Extended Resections for Advanced Gallbladder Cancer: Results from a Nationwide Cohort Study

Abstract

Background. Extended resections (i.e., major hepatectomy and/or pancreatoduodenectomy) are rarely performed for gallbladder cancer (GBC) because outcomes remain inconclusive. Data regarding extended resections from Western centers are sparse. This Dutch, multicenter cohort study analyzed the outcomes of patients who underwent extended resections for locally advanced GBC. Methods. Patients with GBC who underwent extended resection with curative intent between January 2000 and September 2018 were identified from the Netherlands Cancer Registry. Extended resection was defined as a major hepatectomy (resection of C 3 liver segments), a pancreatoduodenectomy, or both. Treatment and survival data were obtained. Postoperative morbidity, mortality, survival, and characteristics of short-and long-term survivors were assessed. Results. The study included 33 patients. For 16 of the patients, R0 resection margins were achieved. Major postoperative complications (Clavien Dindo C 3A) occurred for 19 patients, and 4 patients experienced postoperative mortality within 90 days. Recurrence occurred for 24 patients. The median overall survival (OS) was 12.8 months (95% confidence interval, 6.5-19.0 months). A 2-year survival period was achieved for 10 patients (30%) and a 5-year survival period for 5 patients (15%). Common bile duct, liver, perineural and perivascular invasion and jaundice were associated with reduced survival. All three recurrence-free patients had R0 resection margins and no liver invasion. Conclusion. The median OS after extended resections for advanced GBC was 12.8 months in this cohort. Although postoperative morbidity and mortality were significant, long-term survival (C 2 years) was achieved in a subset of patients. Therefore, GBC requiring major surgery does not preclude long-term survival, and a subgroup of patients benefit from surgery. Gallbladder cancer (GBC) is a rare tumor. Worldwide incidence rates are fewer than 2 per 100,000, with significant geographic variation. 1,2 Nevertheless, it is the most H. Kuipers and E. A. J. de Savornin Lohman have contributed equally to this work.

Insights From the Analysis of Clinicopathological and Prognostic Factors in Patients With Gallbladder Cancer

“…D’Souza insisted that although HPD was associated with perioperative mortality and morbidity, it can still offer a survival benefit in patients with GBC ( 13 ). Kuipers had reached the similar conclusion ( 14 ). However, some experts took a more cautious attitude.…”

The clinical outcomes of extended resections in patients with IV stage gallbladder cancers: A retrospective study from a large tertiary center

“…Searching the prognosis data about the advanced GBC patients who did not receive surgical resections, a Netherland population-based study that the 1-year survival rate for patients with advanced unresected GBC is less than 10% ( 20 ). The median OS of all patients who had unresected GBC treated with palliative chemotherapy was 6.4 months ( 14 ). Moreover, in a large scale randomized controlled ABC-02 trial (gemcitabine + cisplatin vs gemcitabine alone for unresected biliary tract cancer), no patient survived beyond 3 years ( 21 ).…”

“…First, the baseline characteristics, including age, sex, body mass index (BMI), initial symptoms, hospital stay days, and surgical methods. Major hepatectomy (resection of three or more segments of the liver), PD, or both, with or without en bloc resection of the duodenum, colon, or stomach, were the surgical methods used in our study ( 14 ). Enlarged lymph node dissection and biliary anastomosis were performed in each case.…”

Preoperative Assessment and Perioperative Management of Resectable Gallbladder Cancer in the Era of Precision Medicine and Novel Technologies: State of the Art and Future Perspectives

“…Results from a retrospective analysis on the risk factors for incidental GBC include chole- Finally, an interesting recent article showed acceptable results from extended resection for more advanced diseases (where extended resection was defined as a major hepatectomy, a pancreatoduodenectomy, or both) [47]. The median OS after extended surgery for advanced GBC was 12.8 months, but postoperative morbidity was significant (>60%) [47].…”

“…Results from a retrospective analysis on the risk factors for incidental GBC include chole- Finally, an interesting recent article showed acceptable results from extended resection for more advanced diseases (where extended resection was defined as a major hepatectomy, a pancreatoduodenectomy, or both) [47]. The median OS after extended surgery for advanced GBC was 12.8 months, but postoperative morbidity was significant (>60%) [47]. A 2-year survival was achieved for 30% of patients, and a 5-year survival period for 15%.…”