Outcomes of surgical resection of gallbladder cancer in patients presenting with jaundice: A systematic review and meta‐analysis

Dasari, B.; Ionescu, M; Pawlik, Timothy M.; Hodson, James; Sutcliffe, Robert P.; Roberts, Keith; Muiesan, Paolo; Isaac, John; Marudanayagam, R.; Mirza, Darius F.

doi:10.1002/jso.25186

Cited by 37 publications

(30 citation statements)

References 40 publications

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“…Our results show that except for a shortterm survivor, all the patients were jaundiced at presentation, a factor known to have a negative influence on survival. 29 Additionally, all the short-term survivors had a pT3 or pT4 stage tumor, and the majority had positive lymph nodes. In contrast, few long-term survivors had a high T stage and positive lymph nodes.…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2020

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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.

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Section: Discussionmentioning

confidence: 97%

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

et al. 2020

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“…In GBC patients, the presence of associated symptoms is considered a relative contraindication to radical resection as these patients have a poor prognosis and high postoperative morbidity[ 1 - 3 , 9 ]. Of our eight symptomatic patients (Table 1 ), all were categorized as stage ≥ IIB, and seven (87.5%) showed poor outcomes (Table 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…Of our eight symptomatic patients (Table 1 ), all were categorized as stage ≥ IIB, and seven (87.5%) showed poor outcomes (Table 4 ). Although jaundiced patients with advanced GBC should be considered as candidates for surgical resection, careful evaluation is important before undertaking aggressive surgery in this population[ 2 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although GBC generally carries a poor prognosis[ 1 - 4 , 7 - 15 ], complete surgical resection is associated with improved outcomes in GBC patients[ 1 , 2 , 11 , 14 , 16 - 23 ]. Some surgeons have suggested that aggressive surgeries [ e.g ., resection of the extrahepatic bile duct (EHBD), extended hepatectomy and intentional lymph node dissection (lymphadenectomy) of the para-aortic lymph nodes (LNs)] may improve long-term survival in patients with advanced GBC[ 1 , 2 , 9 , 11 , 13 , 14 , 16 , 18 - 25 ]. Metastatic LNs, invasion into the peribiliary nerve plexuses and positive surgical margins of the biliary tract are important prognostic factors[ 1 , 7 , 11 , 15 , 18 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Surgical treatment of gallbladder cancer: An eight-year experience in a single center

Kamada

Hori

Yamamoto

et al. 2020

WJH

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BACKGROUND Gallbladder cancer (GBC) is the most common biliary malignancy and has the worst prognosis, but aggressive surgeries [ e.g ., resection of the extrahepatic bile duct (EHBD), major hepatectomy and lymph node (LN) dissection] may improve long-term survival. GBC may be suspected preoperatively, identified intraoperatively, or discovered incidentally on histopathology. AIM To present our data together with a discussion of the therapeutic strategies for GBC. METHODS We retrospectively investigated nineteen GBC patients who underwent surgical treatment. RESULTS Nearly all symptomatic patients had poor outcomes, while suspicious or incidental GBCs at early stages showed excellent outcomes without the need for two-stage surgery. Lymph nodes around the cystic duct were reliable sentinel nodes in suspicious/incidental GBCs. Intentional LN dissection and EHBD resection prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic LNs or invasion of the nerve plexus. All patients with positive surgical margins ( e.g ., the biliary cut surface) showed poor outcomes. Hepatectomies were performed in sixteen patients, nearly all of which were minor hepatectomies. Metastases were observed in the left-sided liver but not in the caudate lobe. We may need to reconsider the indications for major hepatectomy, minimizing its use except when it is required to accomplish negative bile duct margins. Only a few patients received neoadjuvant or adjuvant chemoradiation. There were significant differences in overall and disease-free survival between patients with stages ≤ IIB and ≥ IIIA disease. The median overall survival and disease-free survival were 1.66 and 0.79 years, respectively. CONCLUSION Outcomes for GBC patients remain unacceptable, and improved therapeutic strategies, including neoadjuvant chemotherapy, optimal surgery and adjuvant chemotherapy, should be considered for patients with advanced GBCs.

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“…The impact of jaundice on the prognosis of patients with GBC is keeping controversial. Some researchers considered that jaundice is a predicting sign of unresectable carcinoma, and palliative treatment should be recommended for these people instead of radical surgery [30] . However, some researchers believed that although preoperative jaundice has an impact on the prognosis of patients with GBC, it is not a major risk factor affecting prognosis, and the degree of bile duct invasion should also be considered as one of the considerations [17,31] .…”

Section: Discussionmentioning

confidence: 99%

Impacts Of Tumor Location On Prognosis Of Patients With Gallbladder Carcinoma

Zhu

Luo²,

Zhu

et al. 2020

Preprint

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Objective: To investigate the impacts of tumor location on the prognosis of patients with T1-3N0-1M0 gallbladder carcinoma(GBC) after radical surgery.Methods: Totally, 136 patients with stage T1-3 gallbladder carcinoma after radical surgery from 2000 to 2018 were enrolled and divided into two groups according to anatomic location of GBC (neck /body and fundus). The clinicopathological features and survival time were compared between these two groups. At last, in combination with the difference between the liver side and the peritoneal side of the tumor, survival analysis and multivariable Cox-proportional hazards regression models were performed in GBC patients with survival differences between gallbladder neck and body/fundus tumors.Results: The bile duct invasion, lymph node metastasis, tumor growth pattern, jaundice, albumin, and tumor markers were significantly related to the tumors in neck of gallbladder(P<0.05). Besides, patients with GBC in body and fundus of gallbladder had a higher rate of appearing microscopic liver metastasis(P<0.05). Survival analysis showed that there was significant difference on patients with stage T2 GBC in different tumor location (neck /body and fundus), but no significant difference on stage T1 and T3. Further combining the differences between the liver side and the peritoneal side of the tumor, tumor location, lymph node metastasis, bile duct invasion, microscopic liver metastasis, tumor differentiation, and jaundice were deemed as prognostic factors according to univariable survival analysis. Among these factors, multivariable Cox analysis showed that lymph node metastasis and tumor location were independent prognostic factors for survival of patients with T2 GBC (P <0.05).Conclusions: Tumor location is an important prognostic factor for GBC, especially for the patients with T2 stage. Besides the survival differences between the hepatic-side and peritoneal-side tumors, tumor in neck is also one of the factors predicting the poor prognosis at T2 stage. GBC in neck was more prone to cause bile duct invasion, lymph node metastasis and jaundice. However, tumors in body and fundus were more likely to appear microscopic liver metastasis. Further refinement of the surgery for T2 GBC according to the tumor location may improve their survival time.

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Outcomes of surgical resection of gallbladder cancer in patients presenting with jaundice: A systematic review and meta‐analysis

Cited by 37 publications

References 40 publications

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

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

Surgical treatment of gallbladder cancer: An eight-year experience in a single center

Impacts Of Tumor Location On Prognosis Of Patients With Gallbladder Carcinoma

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