Towards standardization of management of gallbladder carcinoma with obstructive jaundice: Analysis of 113 cases over 10 years at a single institution

Abstract

Background Presence of jaundice in gallbladder carcinoma (GBC) is considered a sign of inoperability with no defined treatment pathways. Methods Retrospective analysis of all surgically treated GBC patients from January 2010 to December 2019 was performed for evaluating etiology of obstructive jaundice, resectability, postoperative morbidity, mortality, disease‐free survival (DFS) and overall survival (OS). Results Out of 954 patients, 521 patients (54.61%) were locally advanced gallbladder carcinoma (LAGBC: Stage III and IV) and 113 patients (11.84%) had jaundice at presentation. Thirty‐four (30%) patients had benign cause of obstructive jaundice. Median OS of the whole cohort (n=113) was 22 months (16.5–27.49 months) with resectability rate of 62% (70/113). Median OS of curative resection group (n=70) was 32 months and DFS was 25 months. Treatment completion was achieved in 30% (n= 21/70) patients with median OS of 46 months and median DFS of 27 months. Isolated bile duct infiltration subgroup fared the best with median OS of 74 months with a 5‐year survival of 66.7%. Conclusion Surgical resection as a part of multimodality treatment improves survival in carefully selected locally advanced gallbladder cancer patients with jaundice. Early introduction of systemic therapy is the key in the management of this disease with aggressive tumor biology.

Gallbladder Cancer With Jaundice: Surgery Versus No Surgery

“…The recurrence rate of GBC jaundice patients is usually high, as seen in the study by Goel et al of 53% [17].…”

“…Another study by Goel et al reported a resectability rate of 62% using neoadjuvant chemotherapy. Moreover, 44% of these patients had benign etiology as the cause of obstructive jaundice [ 17 ]. The resectability rate in our study was around 41.5%, even in advanced cases and without the use of neoadjuvant chemotherapy in most cases.…”

“…The perioperative mortality rate was 17.6% in our study, and all these patients underwent major liver resections and hepatopancreaticoduodenectomy. Goel et al reported a mortality rate of only 4.2% with the use of neoadjuvant chemotherapy in 50% of their patients [ 17 ]. However, no major liver resections were performed in their study, probably due to downstaging after neoadjuvant chemotherapy.…”

“…The recurrence rate of GBC jaundice patients is usually high, as seen in the study by Goel et al of 53% [ 17 ]. The recurrence rate in our study was around 56%, and most of them had hilar recurrence, followed by liver lesions.…”

“…While those who did not receive adjuvant chemotherapy had a significantly lower median overall survival of 16 months in the resected group and three months in the unresected group. In the study by Goel et al [ 17 ], median overall survival of 32 months was seen using both neoadjuvant and adjuvant chemotherapy though many patients had benign etiology for jaundice.…”