (p < 0.05). No significant association was found between year of diagnosis and OS or RFS (p > 0.05) for patients with complete resection. CONCLUSION Over the study period, GBCA treatment evolved to include fewer biliary and major hepatic resections with no apparent adverse impact on outcome. Further prospective trials, specifically limited to GBCA, are needed to determine the impact of adjuvant chemotherapy.
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Affiliation(s)
- John M. Creasy
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra A. Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vikas Dudeja
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eileen M. O’Reilly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James J. Harding
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jeffrey A. Drebin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter J. Allen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T. Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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10
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Yu LH, Yuan B, Fu XH, Yu WL, Liu J, Zhang YJ. Does Anatomic Resection Get More Benefits than Wedge Hepatectomy on the Prognosis for pT3 Unsuspected Gallbladder Cancer? J Laparoendosc Adv Surg Tech A 2019; 29:1414-1418. [PMID: 31403381 DOI: 10.1089/lap.2018.0690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Re-radical surgery is the only curative therapy for unsuspected gallbladder carcinoma (UGC). The aim of this study was to compare prognosis of pT3 UGC patients receiving anatomic hepatectomy (AH) or wedge hepatectomy (WH) combined with en bloc local-regional lymphadenectomy of the hepatoduodenal ligament using propensity score-matching (PSM) analysis. Materials and Methods: A retrospective study was carried out on 81 consecutive pT3 UGC patients who underwent radical re-resection at Eastern Hepatobiliary Surgery Hospital from 2006 to 2015. Overall survival (OS) was estimated using Kaplan-Meier method. The difference in OS between the AH and WH groups was analyzed using the log-rank test and the PSM method. Result: The AH and WH groups showed no significant difference in OS (P > .05) by either log-rank test or PSM analysis. Conclusions: Both AH and WH radical re-resections are effective treatments for UCG patients with pT3 tumors.
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Affiliation(s)
- Liang-He Yu
- Second Military Medical University, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Bo Yuan
- Second Military Medical University, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Xiao-Hui Fu
- Second Military Medical University, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Wen-Long Yu
- Second Military Medical University, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Jian Liu
- Second Military Medical University, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - Yong-Jie Zhang
- Second Military Medical University, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
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11
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Vega EA, Vinuela E, Okuno M, Joechle K, Sanhueza M, Diaz C, Jarufe N, Martinez J, Troncoso A, Diaz A, Chun YS, Tzeng CWD, Lee JE, Vauthey JN, Conrad C. Incidental versus non-incidental gallbladder cancer: index cholecystectomy before oncologic re-resection negatively impacts survival in T2b tumors. HPB (Oxford) 2019; 21:1046-1056. [PMID: 30711243 DOI: 10.1016/j.hpb.2018.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/08/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conflicting data exists whether non-oncologic index cholecystectomy (IC) leading to discovery of incidental gallbladder cancer (IGBC) negatively impacts survival. This study aimed to determine whether a subgroup of patients derives a disadvantage from IC. METHODS Patients with IGBC and non-IGBC treated at an academic USA and Chilean center during 1999-2016 were compared. Patients with T1, T4 tumor or preoperative jaundice were excluded. T2 disease was classified into T2a (peritoneal-side tumor) and T2b (hepatic-side tumor). Disease-specific survival (DSS) and its predictors were analyzed. RESULTS Of the 196 patients included, 151 (77%) had IGBC. One hundred thirty-six (90%) patients of whom 118 (87%) had IGBC had T2 disease. Three-year DSS rates were similar between IGBC and non-IGBC for all patients. However, for T2b patients, 3-year survival rate was worse for IGBC (31% vs 85%; p = 0.019). In multivariate analysis of T2 patients, predictors of poor DSS were hepatic-side tumor hazard ratio [HR], 2.9; 95% CI, 1.6-5.4; p = 0.001) and N1 status (HR, 2.4; 95% CI, 1.6-3.6; p < 0.001). CONCLUSIONS Patients with T2b gallbladder cancer specifically benefit from a single operation. These patients should be identified preoperatively and referred to hepatobiliary center.
