Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 27, 2020; 12(9): 641-660
Published online Sep 27, 2020. doi: 10.4254/wjh.v12.i9.641
Surgical treatment of gallbladder cancer: An eight-year experience in a single center
Yasuyuki Kamada, Tomohide Hori, Hidekazu Yamamoto, Hideki Harada, Michihiro Yamamoto, Masahiro Yamada, Takefumi Yazawa, Masaki Tani, Asahi Sato, Ryotaro Tani, Ryuhei Aoyama, Yudai Sasaki, Masazumi Zaima
Yasuyuki Kamada, Tomohide Hori, Hidekazu Yamamoto, Hideki Harada, Michihiro Yamamoto, Masahiro Yamada, Takefumi Yazawa, Masaki Tani, Asahi Sato, Ryotaro Tani, Ryuhei Aoyama, Yudai Sasaki, Masazumi Zaima, Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
Author contributions: Kamada Y collected the data; Kamada Y and Hori T analyzed the data, reviewed the published literature and wrote the manuscript; Kamada Y and Hori T contributed equally to this work; all authors discussed therapeutic options, reviewed previous papers, and provided important opinions; Zaima M and Hori T supervised this report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Shiga General Hospital.
Informed consent statement: The patients involved in this study provided written informed consent authorizing the use and disclosure of their protected health information.
Conflict-of-interest statement: None of the authors have any financial conflicts of interest to declare.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tomohide Hori, PhD, MD, FACS, Associate Professor, Surgeon, Department of Surgery, Shiga General Hospital, 5-4-30, Moriyama, Moriyama 524-8524, Shiga, Japan. horitomo55office@yahoo.co.jp
Received: March 9, 2020
Peer-review started: March 9, 2020
First decision: May 5, 2020
Revised: July 10, 2020
Accepted: July 18, 2020
Article in press: July 18, 2020
Published online: September 27, 2020
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.

Keywords: Gallbladder cancer, Surgery, Prognosis, Outcome, Metastasis, Lymph node, Extrahepatic bile duct

Core Tip: Gallbladder cancer (GBC) has a poor prognosis. Our GBC patients who underwent surgeries were retrospectively evaluated. Lymphadenectomy and resection of the extrahepatic bile duct prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic lymph nodes or invasion of the nerve plexus. We should reconsider the indications for major hepatectomy, when it is required to achieve negative bile duct margins. 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. Postoperative outcome remains unacceptable.