The significance of anatomic tumor location in gallbladder cancer

Abstract

Background and Objectives Current management guidelines recognize the impact of hepatic versus peritoneal sided gallbladder cancers (GBC) on survival. However, no data exist regarding the significance of anatomic tumor location within the gallbladder. Methods We retrospectively analyzed all GBC that underwent surgical resection with curative intent in our health system from 2007 to 2017. We evaluated the effect of anatomic pathologic tumor location (fundus/body, neck, and multifocal) on clinicopathologic, perioperative, and oncologic outcomes. Results About 97 patients met criteria; 63% fundus/body, 22% multifocal, and 15% neck. Compared with fundus/body, neck tumors more frequently presented with preoperative jaundice (53% vs. 13%, p < .001), were smaller (20 mm vs. 30 mm, p = .068) and had significantly more biliary tree invasion (33% vs. 13%, p = .030) on histopathology. Although tumor characteristics (pTNM stage, liver invasion, lymphovascular invasion, prognostic nutritional index, and grade) were similar, neck tumors had significantly higher rates of R0 resection (53% vs. 11%, p < .001). Rates of adjuvant therapy were similar. Median PFS was similar between cohorts (p = .356). However, median overall survival (OS) was significantly shorter in neck (21 months) than fundus/body tumors (NR > 109 months), p = .015. Conclusions Neck tumors were rare, small and more likely to result in jaundice secondary to biliary tree invasion. Despite higher R0 resection rates, these tumors had significantly worse OS.

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

“…According to the literature, the tumor location in GBC can significantly influence the outcome [ 14 , 21 , 22 ]. T2 tumors involving the hepatic side of the GB (T2b) are more aggressive and have a worse prognosis than T2 tumors involving the peritoneal side (T2a) [ 21 ].…”

“…T2 tumors involving the hepatic side of the GB (T2b) are more aggressive and have a worse prognosis than T2 tumors involving the peritoneal side (T2a) [ 21 ]. Similarly, Leigh et al [ 14 ] performed a retrospective study to determine the significance of the anatomical location of tumors in GBC for the outcome. They reported that compared to fundus/body tumors, neck tumors have a higher rate of preoperative jaundice, significantly more EHBD resection and bile duct involvement in HPE, a higher rate of PNI, a comparable TNM stage distribution, a significantly shorter OS, and thus significantly worse prognosis.…”

“…The second group included patients with tumors not involving the neck (e.g., tumor in the fundus, tumor in the body, and tumor in the fundus and the body). Histologically, the neck was defined as the area adjacent to the cystic duct having tubulo-alveolar mucus glands [ 14 ]. The fundus/body region was defined as the region distal to the neck where mucus glands are absent [ 14 ].…”

“…Histologically, the neck was defined as the area adjacent to the cystic duct having tubulo-alveolar mucus glands [ 14 ]. The fundus/body region was defined as the region distal to the neck where mucus glands are absent [ 14 ].…”

New trends in diagnosis and management of gallbladder carcinoma

“…The importance of GB carcinoma location has been evaluated. Proximal tumors (neck and cystic duct) are less common, more frequently associated with obstructive jaundice, and had more aggressiveness with worse prognosis compared to distal tumors (body and fundus)[ 103 ]. Cystic duct location was an independent prognostic risk factor that did not have any survival benefit by common bile duct resection.…”