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Lv TR, Wang JK, Li FY, Hu HJ. Prognostic factors for resected cases with gallbladder carcinoma: a systematic review and meta-analysis. Int J Surg 2024; 110:4342-4355. [PMID: 38537060 PMCID: PMC11254228 DOI: 10.1097/js9.0000000000001403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/11/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE Current meta-analysis was performed to systematically evaluate the potential prognostic factors for overall survival among resected cases with gallbladder carcinoma. METHODS PubMed, EMBASE, and the Cochrane Library were systematically retrieved and hazard ratio (HR) and its 95% confidence interval were directly extracted from the original study or roughly estimated via Tierney's method. Standard Parmar modifications were used to determine pooled HRs. RESULTS A total of 36 studies with 11 502 cases were identified. Pooled results of univariate analyses indicated that advanced age (HR=1.02, P =0.00020), concurrent gallstone disease (HR=1.22, P =0.00200), elevated preoperative CA199 level (HR=1.93, P <0.00001), advanced T stage (HR=3.09, P <0.00001), lymph node metastasis (HR=2.78, P <0.00001), peri-neural invasion (HR=2.20, P <0.00001), lymph-vascular invasion (HR=2.37, P <0.00001), vascular invasion (HR=2.28, P <0.00001), poorly differentiated tumor (HR=3.22, P <0.00001), hepatic side tumor (HR=1.85, P <0.00001), proximal tumor (neck/cystic duct) (HR=1.78, P <0.00001), combined bile duct resection (HR=1.45, P <0.00001), and positive surgical margin (HR=2.90, P <0.00001) were well-established prognostic factors. Pathological subtypes ( P =0.53000) and postoperative adjuvant chemotherapy ( P =0.70000) were not prognostic factors. Pooled results of multivariate analyses indicated that age, gallstone disease, preoperative CA199, T stage, lymph node metastasis, peri-neural invasion, lymph-vascular invasion, tumor differentiation status, tumor location (peritoneal side vs hepatic side), surgical margin, combined bile duct resection, and postoperative adjuvant chemotherapy were independent prognostic factors. CONCLUSION Various prognostic factors have been identified beyond the 8th AJCC staging system. By incorporating these factors into a prognostic model, a more individualized prognostication and treatment regime would be developed. Upcoming multinational studies are required for the further refine and validation.
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Affiliation(s)
- Tian-Run Lv
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun-Ke Wang
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fu-Yu Li
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hai-Jie Hu
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University
- Research Center for Biliary Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Tohyama T, Hosobe H, Kobayashi T, Murakami T, Fujimoto Y, Hayashi T, Matsumoto T, Asakawa T, Omori M. A case of granulocyte-colony-stimulating factor-producing gallbladder cancer with lymph node metastasis together with a literature review. Clin J Gastroenterol 2023; 16:732-742. [PMID: 37258993 DOI: 10.1007/s12328-023-01816-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/22/2023] [Indexed: 06/02/2023]
Abstract
The granulocyte-colony-stimulating factor (G-CSF) glycoprotein stimulates precursor cell proliferation and differentiation in the bone marrow. Various G-CSF-producing tumors have been reported; they showed early progression and an extremely poor prognosis. Here, we report a case of G-CSF-producing gallbladder cancer with lymph node metastasis. In addition, we reviewed 30 previous case reports of G-CSF-producing gallbladder cancers to elucidate the characteristics and most appropriate treatment. During a routine visit to her local doctor for monitoring of diabetes and hypertension, a 68-year-old female was found to have an elevated white-blood-cell (WBC) count and C-reactive protein (CRP) level, and a gallbladder mass. Laboratory tests revealed a high serum G-CSF level, and imaging revealed a tumor of the gallbladder with regional lymphadenopathy. We diagnosed a G-CSF-producing gallbladder cancer and performed liver resection of segment IVa/V: regional lymph node dissection with extrahepatic bile duct resection. Pathologically, the tumor was a poorly differentiated squamous cell carcinoma. G-CSF immunostaining for tumor cells was positive. She is alive without recurrence at 16 months after surgery. If a patient exhibits a gallbladder tumor, with an elevated WBC count and CRP level but no symptoms of infection, a G-CSF-producing gallbladder cancer should be suspected; radical resection should be performed immediately after diagnosis.
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Affiliation(s)
- Taiji Tohyama
- Department of Surgery, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan.
| | - Hirotaka Hosobe
- Department of Surgery, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan
| | - Teruki Kobayashi
- Department of Surgery, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan
| | - Takayoshi Murakami
- Department of Surgery, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan
| | - Yoshimi Fujimoto
- Department of Surgery, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan
| | - Tatsuro Hayashi
- Department of Surgery, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan
| | - Takamasa Matsumoto
- Department of Surgery, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan
| | - Toru Asakawa
- Department of Radiology, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan
| | - Masako Omori
- Department of Pathology, Kurashiki Medical Center, Bakuro-cho, Kurashiki, Okayama, 710-8522, Japan
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Lv TR, Hu HJ, Liu F, Ma WJ, Jin YW, Li FY. The role of extra-hepatic bile duct resection in patients with gallbladder carcinoma with peri-neural invasion: A ten-year experience in China. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:1009-1015. [PMID: 36604233 DOI: 10.1016/j.ejso.2022.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/19/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Peri-neural invasion (PNI) in gallbladder carcinoma (GBC) has been demonstrated as a vital prognostic factor. However, whether PNI in patients with GBC can be regarded as a surgical indication of bile duct resection (BDR) remains controversial. METHODS GBC patients with pathologically-confirmed PNI between September 2010 and September 2020 were retrospectively reviewed. Comparative analyses were performed in patients with PNI according to the performance of BDR. SPSS 25.0 software and Graph pad PRISMA 7.0 software were used for statistical analyses. RESULTS A total of 70 patients GBC patients with PNI were incorporated. The results of comparative analyses indicated that patients who received BDR were generally in a more advanced stage and often required a more extended radical cholecystectomy. Higher incidences of preoperative jaundice (48.6% vs 2.9%, P < 0.0001), major hepatectomy (25.7% vs 8.6%, P = 0.055), combined multi-visceral resections (48.6% vs 5.7%, P < 0.0001), combined major vascular reconstruction (22.9% vs 2.9%, P = 0.014), and a lower R0 rate (68.6% vs 88.6%, P = 0.039) were detected in patients who received BDR. Even after propensity score matching (PSM), BDR still had no significant survival advantage but only increased the length of postoperative stay and the frequency of postoperative morbidities. CONCLUSION BDR seemed to have no significant survival advantage in GBC patients with PNI and was only correlated with a longer postoperative hospital stay and a higher rate of morbidities. PNI should not be regarded as a surgical indication of BDR in patients with GBC.
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Affiliation(s)
- Tian-Run Lv
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yan-Wen Jin
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Lv TR, Liu F, Hu HJ, Regmi P, Ma WJ, Yang Q, Jin YW, Li FY. The role of extra-hepatic bile duct resection in the surgical management of gallbladder carcinoma. A first meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:482-491. [PMID: 34955314 DOI: 10.1016/j.ejso.2021.11.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 10/06/2021] [Accepted: 11/26/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To systematically evaluate the clinicopathological and prognostic value of extra-hepatic bile duct resection (EHBDR) in the surgical management of patients with gallbladder carcinoma (GBC), especially in non-jaundiced patients. METHODS PubMed, EMBASE and the Cochrane Library were searched up to March 1st 2021 for comparative studies between bile duct resected and non-resected groups. RevMan5.3 and Stata 13.0 software were used for the statistical analyses. RESULTS EHBDR did not correlate with a better overall survival (OS) (P = 0.17) or disease-free survival (P = 0.27). No survival benefit was also observed in patients with T2N1 (P = 0.4), T3N0 (P = 0.14) disease and node-positive patients (P = 0.75), rather, EHBDR was even harmful for patients with T2N0 (P = 0.01) and node-negative disease (P = 0.02). Significantly higher incidences of recurrent disease (P = 0.0007), postoperative complications (P < 0.00001) and positive margins (P = 0.02) were detected in the bile duct-resected group. The duration of postoperative hospital stay between the two groups was comparable (P = 0.58). Selection bias was also detected in our analysis that a significantly higher proportion of advanced lesions with T3-4 or III-IV disease was observed in the bile duct-resected group (P < 0.00001). EHBDR only contributed to a greater lymph yield (P = 0.01). CONCLUSION EHBDR has no survival advantage for patients with GBC, especially for those with non-jaundiced disease. Considering the unfairness of comparing OS between jaundiced patients receiving EHBDR with non-jaundiced patients without EHBDR, we could only conclude that routine EHBDR in non-jaundiced patients is not recommended and future well-designed studies with more specific subgroup analyses are required for further validation.
