To Resect or Not to Resect Extrahepatic Bile Duct in Gallbladder Cancer?

Abstract

The indications for and limitations of extrahepatic bile duct resection (EHBDR) in the context of gallbladder (GB) cancer are unclear. The purpose of this review was to examine the current literature to determine the impact of EHBDR on loco-regional recurrence and survival in GB cancer. The EMBASE and Medline databases were searched up to February 2016 using the terms: extrahepatic bile duct resection and gallbladder cancer. Studies published in the last 20 years were eligible for inclusion. Given the heterogeneity of the population and the study methodologies employed, qualitative data synthesis in the form of meta-analysis was deemed implausible. Twenty-four studies fulfilled the inclusion criteria. The selected studies include 6,722 (55%) EHBDRs in a total of 12,251 GB cancer operations. The 25 studies were categorized into seven groups: 1) cancer survival all stages; 2) hepatoduodenal ligament invasion; 3) outcome in EHBDR and EHBDNR; 4) pT1b tumors; 5) pT2 tumors; 6) pT3/T4 tumors; and 7) incidental GB cancer. Radical cholecystectomy with EHBDR should be used as a standard operation for tumors involving the neck or the cystic duct of the GB (either macroscopically or microscopically). In all other cases, operative strategy should be individualized to the patient.

Brazilian Consensus on Incidental Gallbladder Carcinoma

“…Some authors suggest bile duct resection if the cystic duct stump cannot be identified and in selected young patients with biliopancreatic maljunction. In gallbladder cancers with the presence of perineural invasion, extra-hepatic bile duct resection presents significantly better survival than those without extra-hepatic bile duct resection 12,18,27 . The main finding of this review is that extra-hepatic bile duct resection is not preventative of loco-regional recurrence but can be curative in selected cases.…”

“…Radical cholecystectomy with extra-hepatic bile duct resection is useful as a standard operation for tumors involving (macroscopically or microscopically) the neck and/or the cystic duct of the GB. In all other cases, the ability to achieve R0 resection, the presence of distant metastases, and extent of extra-hepatic bile duct resection, lymph node status and postoperative morbidity should guide the operative strategy 12,18,27 . A recent Japanese Society of Biliary Surgery survey reported that there was no benefit in overall survival in patients who underwent a routine bile duct resection.…”

“…In gallbladder cancer resection, most of recurrences are distant metastasis and not local recurrence 12,18,27 . The potential adverse effect of extra-hepatic bile duct resection is the bilioenteric anastomosis that is associated with longer operation time and postoperative hospital stay, besides more blood transfusion.…”

“…The potential adverse effect of extra-hepatic bile duct resection is the bilioenteric anastomosis that is associated with longer operation time and postoperative hospital stay, besides more blood transfusion. These factors are associated with significantly higher occurrence of postoperative complications 12,18,27 . Minimally invasive approach for gallbladder cancer involves several complex procedures, such as hepatectomy, hepatoduodenal lymphadenectomy, and bilioenteric anastomosis.…”

Gallbladder carcinoma: An analysis of the national cancer data base to examine hispanic influence

“…When comparing stage of disease at presentation, there was no statistically significant difference in percentages for Whites versus Hispanics, suggesting that stage of disease correlates better with overall survival than age of diagnosis. Previous studies have also confirmed that tumor stage is the strongest prognostic factor for survival in GBC …”