789 Surgery for Gallbladder Cancer in the US: Greater Need for Radical Cholecystectomy and Maximal Lymph Node Clearance

Tran, Thuy B.; Menon, Vijay G.; Nissen, Nicholas N.

doi:10.1016/s0016-5085(13)63959-1

Cited by 15 publications

(26 citation statements)

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“…In addition, it cannot be excludedinherently among all studies that assessed LNE among early stage GBC -that only patients with suspected LNs underwent a dedicated LNE in T1a GBC, which might bias the results towards overestimating LN positivity compared to other studies. 19,20,34,36,37,40,42,43 Despite the guideline recommendation to perform a LNE for T1b and T2 tumors, in this patient cohort, 58% and 48% of the patients did not undergo a LNE, respectively. This is consistent with previous findings showing that patients are significantly less likely to undergo an extended cholecystectomy (EC) compared to SC for T2 and T3 disease.…”

Section: Discussionmentioning

confidence: 84%

“…40,42 A recent retrospective analysis of 8436 patients diagnosed with GBC and SC or radical resection showed that the extent of LNE is an independent predictor of survival in patients with GBC for T1-T4 tumor stage. 43 However, there was no difference in OS between patients with T1a and T1b tumors, and overall, patients with T1 tumors in general have similar survival rates regardless of whether 1-3 or 4 or greater LNs were examined. A recent large-scale nationwide multicenter survey of South Korea did not confirm any benefit for LNE even in T1b tumors, asking for additional comparative data before final recommendations can be made.…”

Section: Discussionmentioning

confidence: 87%

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High rate of positive lymph nodes in T1a gallbladder cancer does not translate to decreased survival: a population-based, propensity score adjusted analysis

Köhn

Maubach

Warschkow

et al. 2018

HPB

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 87%

High rate of positive lymph nodes in T1a gallbladder cancer does not translate to decreased survival: a population-based, propensity score adjusted analysis

Köhn

Maubach

Warschkow

et al. 2018

HPB

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“…In the present study, about 43.0% of the cases were diagnosed as incidental cases of gallbladder carcinoma, with the primary clinical diagnosis in over 40.0% being biliary colic followed by acute cholecystitis. Fortunately, the introduction of laparoscopic surgeries has improved the frequency of performing surgical removal of the gallbladder and increasing the rate of diagnosis for GBC [ [17] , [18] , [19] , [20] ].…”

Section: Discussionmentioning

confidence: 99%

Gallbladder cancer in Eastern Province of Saudi Arabia: A retrospective cohort study

Aldossary

Alayed

Amr

et al. 2018

Annals of Medicine and Surgery

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BackgroundThere is paucity in the literature regarding gallbladder cancer in Saudi Arabia, possibly because it is not among the top 10 cancers diagnosed nationwide according to the Saudi Cancer Registry. Moreover, national or regional data on gallbladder cancer in Saudi Arabia have not been analyzed. The purpose of this study was to describe the presentation, disease stage, histology, and survival rates for gallbladder cancer in Saudi patients at a single institution between January 1, 2010 and December 31, 2017.Materials and methodsThis was a retrospective study of 76 patients who presented to our hospital between January 1, 2010 and December 31, 2017, with established diagnosis of gallbladder carcinoma. The diagnosis was made either histopathologically following simple laparoscopic cholecystectomy or biopsy from metastatic liver lesion in patients with gallbladder mass, or the high suspicion of gallbladder carcinoma based on incidental radiological findings. Presentation, disease stage, histology, and treatment modalities were analyzed using descriptive statistics and frequency distributions. Survival rates were analyzed and presented using Kaplan-Meier curves.ResultsBased on initial analyses the disease was more frequent among women (62.0%) than men (39.0%). Surgical resection was attempted in 40.8% patients. The average age at presentation and diagnosis of gallbladder carcinoma was 62.4 years. The disease had two peaks, one at 51.0 years and the other between 66.0 and 70.0 years. The median survival time for the overall at-risk patients was only 1.0 year, while for stage IVB patients was 7.2 months. Adenocarcinoma not otherwise specified (NOS) was the most common histopathology type (75.0%), with most patients presenting with stage IVB disease (75.0%). Gallbladder carcinoma was incidentally detected in 42.1%, including three cases (3.9%) diagnosed at our hospital.ConclusionsGallbladder cancer is a rare type of cancer in Saudi Arabia, and most patients are treated surgically, despite being mostly diagnosed at the advanced stage of the disease.

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“…Although surgery remains the best chance for cure, 5‐year overall survival (OS) of patients with GBC is less than 35% among all patients even after surgical resection . Due to the tendency of GBC to metastasize to the lymphatics, routine lymphadenectomy has been advocated as part of the oncological resection for GBC . Adequate sampling of the lymph nodes (LNs) is crucial to stage the disease appropriately, as well as assist in determining the adjuvant therapeutic strategy.…”

Section: Introductionmentioning

confidence: 99%

“…2,4 Due to the tendency of GBC to metastasize to the lymphatics, routine lymphadenectomy has been advocated as part of the oncological resection for GBC. 5 Adequate sampling of the lymph nodes (LNs) is crucial to stage the disease appropriately, as well as assist in determining the adjuvant therapeutic strategy. The required extent of LN clearance is, however, still debated.…”

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confidence: 99%

The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients

Tsilimigras

Hyer

Paredes

et al. 2019

Journal of Surgical Oncology

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Background The aim of the current study was to identify the minimum number and the optimal range of lymph nodes (LNs) to be examined among patients with gallbladder cancer (GBC). Methods Between January 1, 2004, and December 31, 2015, patients with a diagnosis of GBC were identified in the National Cancer Database. A machine‐based learning approach was used to identify the minimum number and range of LNs to evaluate relative to long‐term outcomes. Results Among 6531 patients with GBC, median number of LNs evaluated was 2 (IQR:1‐5); only 21.1% (n = 1376) of patients had 6 or more LNs evaluated. The median number of metastatic LNs was 0 (IQR: 0‐1). On multivariable analysis, evaluation of < 4 LNs was associated with a higher hazard of death (referent 4‐7 LNs: < 4 LNs, HR = 1.27, 95% CI, 1.16‐1.40; P < 0.001), whereas, patients who had 4 to 7 LNs and > 7 LNs evaluated had comparable long‐term mortality risk (HR = 1.10, 95%CI, 0.98‐1.24; P = 0.11). There was no difference in the proportion of patients who had at least one metastatic LN identified per T category based on total number of nodes resected (all P > 0.05). Conclusion The overwhelming majority of patients did not have the American Joint Committee on Cancer (AJCC) recommended 6 total LN count . A machine‐based learning approach identified evaluation of 4 to 7 LNs as the LN number associated with optimal staging and survival. While obtaining 6 LNs may be challenging, evaluation of at least 4 LNs may be a more appropriate threshold as this cut‐off value was associated with optimal patient outcomes and staging.

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789 Surgery for Gallbladder Cancer in the US: Greater Need for Radical Cholecystectomy and Maximal Lymph Node Clearance

Cited by 15 publications

References 0 publications

High rate of positive lymph nodes in T1a gallbladder cancer does not translate to decreased survival: a population-based, propensity score adjusted analysis

High rate of positive lymph nodes in T1a gallbladder cancer does not translate to decreased survival: a population-based, propensity score adjusted analysis

Gallbladder cancer in Eastern Province of Saudi Arabia: A retrospective cohort study

The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients

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