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Affiliation(s)
- Tian-Run Lv
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Parbatraj Regmi
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Qing Yang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yan-Wen Jin
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Liu F, Li FY. Puzzle and Challenge in Routine Extrahepatic Bile Duct Resection for Advanced Gallbladder Carcinoma. Gut Liver 2020; 14:850-851. [PMID: 33055359 PMCID: PMC7667927 DOI: 10.5009/gnl20150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/20/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Fei Liu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
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Ma W, Li W, Wang J, Wu R, Liu C, Feng F, Jiang X. The Clinical Role of Preoperative Serum CA19-9 and Carcinoembryonic Antigen (CEA) Levels in Evaluating the Resectability of Advanced Gallbladder Cancer. Med Sci Monit 2020; 26:e925017. [PMID: 32950997 PMCID: PMC7513615 DOI: 10.12659/msm.925017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The present study was designed to study the ability of preoperative serum concentrations of the tumor-associated biomarkers carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9) and adjusted CA19-9 to assess the resectability of advanced gallbladder cancer (GBC). MATERIAL AND METHODS This retrospective study included patients with potentially resectable stage II-IV (AJCC 8th) GBC examined at our institution between January 2012 and December 2016. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive value and optimal cut-off point of tumor-associated biomarkers for curative resection. RESULTS Pathological examination of the 309 patients included in this study found that 169 (54.7%) underwent R0 (curative) resection, whereas 121 (39.2%) underwent R1/2 (non-curative) resection, and 19 (6.1%) were unresectable. The mean serum concentrations of CEA, CA19-9 and adjusted CA19-9 were significantly lower in patients who underwent R0 resection than in the other groups. ROC curve analysis showed that adjusted CA19-9 concentration was better able to predict resectability (area under the curve, 0.774; 95% confidence interval, 0.722-0.826; P<0.001) than total bilirubin, CEA, and CA19-9 concentrations. The optimal cut-off for adjusted CA19-9 concentration was 47.63 U/mL, which had a sensitivity of 69.82%, a specificity of 75%, a positive predictive value of 77.12% and a negative predictive value of 67.31%. CONCLUSIONS Adjusted CA19-9 concentration is an easily calculated parameter superior to CA19-9 and CEA concentrations in predicting the resectability of advanced gallbladder cancer.
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Affiliation(s)
- Wencong Ma
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Wei Li
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Jinghan Wang
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Rui Wu
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Chen Liu
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Feiling Feng
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
| | - Xiaoqing Jiang
- Department of Biliary Tract Surgery I, Third Affiliated Hospital of Second Military Medical University, Shanghai, China (mainland)
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Wang JK, Ma WJ, Wu ZR, Yang Q, Hu HJ, Liu F, Li FY. Is combined extra-hepatic bile-duct resection justified for advanced gallbladder carcinoma? Gastroenterol Rep (Oxf) 2019; 7:426-433. [PMID: 31857904 PMCID: PMC6911994 DOI: 10.1093/gastro/goz018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/26/2019] [Accepted: 04/08/2019] [Indexed: 02/05/2023] Open
Abstract
Background Whether the extra-hepatic bile duct (EHBD) should be routinely resected for gallbladder carcinoma (GBC) remains controversial. The current study aimed to determine the clinical impact of combined EHBD resection during curative surgery for advanced GBC. Methods In total, 213 patients who underwent curative surgery for T2, T3 or T4 GBC were enrolled. The clinicopathological features were compared between the patients treated with EHBD resection and those without EHBD resection. Meanwhile, univariable and multivariable Cox-proportional hazards regression models were used to identify risk factors for overall survival (OS). Results Among the 213 patients identified, 87 (40.8%) underwent combined EHBD resection. Compared with patients without EHBD resection, patients with EHBD resection suffered more post-operative complications (33.3% vs. 21.4%, P = 0.046). However, the median OS of the EHBD resection group was longer than that of the non-EHBD resection group (25 vs. 11 months, P = 0.008). Subgroup analyses were also performed according to tumor (T) category and lymph-node metastasis. The median OS was significantly longer in the EHBD resection group than in the non-EHBD resection group for patients with T3 lesion (15 vs. 7 months, P = 0.002), T4 lesion (11 vs. 6 months, P = 0.021) or lymph-node metastasis (12 vs. 7 months, P < 0.001). No survival benefit of EHBD resection was observed in GBC patients with T2 lesion or without lymph-node metastasis. T category, lymph-node metastasis, margin status, pre-operative CA19-9 level and EHBD resection were identified as independent prognostic factors for OS of patients with advanced GBC (all P values <0.05). Conclusions EHBD resection can independently affect the OS in advanced GBC. For GBC patients with T3 lesion, T4 lesion and lymph-node metastasis, combined EHBD resection is justified and may improve OS.
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Affiliation(s)
- Jun-Ke Wang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Zhen-Ru Wu
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Qin Yang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Fei Liu
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
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Cho JK, Lee W, Jang JY, Kim HG, Kim JM, Kwag SJ, Park JH, Kim JY, Park T, Jeong SH, Ju YT, Jung EJ, Lee YJ, Hong SC, Jeong CY. Validation of the oncologic effect of hepatic resection for T2 gallbladder cancer: a retrospective study. World J Surg Oncol 2019; 17:8. [PMID: 30616645 PMCID: PMC6323785 DOI: 10.1186/s12957-018-1556-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While extended cholecystectomy is recommended for T2 gallbladder cancer (GBC), the role of hepatic resection for T2 GBC is unclear. This study aimed to identify the necessity of hepatic resection in patients with T2 GBC. METHODS Data of 81 patients with histopathologically proven T2 GBC who underwent surgical resection between January 1999 and December 2017 were enrolled from a retrospective database. Of these, 36 patients had peritoneal-side (T2a) tumors and 45 had hepatic-side (T2b) tumors. To identify the optimal surgical management method, T2 GBC patients were classified into the hepatic resection group (n = 44, T2a/T2b = 20/24) and non-hepatic resection group (n = 37, T2a/T2b = 16/21). The recurrence pattern and role of hepatic resection for T2 GBC were then investigated. RESULTS Mean age of the patients was 69 (range 36-88) years, and the male-to-female ratio was 42:39 (male, 51.9%; female, 48.1%). Hepatic-side GBC had a higher rate of recurrence than peritoneal-side GBC (44.4% vs. 8.3%, p = 0.006). The most common type of recurrence in T2a GBC was para-aortic lymph node recurrence (n = 2, 5.6%); the most common types of recurrence in T2b GBC were para-aortic lymph node recurrence (n = 7, 15.6%) and intrahepatic metastasis (n = 6, 13.3%). Hepatic-side GBC patients had worse survival outcomes than peritoneal-side GBC patients (76.0% vs. 96.6%, p = 0.041). Hepatic resection had no significant treatment effect in T2 GBC patients (p = 0.272). Multivariate analysis showed that lymph node metastasis was the only significant prognostic factor (p = 0.002). CONCLUSIONS Hepatic resection is not essential for curative treatment in T2 GBC, and more systemic treatments are needed for GBC patients, particularly for those with T2b GBC.