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Affiliation(s)
- Eduardo A Vega
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile
| | - Eduardo Vinuela
- Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile; Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Masayuki Okuno
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katharina Joechle
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Marcel Sanhueza
- Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile; Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Cristian Diaz
- Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile; Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Nicolas Jarufe
- Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Jorge Martinez
- Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Andres Troncoso
- Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Alfonso Diaz
- Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile; Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Yun S Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Claudius Conrad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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12
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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.
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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
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13
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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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14
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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.
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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
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15
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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.
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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
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16
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Hickman L, Contreras C. Gallbladder Cancer: Diagnosis, Surgical Management, and Adjuvant Therapies. Surg Clin North Am 2019; 99:337-355. [PMID: 30846038 DOI: 10.1016/j.suc.2018.12.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gallbladder cancer (GBC) is an often lethal disease, but surgical resection is potentially curative. Symptoms may be misdiagnosed as biliary colic; over half of new diagnoses are made after laparoscopic cholecystectomy for presumed benign disease. Gallbladder polyps >1 cm should prompt additional imaging and cholecystectomy. For GBC diagnosed after cholecystectomy, tumors T1b and greater necessitate radical cholecystectomy. Radical cholecystectomy includes staging laparoscopy, hepatic resection, and locoregional lymph node clearance to achieve R0 resection. Patients with locally advanced disease (T3 or T4), hepatic-sided T2 tumors, node positivity, or R1 resection may benefit from adjuvant chemotherapy. Chemotherapy increases survival in unresectable disease.
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Affiliation(s)
- Laura Hickman
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Carlo Contreras
- Division of Surgical Oncology, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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17
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Nitta T, Kataoka J, Ohta M, Takashima Y, Fujii K, Ishii M, Inoue Y, Takeshita A, Ishibashi T. Laparoscopic Excisional Cholecystectomy with Full-Thickness Frozen Biopsy in Suspected Gallbladder Carcinoma. Case Rep Gastroenterol 2019; 12:747-756. [PMID: 30686959 PMCID: PMC6341341 DOI: 10.1159/000495603] [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: 10/22/2018] [Revised: 11/19/2018] [Indexed: 11/22/2022] Open
Abstract
Owing to the advantages of a laparoscopic approach, laparoscopic cholecystectomy (LC) is thought to be the treatment of choice in gallbladder disease, even in cases of suspected malignancy. However, it is difficult to differentiate between cholecystitis and gallbladder carcinoma (GBC). We performed radical hepatectomy in patients with pT2 GBC diagnosed by full-thickness frozen biopsy. A 75-year-old Japanese man presented to our hospital with discomfort in the right upper quadrant of the abdomen. This patient was diagnosed with suspected GBC and was scheduled to undergo LC and intraoperative histological examination. Following the procedure, we made a diagnosis of GBC with negative invasion of the cystic duct stump. We converted the laparoscopic procedure to an open surgery involving wedge liver resection with lymphadenectomy. The patient was discharged from our hospital in remission 14 days following the radical hepatectomy. Histological examination showed that the GBC had invaded the liver (T3a), but there was no lymph node metastasis (N0): stage IIIA. Between April 2009 and September 2018, 580 patients underwent cholecystectomy for gallbladder disease at our hospital. Among these, 8 (1.4%) were suspected to have GBC preoperatively and underwent laparoscopic excisional cholecystectomy. We performed elective surgery in the early stage in two patients and second-look surgery in two patients recently. We were able to perform what we termed a laparoscopic excisional cholecystectomy, involving LC with a full-thickness frozen biopsy, even in situations where intraoperative histological examination was not available. Altogether, laparoscopic excisional cholecystectomy is an effective surgical treatment for suspected early GBC.
