Role of common bile duct resection in T2 and T3 gallbladder cancer patients

Abstract

Backgrounds/AimsRoutine bile duct resection as part of the typical oncological resection for patients with advanced gallbladder cancer remains controversial with regard to, ultimately, curative value. The aim of this study was to compare oncological outcomes for patients undergoing surgery for gallbladder cancer with or without bile duct resection.MethodsWe recruited, for the purpose of this study, all patients who underwent surgical resection for T2 and T3 gallbladder cancer at Severance hospital, Seoul, Korea, during the period January 2000 and December of 2011. The patient data was reviewed retrospectively.ResultsThe patients (n=149) recruited to participate in the study were divided into two groups according to their bile duct resection status: The bile duct resection group (BDR group, n=54); and, the bile duct non-resection group (BDNR group, n=95). Significant difference was found in lymph node retrieval between BDR and BDNR groups (15 vs. 5, respectively with p<0.001). There was no significant difference between the two groups with regard to the five year survival rate (43% in BDR group vs. 57% in BDNR group, p=0.339). Following multivariate analysis, lymph node metastasis, advanced T-stage, and total retrieved lymph nodes <6 were independent prognostic factors for poor survival in patients with T2 and T3 gallbladder cancer.ConclusionsThe findings revealed by the current study suggest that the role of bile duct resection might be limited to improved staging, and offers no advantage in long-term survival. However, in view of the foregoing and given the minimal increase in morbidity associated with BDR, it should be actively considered as a treatment option for patients who present with findings suspicious for invasion around hepatoduodenal ligament.

Systematic review of management of incidental gallbladder cancer after cholecystectomy

“…In patients without involvement of the CBD (for instance, based on cystic duct evaluation), there was no benefit for extrahepatic bile duct resection over ‘radical cholecystectomy’ in terms of overall survival, lymph node yield and recurrence rate, but associated morbidity was higher when the CBD was resected. Recent studies further showed no improvement in lymph node retrieval with resection of the CBD, and overall survival was worse. When adjusting for disease stage, survival was similar in patients undergoing CBD resection and those having no resection, suggesting that it is disease stage that drives the biology and thus the outcome, rather than extent of surgery.…”

Survival benefit of lymphadenectomy for gallbladder cancer based on the therapeutic index: An analysis of the US extrahepatic biliary malignancy consortium

“…As such, the aim of this study was to evaluate the survival benefit of LND among patients with GBC based on the therapeutic index. Additionally, we sought to identify whether common bile duct (CBD) resection, which has been suggested as a means to achieve a more thorough LND, 14 provided any additional survival benefit in terms of the nodal therapeutic index.…”

Effects of Cystic Duct Margin Involvement on the Survival Rates of Patients With Gallbladder Cancer: A Propensity Score-Matched Case-Control Study

“…As reported in the literature, patients who required additional bile duct resection had significantly higher blood loss, longer duration of surgery and postoperative hospital stay, and increased risk of postoperative morbidity [ 19 , 20 ]. In the present study, positive CDM requiring EHBD resection had significantly higher intraoperative blood loss (375 vs. 200 ml, p=0.026) and longer hospital stay (11.5 vs. five days, p=0.002), while postoperative morbidity was comparable (p=0.722).…”