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Affiliation(s)
- Jin-Kyu Cho
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Woohyung Lee
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University Postgraduate School of Medicine, 11, Samjeongja-ro, Changwoun-si, 51472 South Korea
| | - Jae Yool Jang
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Han-Gil Kim
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Jae-Myung Kim
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Seung-Jin Kwag
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Ji-Ho Park
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Ju-Yeon Kim
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Taejin Park
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University Postgraduate School of Medicine, 11, Samjeongja-ro, Changwoun-si, 51472 South Korea
| | - Sang-Ho Jeong
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University Postgraduate School of Medicine, 11, Samjeongja-ro, Changwoun-si, 51472 South Korea
| | - Young-Tae Ju
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Eun-Jung Jung
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University Postgraduate School of Medicine, 11, Samjeongja-ro, Changwoun-si, 51472 South Korea
| | - Young-Joon Lee
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Soon-Chan Hong
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
| | - Chi-Young Jeong
- 0000 0001 0661 1492grid.256681.eDepartment of Surgery, Gyeongsang National University Hospital, Gyeongsang National University Postgraduate School of Medicine, 79, Gangnam-ro, Jinju, 660-702 South Korea
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Fujii Y, Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T. Significance of bile duct resection for advanced gallbladder cancer without biliary infiltration. Am J Surg 2018; 216:1122-1126. [DOI: 10.1016/j.amjsurg.2018.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 07/06/2018] [Accepted: 07/17/2018] [Indexed: 02/06/2023]
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10
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Park TJ, Ahn KS, Kim YH, Kim TS, Hong JH, Kang KJ. The optimal surgical resection approach for T2 gallbladder carcinoma: evaluating the role of surgical extent according to the tumor location. Ann Surg Treat Res 2018; 94:135-141. [PMID: 29520347 PMCID: PMC5842085 DOI: 10.4174/astr.2018.94.3.135] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/14/2017] [Accepted: 08/03/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The clinical behavior of T2 gallbladder cancer varies among patients. The aims of this study were to identify prognostic factors for survival and recurrence, and to determine the optimal surgical strategy for T2 gallbladder cancer. METHODS We conducted a retrospective analysis of 78 patients with T2 gallbladder cancer who underwent surgical resection for gallbladder cancer. RESULTS Twenty-eight patients (35.9%) underwent simple cholecystectomy and 50 (64.1%) underwent extended cholecystectomy. Among 56 patients without LN metastasis (n = 20) or unknown LN status (no LN dissection, n = 36), the 5-year disease-free survival rates were 81.6%, and 69.8% (P = 0.080). In an analysis according to tumor location, patients with tumors located on the hepatic side (n = 36) had a higher recurrence rate than patients with tumors located on the peritoneal side only (n = 35) (P = 0.043). On multivariate analysis, R1 resection and lymph node metastasis were significant, independent prognostic factors for poor disease-free and overall survival. CONCLUSION R0 resection and LN dissection are an appropriate curative surgical strategy in patients with T2 gallbladder cancer. Tumors located on the hepatic side show worse prognosis than tumors located on the peritoneal side only, hepatic resection should be considered.
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Affiliation(s)
- Tae Jun Park
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
- Department of Surgery, Andong Medical Group Hospital, Andong, Korea
| | - Keun Soo Ahn
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Yong Hoon Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Tae-Seok Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jung Hee Hong
- Department of Radiology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Koo Jeong Kang
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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11
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Vega EA, Vinuela E, Yamashita S, Sanhueza M, Cavada G, Diaz C, Aloia TA, Chun YS, Tzeng CWD, Okuno M, Goumard C, Vauthey JN, Lee JE, Conrad C. Extended Lymphadenectomy Is Required for Incidental Gallbladder Cancer Independent of Cystic Duct Lymph Node Status. J Gastrointest Surg 2018; 22:43-51. [PMID: 28752405 DOI: 10.1007/s11605-017-3507-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 07/11/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND We examined whether the incidental cystic duct nodal status predicts the status of the hepatoduodenal ligament (D1) or common hepatic artery, the pancreaticoduodenal and paraaortic lymph nodes (D2), and the overall prognosis and thus indicates whether an oncologic extended resection (OER) is required. METHODS The study included patients who underwent OER for incidental gallbladder cancer (IGBC) during 1999-2015. Associations between a positive cystic duct node and D2 nodal status and disease-specific survival (DSS) were analyzed. RESULTS One-hundred-eight-seven patients were included. Seventy-three patients (39%) had the incidental cystic duct node retrieved. Cystic duct node positivity was associated with positive D1 (odds ratio 5.2, p = 0.012) but not with D2. Among all patients, a positive cystic duct node was associated with worse DSS (hazard ratio [HR] 2.09). Patients without residual cancer at OER and positive incidental cystic duct node had similar DSS to patients with negative nodes 70 vs 60% (p = 0.337). Positive D1 (HR 6.07) or positive D2 (HR 13.8) was predictive of worse DSS. CONCLUSIONS Patients with no residual cancer at OER and regional disease limited to their incidental cystic duct node have similar DSS to pN0 patients. The status of the cystic duct node only predicts the status of hepatic pedicle nodes.
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Affiliation(s)
- Eduardo A Vega
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA.,Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile
| | - Eduardo Vinuela
- Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile.,Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Suguru Yamashita
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA.,Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Marcel Sanhueza
- Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile.,Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Gabriel Cavada
- Department of Epidemiology, Faculty of Medicine and Public Health School, University of Los Andes Santiago, Santiago, Chile
| | - Cristian Diaz
- Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile.,Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Thomas A Aloia
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA
| | - Yun Shin Chun
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA
| | - Ching-Wei D Tzeng
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA
| | - Masayuki Okuno
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA
| | - Claire Goumard
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA
| | - Jeffrey E Lee
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA
| | - Claudius Conrad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, 1400 Pressler, Unit 1484, Houston, TX, 77030, USA.
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12
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Hiraki M, Ueda J, Kai K, Ide T, Asai M, Ohtsuka T, Kohya N, Mukai S, Kitahara K, Noshiro H. A Case of Signet Ring Cell Carcinoma of the Gallbladder Which Was Treated by Aggressive Surgery and Intensive Adjuvant Chemotherapy. J Gastrointest Cancer 2017; 48:83-86. [PMID: 26825388 DOI: 10.1007/s12029-016-9804-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Masatsugu Hiraki
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan
| | - Junji Ueda
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan
| | - Keita Kai
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga City, Saga, 849-8501, Japan
| | - Takao Ide
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan
| | - Masako Asai
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan
| | - Takao Ohtsuka
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan
| | - Naohiko Kohya
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan
| | - Shinsuke Mukai
- Department of Surgery, Fuji-Yamato Spa. Hospital, Saga City, 840-0516, Japan
| | - Kenji Kitahara
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan.
