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

Abstract

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.

Clinicopathological prognostic factors for gallbladder carcinoma: a retrospective study

“…Surgical resection is the only effective treatment and the benefit of systemic adjuvant therapy following resection remains uncertain (6,7). Some data suggest a survival benefit for adjuvant chemoradiation therapy in locally advanced disease (T2b, T3 and T4) (8).…”

Update on Surgical Management of Gallbladder Cancer

“…Most GBC patients are female and the median survival for stage IV cancer is 4-6 months [5][6][7] . The overall 5-year survival rate is less than 5%, and until the latest guidelines update, complete surgical resection was the main curative treatment for early stage gallbladder cancer, which can significantly prolong survival outcomes [8][9][10][11][12][13] .…”

TRIM37 promotes gallbladder cancer proliferation by activating the Wnt/β-catenin pathway via ubiquitination of Axin1

“…For the treatment of GBC, surgical resection remains the most effective method at the moment. However, the lack of a specific early diagnostic method results in the majority of GBC patients being diagnosed at an advanced stage of the disease when patients lost the opportunity to receive radical resection [ 2 , 3 ]. In addition, GBC is often resistant to adjuvant treatments (chemotherapy and radiotherapy) [4] .…”