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Affiliation(s)
- Toshikatsu Nitta
- Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan
| | - Jun Kataoka
- Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan
| | - Masato Ohta
- Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan
| | - Yuko Takashima
- Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan
| | - Kensuke Fujii
- Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan
| | - Masatsugu Ishii
- Department of Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Yoshihiro Inoue
- Department of Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | | | - Takashi Ishibashi
- Division of Surgery, Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan
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18
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Surgical strategy for suspected early gallbladder carcinoma including incidental gallbladder carcinoma diagnosed during or after cholecystectomy. Ann Med Surg (Lond) 2018; 33:56-59. [PMID: 30197784 PMCID: PMC6127871 DOI: 10.1016/j.amsu.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 07/07/2018] [Accepted: 07/25/2018] [Indexed: 02/06/2023] Open
Abstract
Purpose This paper presents an overview of the surgical strategy for patients with suspected gallbladder carcinoma (GBC), including incidental GBC cases, preoperatively or intraoperatively, as well as their outcomes. Methods Between April 2009 and December 2017, 529 patients underwent cholecystectomy for gallbladder disease at our hospital. Both intraoperative and postoperative histological examinations of the excised gallbladder facilitated the diagnosis of GBC. Surgery-related variables and surgical approaches were evaluated according to the extent of tumor invasion. Results Of 529 patients, eight were diagnosed with GBC during/after cholecystectomy, including four women and four men. Mean age was 75.4 (range, 59–89) years. Five patients had gallbladder stones and three had cholecystitis. Three patients with stages T1b and T2 underwent additional liver bed wedge resections with or without prophylactic common bile duct excision. Five of the eight patients are still alive and two of the remaining three died from other diseases; one patient with pT3 died of recurrent GBC (peritonitis carcinomatosa). Conclusion Because of the ability to obtain full-thickness frozen biopsies during laparoscopic cholecystectomy, we could diagnose GBC intraoperatively, allowing for rapid diagnosis and tumor resection. We recommend developing a surgical treatment strategy for suspected early GBC in advance of cholecystectomy. Gallbladder carcinoma can be diagnosed during or after cholecystectomy. Frozen biopsies from cholecystectomy allow for the intraoperative diagnosis of GBC. The intraoperative diagnosis of GBC facilitates surgical resection of tumors. Surgical strategies incorporating intraoperative diagnosis should be developed.
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Clinicopathological characteristics and outcomes of rare histologic subtypes of gallbladder cancer over two decades: A population-based study. PLoS One 2018; 13:e0198809. [PMID: 29889907 PMCID: PMC5995371 DOI: 10.1371/journal.pone.0198809] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 05/09/2018] [Indexed: 02/06/2023] Open
Abstract
Background There is limited literature about the clinicopathological characteristics and outcomes of rare histologic variants of gallbladder cancer (GBC). Methods Using SEER database, surgically managed GBC patients with microscopically confirmed adenocarcinoma, adenosquamous/squamous cell carcinoma and papillary carcinoma were identified from 1988 to 2009. Patients with second primary cancer and distant metastasis at presentation were excluded. The effect of clinicopathological variables on overall survival (OS) and disease specific survival (DSS) were analyzed using univariate and multivariate proportional hazards modeling. All associations were considered statistically significant at an alpha error of 0.01. Results Out of 4738 cases, 217 adenosquamous/squamous (4.6%), 367 papillary (7.7%), and 4154 adenocarcinomas (87.7%) were identified. Median age was 72 years. Higher tumor grade (grade 2, 3, 4 versus grade 1), higher T stage (T2, T3, T4 versus T1), lymph node positivity (N1 versus N0) and adenosquamous/squamous histology (versus adenocarcinoma) had worse OS and DSS (p < .001). Papillary GBC had better OS and DSS than adenocarcinoma (HR = 0.7; p < .001). Radical surgery (versus simple cholecystectomy) had better OS (HR = 0.83, p = 0.002) in multivariate analysis. OS rates at 3 and 5 years were 0.56 and 0.44 for papillary, 0.3 and 0.22 for adenocarcinoma, and 0.14 and 0.12 for adenosquamous/squamous histology, while DSS rates at 3 and 5 years were 0.67 and 0.61 for papillary, 0.38 and 0.31 for adenocarcinoma, and 0.17 and 0.16 for adenosquamous/squamous subtypes respectively. Conclusion Papillary GBC had better survival outcomes while adenosquamous/squamous GBC had worse survival outcomes compared to gallbladder adenocarcinoma.