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13
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Nigri G, Berardi G, Mattana C, Mangogna L, Petrucciani N, Sagnotta A, Aurello P, D'Angelo F, Ramacciato G. Routine extra-hepatic bile duct resection in gallbladder cancer patients without bile duct infiltration: A systematic review. Surgeon 2016; 14:337-344. [PMID: 27395014 DOI: 10.1016/j.surge.2016.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 05/08/2016] [Accepted: 06/11/2016] [Indexed: 02/06/2023]
Abstract
AIM The optimal treatment for advanced gallbladder cancer, in particular T2 stage cancer, is unclear. The use of "radical cholecystectomy" or more extended procedures with extra-hepatic bile duct resection are matter of debate. Due to the lack of consensus regarding the oncological significance of routine extra-hepatic bile duct (EBD) resection for gallbladder carcinoma, we decided to perform a systematic review investigating the real benefit of this procedure focusing on the primary outcomes of overall survival and disease-free survival. METHODS A systematic literature search was performed using PubMed, EMBASE, Scopus and the Cochrane Library Central according to the PRISMA statement guidelines for conducting and reporting systematic reviews. Multiple primary and secondary outcomes were analyzed. RESULTS The selected articles included 424 patients who underwent routine EBD resection without bile duct infiltration. Only two papers discussed the number of dissected lymph nodes during EBD resection for gallbladder carcinoma. Four of the seven included papers reported on tumor involvement in lymph nodes at rates ranging between 39% and 83%. All of the studies included in this systematic review reported on results of overall survival. In general, 5-years OS rate of the EBD-resected patients was not significantly different than that of the EBD-preservation group, while the mobility was significantly higher in the EBD resection group. CONCLUSIONS Routine EBD resection in gallbladder cancer patients without bile duct infiltration is not associated with improved overall survival, improved lymph-node harvesting or with minor recurrence rate, but it is associated with higher morbidity rates.
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Affiliation(s)
- Giuseppe Nigri
- General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy.
| | - Giammauro Berardi
- General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Chiara Mattana
- General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Livia Mangogna
- General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Niccolò Petrucciani
- General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Sagnotta
- General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Paolo Aurello
- General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Francesco D'Angelo
- General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Giovanni Ramacciato
- General Surgery and Hepato-pancreato-biliary Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
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14
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Clemente G. Unexpected gallbladder cancer: Surgical strategies and prognostic factors. World J Gastrointest Surg 2016; 8:541-544. [PMID: 27648157 PMCID: PMC5003932 DOI: 10.4240/wjgs.v8.i8.541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/07/2016] [Accepted: 06/16/2016] [Indexed: 02/06/2023] Open
Abstract
Gallbladder cancer is the most common tumor of the biliary tract and it is associated with a poor prognosis. Unexpected gallbladder cancer is a cancer incidentally discovered, as a surprise, at the histological examination after cholecystectomy for gallstones or other indications. It is a potentially curable disease, with an intermediate or good prognosis in most cases. An adequate surgical strategy is mandatory to improve the prognosis and an adjunctive radical resection may be required depending on the depth of invasion. If the cancer discovered after cholecystectomy is a pTis or a pT1a, a second surgical procedure is not mandatory. In the other cases (pT1b, pT2 and pT3 cancer) a re-resection (4b + 5 liver segmentectomy, lymphadenectomy and port-sites excision in some cases) is required to obtain a radical excision of the tumor and an accurate disease staging. The operative specimens of re-resection should be examined by the pathologist to find any “residual” tumor. The “residual disease” is the most important prognostic factor, significantly reducing median disease-free survival and disease-specific survival. The other factors include depth of parietal invasion, metastatic nodal disease, surgical margin status, cholecystectomy for acute cholecystitis, histological differentiation, lymphatic, vascular and peri-neural invasion and overall TNM-stage.
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15
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Tomita K, Takano K, Shimazu M, Okihara M, Sano T, Chiba N, Kawachi S. Long-term survival of a recurrent gallbladder carcinoma patient with lymph node and peritoneal metastases after multidisciplinary treatments: a case report. Surg Case Rep 2016; 2:12. [PMID: 26943688 PMCID: PMC4751098 DOI: 10.1186/s40792-016-0135-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/01/2016] [Indexed: 02/06/2023] Open
Abstract
Background Gallbladder carcinoma with peritoneal metastasis has a poor prognosis, with a median survival time of 4.8 months. We report the survival of a patient with gallbladder carcinoma with peritoneal metastasis for 7.6 months owing to treatment with tumor resection after chemoradiotherapy. Case presentation A 69-year-old man was referred to our hospital for gallbladder carcinoma with hepatic invasion. Cholecystectomy was performed along with S4a and S5 hepatectomy and extrahepatic bile duct resection with lymph node dissection. The postoperative pathological diagnosis was moderately differentiated adenocarcinoma, T3, N0, M0, stage IIIA by the International Union Against Cancer TNM classification. Despite treatment with gemcitabine, the common hepatic artery and para-aortic lymph nodes showed metastases after 3 months from surgery. Although a combination of cisplatin, gemcitabine, and radiotherapy reduced the size of the lymph node metastasis, the peritoneal metastasis persisted. The peritoneal metastasis responded to chemoradiotherapy using tegafur-uracil and leucovorin, but it recurred. The metastasis was resected after 3 years and 9 months from the first surgery, and chemotherapy was discontinued. Seven years and 6 months after the initial surgery, the patient exhibited no signs of tumor recurrence or metastasis. Conclusions Multidisciplinary treatment including resection without residual tumors could achieve complete remission of gallbladder carcinoma with lymph node and peritoneal metastases in the selected patient.
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Affiliation(s)
- Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan.
| | - Kiminori Takano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan.
| | - Motohide Shimazu
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan.
| | - Masaaki Okihara
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan.
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan.
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan.
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan.
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16
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Abstract
Gallbladder carcinoma (GBC) is the most common biliary epithelial malignancy, with an estimated 10,910 new cases and 3700 deaths per year (Siegel et al. in CA Cancer J Clin 65:5–29, 2015 [1]). This disease’s insidious nature and typically late presentation place it among the most lethal of invasive neoplasms. Gallbladder cancer spreads early by lymphatic or hematogenous metastasis and by direct invasion into the liver. While surgery may well be curative at early stages, both surgical and nonsurgical treatments remain largely unsuccessful in patients with more advanced disease.
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17
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Lai QY, Wang DS. Surgical treatment of gallbladder cancer: Strategy and optimization. Shijie Huaren Xiaohua Zazhi 2015; 23:1865-1872. [DOI: 10.11569/wcjd.v23.i12.1865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gallbladder cancer is the most common malignant tumor of the biliary tract. It is difficult to diagnose early due to the lack of special symptoms and physical signs. Most cases are diagnosed in advanced stages and the response to traditional chemotherapy and radiotherapy is extremely limited, with modest impact on overall survival. Despite improvements in outcome associated with extended resections, selection of patients for such extensive surgery remains controversial. In this article, we analyze and discuss the key issues about the surgical management of gallbladder cancer, with the hope of a more comprehensive recognition of this malignancy.
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18
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Koerkamp BG, Jarnagin WR. Gallbladder Cancer. Surg Oncol 2015. [DOI: 10.1007/978-1-4939-1423-4_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Goetze TO, Paolucci V. Influence of high- and low-volume liver surgery in gallbladder carcinoma. World J Gastroenterol 2014; 20:18445-18451. [PMID: 25561815 PMCID: PMC4277985 DOI: 10.3748/wjg.v20.i48.18445] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/17/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To clarify whether the performance of liver resections (LR) for incidental gallbladder carcinoma (IGBC)’s depends more on the experience of the hospitals in liver surgery than on complying with the guidelines in Germany.
METHODS: For data analysis, we used the Surgical Association of Endoscopy and Ultrasound and Minimally Invasive Surgery Central Registry of “IGBC” of the German Society of Surgery (the German Registry). In 2010, we started a second form by requesting the frequency of LR at the various hospitals in Germany. The indication for LR was irrelevant. The aim was to determine the overall frequency of liver resections at the hospitals. We divided the hospitals according to their experience in liver surgery into high- (HV), mid- (MV), and low-volume (LV) LR hospitals.
RESULTS: This study includes 487 IGBC’s from 167 centers. There were 36 high-volume, 32 mid-volume, and 99 low-volume centers. In the high-volume centers, the mean (range) number of liver resections was 101 (40-300). In the mid-volume centers, the mean (range) number of liver resections was 26 (20-39). In the low-volume centers, the mean (range) number of liver resections was 6.5 (0-19) (P < 0.001). LV’s perform LR for T2-3 gallbladder carcinomas significantly less often than high-volume or mid-volume centers (χ2 = 13.78, P = 0.001). In HV’s and MV’s, 61% of the patients with an indication for liver resection underwent LR, but in LV centers, only 41% with an indication for LR underwent LR (P < 0.001). In cases of T1b carcinomas, LR was performed significantly more often in HV’s (P = 0.009).
