Surgical Treatment of Advanced Gallbladder Cancer

Abstract

For advanced gallbladder patients with N2 stage lymph node metastasis, ERLN cannot provide a significant survival benefit over SRLN and the rate of morbidity and mortality in ERLN is exceptionally high. ERLN therefore should not be considered in the advanced gallbladder cancers with N2 stage.

Extended cholecystectomy in gallbladder cancer: survival and surgical results in two time periods

“…However, its role in the subsequent resectability and prognosis of patients with GBC is unknown. 10,11 Traditionally, 5-year survival of patients with GBC is approximately 10%. 1 These outcomes occur because the diagnosis is made at very advanced stages of the disease.…”

“…9,13 The number of resected lymph nodes in this study (5.5 in average) was similar to that described in the literature. The range was variable (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), which was to be expected due to anatomical variations in the hepatic pedicle that make the dissection more complex.…”

“…9,[12][13][14] Regarding hospital stay, it has been described that patients who undergo a laparoscopic EC have a shorter hospital stay and less postoperative pain than those who undergo open surgery, advantages associated with the laparoscopic surgery itself. 11,15,16 In terms of the possible role of the EC in patients in early stages of the disease (T1a tumors), in patients with Rokitansky-Aschoff (RA) sinus involvement, there is no categorical consensus as to whether or not they benefit from the EC. 11,15 An exhaustive review of the intraoperative specimen in pathology is important to determine the depth of invasion of these RA sinuses.…”

Technical Aspects of Gallbladder Cancer Surgery

“…More extensive nodal involvement that extends outside the hepatoduodenal ligament (N2) is considered unresectable, given the major post-operative morbidity and mortality associated with resection without any significant survival benefit. 47 Additional celiac and para-aortic lymph node metastases are considered M1 disease, and surgical resection is contraindicated. The highest peri-pancreatic lymph node marks the transition between the N1 and N2 fields, and has been found to be prognostic of disease-specific and recurrence-free survival in biliary tract adenocarcinoma in a retrospective study performed at our institution.…”

The role of microRNAs in gallbladder cancer

“…Despite advances in the treatment of GBC in recent years, the majority of patients eventually develop local recurrent or distant metastatic disease, which is associated with a poor prognosis and an overall 5-year survival rate of <10% (4)(5)(6)(7). Early diagnosis, which is crucial for long-term survival of GBC patients, unfortunately occurs only accidentally in patients undergoing cholecystectomy for gallstones or cholecystitis, while the majority of the patients present with advanced metastatic disease due to the absence of specific symptoms and efficient biomarkers (8)(9)(10)(11)(12). Additionally, coadjuvant therapy consisting of chemotherapy and̸or radiotherapy has not yet proved beneficial in terms of patient survival (13)(14)(15)(16).…”