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20
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Creasy JM, Goldman DA, Gonen M, Dudeja V, Askan G, Basturk O, Balachandran VP, Allen PJ, DeMatteo RP, D’Angelica MI, Jarnagin WR, Kingham TP. Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies. J Gastrointest Surg 2017; 21:1254-1261. [PMID: 28484891 PMCID: PMC5521173 DOI: 10.1007/s11605-017-3436-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/26/2017] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Re-operation is advised for patients with T1b or greater incidental gallbladder cancer (GBCA). The presence of residual disease (RD) impacts resectability, chemotherapy, and survival. This study created a preoperative model to predict RD at re-operation. METHODS Patients with re-operation for incidental GBCA from 1992-2015 were included. The relationship between pathology data from initial cholecystectomy and RD at re-operation was assessed with logistic regression and classification and regression tree (CART) analysis. RESULTS Two hundred fifty-four patients were included and 188 underwent definitive re-resection (74.0%). Distant RD was identified in 69 (27.2%) patients and locoregional only RD in 82 (32.3%). On multivariate analysis, T3 (OR 22.7, 95% CI 5.5-94.4) and poorly differentiated tumors (OR 4.3, 95% CI 1.4-13.3) were associated with RD (p < 0.001-0.012). AUC of multivariate model was 0.78 (95% CI 0.72-0.83). CART analysis split patients into groups based on percentage with RD: 87% RD with T3, 67% RD with T1b/T2 and poorly differentiated, and 35% RD with T1b/T2 and well/moderate differentiated tumors. CONCLUSION Based on T stage and grade from cholecystectomy, this study developed a model for predicting RD at re-operation in incidental GBCA. This model delineates patient groups with variable percentages of RD and could be used to stratify high-risk patients for prospective trials.
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Affiliation(s)
- John M. Creasy
- Department of Surgery, Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debra A. Goldman
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vikas Dudeja
- Department of Surgery, Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Gokce Askan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Olca Basturk
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vinod P. Balachandran
- Department of Surgery, Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter J. Allen
- Department of Surgery, Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ronald P. DeMatteo
- Department of Surgery, Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michael I. D’Angelica
- Department of Surgery, Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William R. Jarnagin
- Department of Surgery, Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - T. Peter Kingham
- Department of Surgery, Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Muszynska C, Lundgren L, Lindell G, Andersson R, Nilsson J, Sandström P, Andersson B. Predictors of incidental gallbladder cancer in patients undergoing cholecystectomy for benign gallbladder disease: Results from a population-based gallstone surgery registry. Surgery 2017; 162:256-263. [PMID: 28400123 DOI: 10.1016/j.surg.2017.02.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/12/2017] [Accepted: 02/24/2017] [Indexed: 02/06/2023]
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Creasy JM, Goldman DA, Dudeja V, Lowery MA, Cercek A, Balachandran VP, Allen PJ, DeMatteo RP, Kingham TP, D'Angelica MI, Jarnagin WR. Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma: Surgical and Survival Outcomes. J Am Coll Surg 2017; 224:906-916. [PMID: 28216422 PMCID: PMC5409857 DOI: 10.1016/j.jamcollsurg.2016.12.058] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Preoperative chemotherapy is a strategy for converting to resection and/or assessing disease biology before operation. The utility of such an approach in gallbladder carcinoma (GBCA) is unknown. This study evaluated outcomes of GBCA patients treated with chemotherapy for locally advanced or lymph node-involved tumors. STUDY DESIGN Patients who received systemic chemotherapy for locally advanced or lymph node-positive GBCA were identified from a departmental database. Patients were excluded if there was any evidence of distant metastases or if records were inadequate to determine initial chemotherapy and response. Response Evaluation Criteria in Solid Tumors (RECIST), operative results, and overall survival (OS) were assessed. RESULTS Seventy-four patients were included, from 1992 to 2015. Eighty-nine percent of patients (n = 64) were treated with gemcitabine and 57% with