CONCLUSION: The central problem is that the performance of the required liver resection in IGBC in Germany depends on the hospital experience in liver surgery and not on the recommendations of the German guidelines.
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20
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Lee H, Choi DW, Park JY, Youn S, Kwon W, Heo JS, Choi SH, Jang KT. Surgical Strategy for T2 Gallbladder Cancer According to Tumor Location. Ann Surg Oncol 2014; 22:2779-86. [PMID: 25519930 DOI: 10.1245/s10434-014-4300-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Radical cholecystectomy is recommended for T2 gallbladder cancer. However, it is unclear whether hepatic resection is essential for peritoneal-side gallbladder cancer. METHODS From January 2000 to December 2011, we identified T2 gallbladder cancer patients who had undergone curative intent surgery. A peritoneal-side tumor was defined when the epicenter of the tumor was located within the free peritoneal-side gallbladder mucosa. Hepatic-side gallbladder cancer was defined when the epicenter of the tumor was located within the gallbladder bed or neck. RESULTS A total of 157 patients with T2 gallbladder cancer were included; 33 peritoneal-side and 124 hepatic-side tumors. In total, 122 patients underwent hepatic resection, whereas the remaining 35 patients did not. After a median follow-up period of 40 (range 5-170) months, the survival of the peritoneal-side group was better than that of the hepatic-side group (p = 0.002). In a multivariate analysis, tumor location, lymph node metastasis, hepatic resection, lymphatic invasion, and perineural invasion were significant prognostic factors (p = 0.045, p < 0.001, p = 0.003, p = 0.046, and p = 0.027, respectively). For the peritoneal-side group, there was no recurrence or death after cholecystectomy without hepatic resection. However, hepatic resection was an important factor associated with overall survival in patients with hepatic-side gallbladder cancer (p = 0.007). CONCLUSIONS In T2 gallbladder cancer patients, hepatic resection is recommended when there is tumor invasion of the gallbladder bed or neck. However, it is not always necessary in selected patients with peritoneal-side gallbladder cancer.
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Affiliation(s)
- Huisong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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21
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Goetze TO, Paolucci V. [Incidental T1b-T3 gallbladder carcinoma. Extended cholecystectomy as an underestimated prognostic factor-results of the German registry]. Chirurg 2014; 85:131-8. [PMID: 24005717 DOI: 10.1007/s00104-013-2587-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The immediate radical re-resection (IRR) after simple cholecystectomy in incidental gallbladder carcinoma (IGBC) is debated in the literature. The German S3 guidelines recommend IRR in T2 and more advanced stages. Current literature recommends more extensive surgery even in T1b tumors. METHODS The German registry database was used for this study. RESULTS To date 883 cases of IGBC have been analyzed. In 8 out of 39 patients with a T1a tumor IRR was carried out as well as in 43 out of 109 patients with a T1b tumor. There was a significant survival benefit for re-resected T1b patients. There was also a significant survival benefit for the 215 T2 tumors and the 75 T3 patients with IRR compared to the 441 T2 tumors and 207 T3 tumors without IRR. Comparison of liver resection techniques showed good results for the wedge resection technique in T1b and T2 carcinomas. For T3 carcinomas more radical techniques showed better results. Less than 50 % of T2-3 tumors in the registry have been re-resection. CONCLUSIONS The IRR should be highly recommended in patients with T1b and more advanced IGBC. The wedge resection technique is an attractive procedure for T1b and T2 IGBC due to the lower invasiveness in spite of oncological adequacy.
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Affiliation(s)
- T O Goetze
- Abt. für Allgemein-, Visceral- und Minimal- Invasive Chirurgie, Ketteler- Krankenhaus, Lichtenplattenweg 85, 63071, Offenbach, Deutschland,
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22
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Kai K, Aishima S, Miyazaki K. Gallbladder cancer: Clinical and pathological approach. World J Clin Cases 2014; 2:515-521. [PMID: 25325061 PMCID: PMC4198403 DOI: 10.12998/wjcc.v2.i10.515] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/13/2014] [Accepted: 07/18/2014] [Indexed: 02/05/2023] Open
Abstract
Gallbladder cancer (GBC) shows a marked geographical variation in its incidence. Middle-aged and elderly women are more commonly affected. Risk factors for its development include the presence of gallstones, chronic infection and pancreaticobiliary maljunction. Controversy remains in regard to the theory of carcinogenesis from adenomyomatosis, porcelain gallbladder and adenoma of the gallbladder. The surgical strategy and prognosis after surgery for GBC differ strikingly according to T-stage. Discrimination of favorable cases, particularly T2 or T3 lesions, is useful for the selection of surgical strategies for individual patients. Although many candidate factors predicting disease progression, such as depth of subserosal invasion, horizontal tumor spread, tumor budding, dedifferentiation, Ki-67 labeling index, p53 nuclear expression, CD8+ tumor-infiltrating lymphocytes, mitotic counts, Laminin-5-gamma-2 chain, hypoxia-inducible factor-1a, cyclooxygenase-2 and the Hedgehog signaling pathway have been investigated, useful prognostic makers or factors have not been established. As GBC is often discovered incidentally after routine cholecystectomy and accurate preoperative diagnosis is difficult, close mutual cooperation between surgeons and pathologists is essential for developing a rational surgical strategy for GBC.
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23
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Lee SE, Kim KS, Kim WB, Kim IG, Nah YW, Ryu DH, Park JS, Yoon MH, Cho JY, Hong TH, Hwang DW, Choi DW, Korean Association of Hepato-Biliary and Pancreas Surgery. Practical guidelines for the surgical treatment of gallbladder cancer. J Korean Med Sci 2014; 29:1333-1340. [PMID: 25368485 PMCID: PMC4214932 DOI: 10.3346/jkms.2014.29.10.1333] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/24/2014] [Indexed: 02/05/2023] Open
Abstract
At present, surgical treatment is the only curative option for gallbladder (GB) cancer. Many efforts therefore have been made to improve resectability and the survival rate. However, GB cancer has a low incidence, and no randomized, controlled trials have been conducted to establish the optimal treatment modalities. The present guidelines include recent recommendations based on current understanding and highlight controversial issues that require further research. For T1a GB cancer, the optimal treatment modality is simple cholecystectomy, which can be carried out as either a laparotomy or a laparoscopic surgery. For T1b GB cancer, either simple or an extended cholecystectomy is appropriate. An extended cholecystectomy is generally recommended for patients with GB cancer at stage T2 or above. In extended cholecystectomy, a wedge resection of the GB bed or a segmentectomy IVb/V can be performed and the optimal extent of lymph node dissection should include the cystic duct lymph node, the common bile duct lymph node, the lymph nodes around the hepatoduodenal ligament (the hepatic artery and portal vein lymph nodes), and the posterior superior pancreaticoduodenal lymph node. Depending on patient status and disease severity, surgeons may decide to perform palliative surgeries.
