Surgical Approaches to Advanced Gallbladder Cancer

Higuchi, Ryota; Ota, Terukazu; Araida, Tatsuo; Kajiyama, Hideki; Yazawa, Takehisa; Furukawa, Toru; Yoshikawa, Takahiro; Takasaki, Ken; Yamamoto, Masakazu

doi:10.1245/s10434-014-3885-1

Cited by 50 publications

(15 citation statements)

References 40 publications

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“…In this study, we analyzed the impact of CBD resection in T3 patients and found that patients with and without CBD resection had similar OS. CBD resection did not yield a higher lymph node count and was not associated with an improved survival [10]. This result was also confirmed by Gani in a study involving 449 GBC patients [50].…”

Section: Discussionmentioning

confidence: 67%

“…Curative resection may be the only available method to cure patients presenting with GBC [18]. It has been widely considered a critical factor influencing the prognosis of GBC in many reports [10,19–22]. Curative resection should be performed according to TNM staging.…”

Section: Discussionmentioning

confidence: 99%

“…However, factors influencing the prognosis of patients with GBC include liver involvement [10], lymphatic metastases [11] and jaundice [12] are still in dispute. Some surgical techniques like the range of liver resection and CBD resection are also inconclusive, and the efficacy of aggressive surgical resection for T4 GBC has not been accepted generally [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcomes and Prognostic Factors in Advanced Gallbladder Cancer: Focus on the Advanced T Stage

et al. 2016

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BackgroundRadical resection is an effective therapeutic method to increase the survival rate of patients with gallbladder cancer (GBC). In addition to the surgical approach, the relationships between various clinicopathologic factors and the outcome of patients with GBC remain controversial.MethodsClinical and laboratory examination characteristics, pathological and surgical data, and post-operative survival time of 338 patients with advanced GBC who received treatment at the First Affiliated Hospital of Xi'an Jiaotong University, China from January 2008 to December 2012 were analyzed retrospectively. Factors influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analysis.ResultsThe overall survival rates for curative resection patients were significantly greater than those for non-curative resection patients (1-,3-,5-year survival rate and mean-survival time: 59.0%, 47.3%, 44.3% and 22.0 months vs. 12.7%, 8.3%, 7.7% and 3.0 months) (P < 0.001). For the curative resection patients, positive margin, lymph node metastasis, poorly pathological differentiation and the presence of ascites were all independent risk factors for poor prognosis. For patients with T3 stage, neither segmentectomy of IVb and V nor common bile duct resection improved the prognosis (P = 0.867 and P = 0.948). For patients with T4 stage, aggressive curative resection improved the prognosis (P = 0.007).ConclusionsAn advanced T stage does not preclude curative resection. Positive margin, lymph node metastasis, poorly pathological differentiation and the presence of ascites are all independent risk factors for poor prognosis in the curative intent resection patients. The range of liver resection and whether common bile duct resection is performed do not influence the prognosis as long as R0 resection is achieved.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long-Term Outcomes and Prognostic Factors in Advanced Gallbladder Cancer: Focus on the Advanced T Stage

et al. 2016

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“…Regional lymph node dissection is indispensable and invaluable for the accurate staging of gallbladder cancer. 3 4 The extent of resection in gallbladder cancer is usually determined by the pre- and intraoperative assessment of the nature and extent of the tumor invasion. According to the National Comprehensive Cancer Network (NCCN) guidelines, 5 simple cholecystectomy is considered appropriate to treat T1a gallbladder cancer.…”

Section: Introductionmentioning

confidence: 99%

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

Lim

Chong

Kim

et al. 2018

Ann Hepatobiliary Pancreat Surg

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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.

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“…Radical resection is currently the main treatment option for GBCs[ 4 , 5 ]. Unfortunately, due to the nonspecific symptoms and highly invasive character of GBC, only a minority of patients are candidates for curative resection at the time of diagnosis[ 4 , 6 ]. In current, the commonly used TNM staging system is inadequate to predict accurate clinical outcomes of GBCs.…”

Section: Introductionmentioning

confidence: 99%

Stathmin 1 expression predicts prognosis and benefits from adjuvant chemotherapy in patients with gallbladder carcinoma

Wang

et al. 2017

Oncotarget

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BackgroundAbnormal expression of Stathmin 1(STMN1) plays an important role in the proliferation and migration of gallbladder carcinoma (GBC). The purpose of current study is to investigate the prognostic significance of STMN1 in GBC patients after surgery.MethodsSTMN1 expression was evaluated with immunohistochemistry (IHC) on tissue microarrays from 70 GBC patients from a single institution between 2009 and 2013. The correlation between STMN1 expression and clinicopathological profiles and the prognosis was statistically inspected.ResultsHigh expression of STMN1 in tumoral tissue was associated with poor tumor differentiation (P<0.001), lymph node metastasis (P=0.028), advanced TNM stage (P=0.011) and short overall survival (P<0.001). Cox multivariate analysis identified the STMN1 expression as an independent prognostic factor. Integrating STMN1 expression with current TNM staging system generate a better clinical predictive model for GBC. Moreover, the postoperative adjuvant chemotherapy (ACT) showed significant benefit in TNM III- IV stage patients with low STMN1 expression.ConclusionSTMN1 might be an independent adverse prognostic factor in GBC patients after surgery, which could be combined with TNM staging system to improve the predictive accuracy for overall survival. Low expression of STMN1 stratified a subgroup of advanced GBC patients who could benefit from ACT.

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Surgical Approaches to Advanced Gallbladder Cancer

Abstract: Surgery may not be indicated for patients with multiple liver metastasis, dissemination, Binf3, or visible para-aortic LN metastasis. Furthermore, it is important to achieve R0 surgery in cases of GBC.

Cited by 50 publications

References 40 publications

Long-Term Outcomes and Prognostic Factors in Advanced Gallbladder Cancer: Focus on the Advanced T Stage

Long-Term Outcomes and Prognostic Factors in Advanced Gallbladder Cancer: Focus on the Advanced T Stage

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

Stathmin 1 expression predicts prognosis and benefits from adjuvant chemotherapy in patients with gallbladder carcinoma

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