gemcitabine/platinum (n = 42). At initial response assessment, 17 patients (23%) had progression. The remaining patients had stable disease (n = 38, 51%) or partial response (n = 19, 26%). Twenty-two patients (30%) underwent attempt at resection, which was definitive for 10 patients (14%). Median OS for the entire cohort was 14 months (95% CI 11.3 to 17.9). Among patients with surgery, definitive resection was associated with a median OS of 51 months (95% CI 11.7 to 55.3) compared with 11 months (95% CI 4.1 to 23.6) for those with unresectable disease (p = 0.003). CONCLUSIONS Even without distant metastases, locally advanced or lymph node-positive GBCA is associated with poor outcomes. Definitive resection was possible in a subset of patients selected for surgery after a favorable response to chemotherapy and was associated with long-term survival. We recommend surgical re-evaluation after chemotherapy to select potential operative candidates.
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Affiliation(s)
- John M Creasy
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Debra A Goldman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vikas Dudeja
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maeve A Lowery
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Peter J Allen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ronald P DeMatteo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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Abstract
In this review, the authors present an updated description of gallbladder cancer in 2 sections based on presentation: disease that presents incidentally following laparoscopic cholecystectomy and malignancy that is suspected preoperatively. Elements pertaining to technical aspects of surgical resection provide the critical focus of this review and are discussed in the context of evidence-based literature on gallbladder cancer today.
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Affiliation(s)
- Motaz Qadan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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Tsirlis T, Ausania F, White SA, French JJ, Jaques BC, Charnley RM, Manas DM. Implications of the index cholecystectomy and timing of referral for radical resection of advanced incidental gallbladder cancer. Ann R Coll Surg Engl 2015; 97:131-6. [PMID: 25723690 PMCID: PMC4473390 DOI: 10.1308/003588414x14055925060073] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Advanced (pT2/T3) incidental gallbladder cancer is often deemed unresectable after restaging. This study assesses the impact of the primary operation, tumour characteristics and timing of management on re-resection. METHODS The records of 60 consecutive referrals for incidental gallbladder cancer in a single tertiary centre from 2003 to 2011 were reviewed retrospectively. Decision on re-resection of incidental gallbladder cancer was based on delayed interval restaging at three months following cholecystectomy. Demographics, index cholecystectomy data, primary pathology, CA19-9 tumour marker levels at referral and time from cholecystectomy to referral as well as from referral to restaging were analysed. RESULTS Thirty-seven patients with pT2 and twelve patients with pT3 incidental gallbladder cancer were candidates for radical re-resection. Following interval restaging, 24 patients (49%) underwent radical resection and 25 (51%) were deemed inoperable. The inoperable group had significantly more patients with positive resection margins at cholecystectomy (p=0.002), significantly higher median CA19-9 levels at referral (p=0.018) and were referred significantly earlier (p=0.004) than the patients who had resectable tumours. On multivariate analysis, urgent referral (p=0.036) and incomplete cholecystectomy (p=0.048) were associated significantly with inoperable disease following restaging. CONCLUSIONS In patients with incidental, potentially resectable, pT2/T3 gallbladder cancer, inappropriate index cholecystectomy may have a significant impact on tumour dissemination. Early referral of breached tumours is not associated with resectability.
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Affiliation(s)
- T Tsirlis
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - F Ausania
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - SA White
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - JJ French
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - BC Jaques
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - RM Charnley
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
| | - DM Manas
- Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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