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Affiliation(s)
- Seung Eun Lee
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Wan Bae Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - In-Gyu Kim
- Department of Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Yang Won Nah
- Department of Surgery, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong Hee Ryu
- Department of Surgery, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Korea
| | - Joon Seong Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hee Yoon
- Department of Surgery, Kosin University College of Medicine, Busan, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Ho Hong
- Department of Surgery, Catholic University College of Medicine, Seoul, Korea
| | - Dae Wook Hwang
- Department of Surgery, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong Wook Choi
- Department of Surgery, Sungkyunkwan University College of Medicine, Seoul, Korea
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Higuchi R, Ota T, Araida T, Kajiyama H, Yazawa T, Furukawa T, Yoshikawa T, Takasaki K, Yamamoto M. Surgical approaches to advanced gallbladder cancer : a 40-year single-institution study of prognostic factors and resectability. Ann Surg Oncol 2014; 21:4308-16. [PMID: 25023547 DOI: 10.1245/s10434-014-3885-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim was to evaluate prognostic factors and factors associated with the resectability of advanced gallbladder cancer (GBC). METHODS This was a single-institution retrospective review of 274 consecutive surgically-treated cases of advanced GBC (excluding incidental GBC and early GBC). Univariate and multivariate analysis were performed to assess prognostic variables. R0 resection and survival rates were investigated for each local extension factor. RESULTS Long-term survival was uncommon among patients with multiple liver metastases (H2-3: n = 22; 2-year survival, 0 %), dissemination (P1-3: n = 16; 3-year survival, 0 %), invasion through the hepatoduodenal ligament (Binf3: n = 45; 5-year survival, 4.6 %), or group 3 lymph node (LN) metastasis including of the para-aortic LN (N3: n = 52; 13.7 %). Long-term survival rates did not differ significantly between patients who did and did not undergo bile duct resection or pancreaticoduodenectomy. Survival did not differ significantly according to the type of hepatectomy performed. CONCLUSION Surgery may not be indicated for patients with multiple liver metastasis, dissemination, Binf3, or visible para-aortic LN metastasis. Furthermore, it is important to achieve R0 surgery in cases of GBC.
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Affiliation(s)
- Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Wiggers JK, Groot Koerkamp B, Ovadia Z, Busch ORC, Gouma DJ, van Gulik TM. Patterns of recurrence after resection of gallbladder cancer without routine extrahepatic bile duct resection. HPB (Oxford) 2014; 16:635-40. [PMID: 24246159 PMCID: PMC4105901 DOI: 10.1111/hpb.12188] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/17/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Routine extrahepatic bile duct (EBD) resection in non-jaundiced patients with gallbladder cancer (GBC) is controversial. The aim of this study was to retrospectively analyse patterns of recurrence in patients who underwent resection of GBC without routine EBD resection. METHODS This analysis referred to 58 patients who had undergone explorative laparotomy for GBC during 2000-2012 at a single, tertiary referral centre. Overall survival, time to recurrence, and patterns of recurrence were assessed in patients who underwent conventional negative-margin (R0) resection without routine EBD resection. RESULTS Of 58 patients submitted to explorative laparotomy for GBC, 26 (45%) patients underwent R0 resection without EBD resection (tumour stage T1b in five patients, T2 in 17, T3 in three, and T4 in one). The 3-year survival rate among these patients was 78% at a median follow-up of 33 months (range: 13-127 months). Seven patients developed recurrent disease at a median of 9 months (range: 2-25 months) after resection. No patients developed isolated recurrent disease at the EBD. CONCLUSIONS Of 26 patients resected for GBC, none developed isolated recurrent disease at the EBD after conventional resection of GBC without EBD resection. This finding suggests that routine EBD resection is of no additional value.
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Affiliation(s)
- Jimme K Wiggers
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
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Lee SE, Jang JY, Kim SW, Han HS, Kim HJ, Yun SS, Cho BH, Yu HC, Lee WJ, Yoon DS, Choi DW, Choi SH, Hong SC, Lee SM, Kim HJ, Choi IS, Song IS, Park SJ, Jo S. Surgical strategy for T1 gallbladder cancer: a nationwide multicenter survey in South Korea. Ann Surg Oncol 2014; 21:3654-60. [PMID: 24743905 DOI: 10.1245/s10434-014-3527-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to investigate the clinical features and clinical outcomes of T1 gallbladder (GB) cancer and to determine an appropriate surgical strategy for T1 GB cancer. METHODS A nationwide multicenter study, in which 16 University Hospitals in Korea participated, was performed from 1995 to 2004. A total of 258 patients, 117 patients with T1a and 141 patients with T1b disease were enrolled. Clinicopathologic findings and long-term follow-up results were analyzed after a consensus meeting of the Korean Pancreas Surgery Club was held. RESULTS Simple cholecystectomy was performed in 95 patients (81.2 %) with T1a tumor and in 89 patients (63.1 %) with T1b tumor (p < 0.01). Lymph node metastasis was observed in 2.9 % of T1a patients and in 9.9 % of T1b patients (p = 0.391). A significant difference in 5-year disease-specific survival (DSS) rates was observed between T1a and T1b patients (96.4 vs 84.8 %, respectively, p = 0.03). However, no significant 5-year DSS rate difference was observed between those who underwent simple cholecystectomy or extended cholecystectomy, regardless of whether lymph node dissection was performed or whether lymph node metastasis was present. There was no significant difference in recurrence-free survival between simple cholecystectomy and extended cholecystectomy. CONCLUSIONS There was no superiority of extended cholecystectomy over simple cholecystectomy in the aspect of survival and recurrence especially in T1b gallbladder cancer. Furthermore, the effectiveness of regional lymphadenectomy for treatment purpose remains questionable. Therefore, simple cholecystectomy could be recommended as a surgical strategy of T1 gallbladder cancer.
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Affiliation(s)
- Seung Eun Lee
- Department of Surgery, Chung-Ang University School of Medicine, Seoul, South Korea
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Horiguchi A, Miyakawa S, Ishihara S, Miyazaki M, Ohtsuka M, Shimizu H, Sano K, Miura F, Ohta T, Kayahara M, Nagino M, Igami T, Hirano S, Yamaue H, Tani M, Yamamoto M, Ota T, Shimada M, Morine Y, Kinoshita H, Yasunaga M, Takada T. Gallbladder bed resection or hepatectomy of segments 4a and 5 for pT2 gallbladder carcinoma: analysis of Japanese registration cases by the study group for biliary surgery of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2014; 20:518-24. [PMID: 23430053 DOI: 10.1007/s00534-012-0584-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE Hepatectomy of segments 4a and 5 (S4a+5) is the recommended treatment for pT2 gallbladder cancer. However, gallbladder bed resection is also occasionally used. Using nationwide data from the Japanese Biliary Tract Cancer Registry and a questionnaire survey, we retrospectively compared these 2 methods of treatment. METHOD The study involved 85 patients with pT2, pN0 gallbladder cancer (55 treated with gallbladder bed resection, and 30, with S4a+5 hepatectomy). The prognosis and mode of tumor recurrence following treatment were analyzed retrospectively, with overall survival as the endpoint. RESULTS The 5-year survival rate did not differ significantly between the 2 groups. Univariate analysis showed that bile duct resection and perineural tumor invasion were significant prognostic factors, but the extent of hepatectomy, location of the major intramural tumor, regional lymph node excision, and histological type were not. Multivariate analysis identified perineural tumor invasion as a significant prognostic factor. Recurrence occurred most frequently in both lobes than S4a+5 of the liver following gallbladder bed resection. CONCLUSION In the present study of cases of Japanese Biliary Tract Cancer Registry, it was not possible to conclude that S4a+5 hepatectomy was superior to gallbladder bed resection.
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Affiliation(s)
- Akihiko Horiguchi
- Department of Biliary-Pancreatic Surgery, Fujita Health University, Toyoake, Aichi, Japan.
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Choi SB, Han HJ, Kim WB, Song TJ, Suh SO, Choi SY. Surgical strategy for T2 and T3 gallbladder cancer: is extrahepatic bile duct resection always necessary? Langenbecks Arch Surg 2013; 398:1137-44. [PMID: 24057276 DOI: 10.1007/s00423-013-1120-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 09/06/2013] [Indexed: 02/06/2023]
Abstract
PURPOSE Resection of the extrahepatic bile duct is not performed uniformly in gallbladder cancer. The study investigated the clinical significance of resection of extrahepatic bile duct (EHBD) in T2 and T3 gallbladder cancer. METHODS Between 2000 and 2010, 71 T2 or T3 gallbladder cancer patients who underwent R0 resection at Korea University Medical Center were included. Clinicopathological data were reviewed retrospectively. Survival analysis and comparison between EHBD resection and non-resection groups were performed. RESULTS The 32 men and 39 women had 49 T2 tumors and 22 T3 tumors. The overall survival rate was 67.8 % at 3 years and 47.2 % at 5 years. In multivariate analysis for overall survival, lymphovascular invasion and lymph node metastasis were significant independent predictors. Comparing the patients according to EHBD resection, the EHBD resection group demonstrated significantly longer hospital stay, longer operative time, more transfusion requirement, more extensive liver resection, and less treatment of neoadjuvant therapy. Significantly higher proportions of perineural invasion and lymph node metastasis were noted in the EHBD resection group. There were no statistically significant differences in survival between the EHBD resection and non-resection groups. CONCLUSIONS Resection of extrahepatic bile duct was not always necessary in T2 and T3 cancers. However, the patients who undergo resection of extrahepatic bile duct tended to have more aggressive tumor characteristics and undergo more aggressive surgical approach. To enhance overall survival for the patients with T2 and T3 gallbladder cancers, surgeons should try to perform R0 resection including EHBD resection.
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Affiliation(s)
- Sae Byeol Choi
- Department of Surgery, Korea University College of Medicine, Korea University Guro Hospital, 80 Guro-dong, Guro-gu, Seoul, Korea,
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Park YJ, Hwang S, Kim KH, Lee YJ, Ahn CS, Moon DB, Park KM, Ha TY, Song GW, Jung DH, Park GC, Lee JH, Lee SG. Prognosis of patients with pT1b/T2 gallbladder carcinoma who have undergone laparoscopic cholecystectomy as an initial operation. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2013; 17:113-7. [PMID: 26155224 PMCID: PMC4304525 DOI: 10.14701/kjhbps.2013.17.3.113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 08/04/2013] [Accepted: 08/12/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUNDS/AIMS Laparoscopic cholecystectomy (LC) has become a standard procedure for treatment of benign gallbladder diseases. There has been a small proportion of gallbladder cancer (GBC) which was incidentally found in the gallbladder specimen, and LC has been tried in some patients with faintly suspected GBC. This study intended to analyze the prognosis of patients with pT1b/T2 GBC who have undergone LC and the outcome of extended re-operation. METHODS After analyzing the institutional profiles of 500 GBC patients who have undergone surgical resection, we selected 64 patients who underwent LC initially from January 1996 to December 2008 and whose gallbladder pathology was confined to pT1b or pT2 lesions. Of them, 34 patients (53.1%) underwent extended reoperation. Their medical records were reviewed retrospectively. RESULTS In the LC only group (n=30), mean age of the 16 pT1 patients was 65.7±12.5 years and mean age of the 14 pT2 patients was 66.7±10.1 years. In the reoperation group (n=34), mean age of the 8 pT1b patients was 52.6±9.9 years and in 26 pT2 patients, mean age was 59.2±7.9 years. The reoperation group showed a younger patient age pattern than the LC only group (p=0.001). The types of reoperation were liver resection with lymph node (LN) dissection in 17, bile duct resection with LN dissection in 2, and hepatectomy and bile duct resection with LN dissection in 15. In the LC only group, the 5-year survival rate (5-YSR) was 70.3% in pT1b and 43.2% in pT2. In the reoperation group, 5-YSR was 62.5% in pT1b (n=8) and 59.5% in pT2 (n=26). A survival comparison between the two groups showed no significant survival gain in pT1 patients (p=0.69) and in pT2 patients (p=0.14). In our whole database analysis, 5-YSR of pT1bNx lesions was 70% after cholecystectomy and 78% after extended cholecystectomy. Lymph node metastasis was identified in 11% of pT1b lesions. For pT2N0 lesions, overall 5-YSR was 62% after R0 resection, showing no survival difference between primary extended surgery and LC-redo operation (p=0.45). CONCLUSIONS The survival gain of reoperation was not evident in pT1b lesions. In contrast, some noticeable but not statistically significant survival difference was observed in pT2 lesions. Thus, reoperation for pT1b/T2 GBC following LC is indicated for individualized reasons, especially in patients with pT1b lesions. Old age was one of the important factors in deciding not to reoperate.
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Affiliation(s)
- Ye-Jong Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Joo Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok-Bog Moon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang-Min Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Hun Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Pottakkat B, Kapoor A, Prakash A, Singh RK, Behari A, Kumar A, Kapoor VK, Saxena R. Evaluation of a prospective surgical strategy of extended resection to achieve R0 status in gall bladder cancer. J Gastrointest Cancer 2013; 44:33-40. [PMID: 22987147 DOI: 10.1007/s12029-012-9432-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Radical resection to achieve R0 status remains the only potential curative option in patients with gall bladder cancer (GBC). This study was aimed to evaluate the efficacy of an extended criterion of radical resection to achieve R0 status in GBC. METHODS A triple-phase CT with 3D reconstruction was done in all patients. A standard resectability criterion was followed in all patients. A minimum of liver segment 4B + 5 resection and radical lymphadenectomy including the para-aortic areas were undertaken in all patients. Adjacent organectomy was added as required. RESULTS Between November 2008 and April 2011, 59 patients with GBC underwent operation and 40 (resectability, 68 %) underwent resection. The resectional procedures performed were segmentectomy 4B + 5 in 31 (78 %), median sectorectomy in 2 (5 %), extended right hepatectomy in 3 (8 %), and hepatopancreaticoduodenectomy in 4 (10 %) patients. Postoperative complications occurred in 24 (60 %) patients. Two patients died postoperatively. A total of 829 lymph nodes were harvested and the median lymph node count was 18 (4-77). Twenty-three (58 %) patients had lymph node metastases. Twenty-eight of 40 (70 %) had disease limited till N1 nodes. Metastases up to N2 lymph nodes were seen in 12 (30 %). American Joint Committee on Cancer seventh edition stages were I-2 (5 %) patients, II-5 (13 %), III-19 (48 %), and IV-14 (35 %). R0 resection was achieved in 33 (83 %) patients. Four patients had recurrence and one died of recurrence. All other patients are alive till the last follow-up. CONCLUSIONS Assessment with triple-phase CT with 3D reconstruction can produce high resectability rate in GBC. Extended criterion of radical resection results in R0 status in more than 80 % of patients with GBC.
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Affiliation(s)
- Biju Pottakkat
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, 226014, UP, India
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Kai K, Masuda M, Ide T, Takase Y, Miyoshi A, Kitahara K, Miyazaki K, Noshiro H, Tokunaga O. Mitotic count reflects prognosis of gallbladder cancer particularly among patients with T3 tumor. Mol Clin Oncol 2013; 1:633-638. [PMID: 24649220 PMCID: PMC3915657 DOI: 10.3892/mco.2013.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 04/05/2013] [Indexed: 02/06/2023] Open
Abstract
The surgical strategy for gallbladder cancer (GBC) depends on the extent of the disease. Thus, the identification of useful prognostic markers exerting strong prognostic impact for each T stage would be beneficial in the development of rational therapeutic strategies. The purpose of this study was to identify useful prognostic markers of GBC for each T stage. CD8+ tumor-infiltrating lymphocytes (TIL), Ki-67 labeling index (LI), p53 nuclear expression and mitotic count (MC) were investigated as candidate prognostic markers. In total, 86 patients with invasive GBC were included. Of the prognostic markers examined, only MC showed a correlation with reduced survival (P=0.0383) in the univariate analysis of overall T stage. In the univariate analysis of T2 stage (n=31), only high p53 expression correlated with survival showing a positive correlation (P=0.0154). In the univariate analysis of T3 stage (n=40), the only factor showing a significant correlation with survival was MC (P=0.0113). Multivariate analysis, including N and M as factors, identified only MC as an independent prognostic factor in T3 stage GBC (P=0.0419). In conclusion, this study demonstrated the strong prognostic impact of MC in GBC, particularly in patients with T3 tumor.
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Affiliation(s)
- Keita Kai
- Departments of Pathology and Microbiology, Saga University, Faculty of Medicine, Saga City, Safa 849-8501, Japan
| | - Masanori Masuda
- Departments of Pathology and Microbiology, Saga University, Faculty of Medicine, Saga City, Safa 849-8501, Japan
| | - Takao Ide
- Surgery, Saga University, Faculty of Medicine, Saga City, Safa 849-8501, Japan
| | - Yukari Takase
- Departments of Pathology and Microbiology, Saga University, Faculty of Medicine, Saga City, Safa 849-8501, Japan
| | - Atsushi Miyoshi
- Surgery, Saga University, Faculty of Medicine, Saga City, Safa 849-8501, Japan
| | - Kenji Kitahara
- Surgery, Saga University, Faculty of Medicine, Saga City, Safa 849-8501, Japan
| | - Kohji Miyazaki
- Surgery, Saga University, Faculty of Medicine, Saga City, Safa 849-8501, Japan
| | - Hirokazu Noshiro
- Surgery, Saga University, Faculty of Medicine, Saga City, Safa 849-8501, Japan
| | - Osamu Tokunaga
- Departments of Pathology and Microbiology, Saga University, Faculty of Medicine, Saga City, Safa 849-8501, Japan
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Gwark SC, Hwang S, Kim KH, Lee YJ, Park KM, Ahn CS, Moon DB, Ha TY, Song GW, Jung DH, Park GC, Lee SG. Extent of resection for T2N0 gallbladder carcinoma regarding concurrent extrahepatic bile duct resection. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:142-6. [PMID: 26388925 PMCID: PMC4574996 DOI: 10.14701/kjhbps.2012.16.4.142] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 10/01/2012] [Accepted: 10/15/2012] [Indexed: 12/12/2022]
Abstract
Backgrounds/Aims Gallbladder carcinoma (GBCa) T2 lesions are considered to be advanced tumors showing diverse features in tumor extent. When this T2 lesion does not involve the cystic duct and there is no evidence of lymph node metastasis, we have to consider what is the most reasonable extent of resection - that is, whether to perform concurrent extra-hepatic bile duct resection (EHBD) resection or not. This study intends to evaluate the adequacy of EHBD resection in patients undergoing resection for T2N0 GBCa. Methods From our institutional database of GBCa, 48 cases of T2N0 GBCa who underwent R0 resection during November 1995 and August 2008 were selected. Patients who underwent prior laparoscopic cholecystectomy were excluded. Their medical records were reviewed retrospectively. Results Their mean age was 63.2±83.3 years and females were 25. The mean serum CA19-9 level was 37.3±89.3 ng/ml. The extents of liver resection were wedge resection (n=36) and segment 4a+5 resection (n=12). Concurrent EHBD resection was performed in 16 (33.3%) patients. No fatal surgical complication occurred. The majority of tumor pathology was adenocarcinoma (n=42), with additional unusual types as papillary (n=3), saromatoid (n=1), signet ring cell (n=1) and adenosquamous (n=1) cancers. The overall survival rate was 87.1% at 1 year, 69.5% at 3 years and 61.7% at 5 years. After exclusion of mortalities not related to cancer, the overall patient survival rate was 89.6% at 1 year, 72.9% at 3 years and 64.7% at 5 years, with 3-year survival rates of 72% in the EHBD resection group and 69.2% in the non-resection group (p=0.661). Conclusions The results of this study indicate that concurrent EHBD resection did not improve patient survival when R0 resection was achieved in patients with T2N0 GBCa. Therefore, routine EHBD resection may not be indicated for T2N0 GBCa unless the tumor is close to the cystic duct.
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Affiliation(s)
- Sung-Chan Gwark
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong-Joo Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang-Min Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok-Bog Moon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Goetze TO, Paolucci V. The prognostic impact of positive lymph nodes in stages T1 to T3 incidental gallbladder carcinoma: results of the German Registry. Surg Endosc 2011; 26:1382-9. [PMID: 22089259 DOI: 10.1007/s00464-011-2044-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 10/25/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the literature, the 5 year survival rates for incidental gallbladder carcinoma (IGBC) show large variations in the different T-stages because the lymph node status often is not addressed. Most early-stage carcinomas are identified by laparoscopy as IGBC, and radical re-resection is needed. Staging is impossible without lymph node dissection, so comparison between various survival rates is impossible. This study aimed to determine the influence of lymph node status on the survival of patients with stages T1 to T3 IGBC. METHODS For data analysis, the German Registry was used. RESULTS In this study, 709 patients with IGBC were analyzed. The re-resected nodal-negative patients had a significant survival advantage over the re-resected nodal-positive patients. The 5 year survival rate for the patients with nodal-negative re-resected T1 carcinomas was 75%. The re-resected T2 and T3 nodal-negative patients had significantly better survival than the corresponding nodal-positive patients. The influence that the radicalness of the different liver resection techniques had on these results was excluded. 53 patients without radical resection had a known nodal-positive status. Nodal-positive patients with radical re-resection always show a better survival rate than nodal-positive patients without radical re-resection, stage for stage. CONCLUSIONS Nodal-positive status is a significant negative prognostic factor in T1 to T3 IGBC. Patients with radical re-resection show a better survival rate than those without it. Lymph node dissection is to be highly recommended up to stage T1b. In the case of T2 carcinomas, lymph node dissection of the hepatoduodenal ligament seems to be the minimum volume of lymph node dissection required, but more radical procedures could be beneficial for tumors infiltrating the serosa or beyond.
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Kai K, Kohya N, Kitahara K, Masuda M, Miyoshi A, Ide T, Tokunaga O, Miyazaki K, Noshiro H. Tumor budding and dedifferentiation in gallbladder carcinoma: potential for the prognostic factors in T2 lesions. Virchows Arch 2011; 459:449-456. [PMID: 21785869 DOI: 10.1007/s00428-011-1131-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 07/10/2011] [Accepted: 07/11/2011] [Indexed: 02/06/2023]
Abstract
Dedifferentiation (DD) is often encountered in gallbladder carcinoma (GBC) and poor prognosis with budding (BD) has been reported for other malignancies. However, the features of DD and BD in GBC remain unclear. The purpose of this study was to clarify the features and prognostic potential of DD and BD in GBC. A total of 80 patients with GBC (excluding intramucosal cancer) were enrolled. DD was histopathologically evaluated as tumors in which the grade of the invasive front is higher than the grade at the surface. BD was defined as an isolated single cancer cell or a cluster of fewer than five cancer cells at the invasive front. Of the 80 patients, 47 (58.8%) were positive for BD and 33 (41.2%) were positive for DD. Both BD and DD correlated significantly with disease-specific survival in univariate analysis (P < 0.0001 and P = 0.0013, respectively), but they were not identified as independent prognostic factors by multivariate analysis. In univariate analysis according to T stage, both BD and DD correlated significantly with survival in patients with T2 (n = 32) tumor (P = 0.0011 and P = 0.0018, respectively), whereas no prognostic impact in patients with T1b (n = 8), T3 (n = 34), or T4 (n = 6) tumor. Both DD and BD are frequently observed in GBC and reflect prognosis, particularly for T2 lesions. Therefore, the status of BD and DD should be taken into consideration in pathological reports on GBC.
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Affiliation(s)
- Keita Kai
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Nabesima 5-1-1, Saga City, Saga, 849-8501, Japan.
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Li J, Hou Y, Gao HB, Liu B. Advanced gallbladder cancer infiltrating the hilar bile duct: an analysis of 15 cases. Shijie Huaren Xiaohua Zazhi 2011; 19:1307-1310. [DOI: 10.11569/wcjd.v19.i12.1307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To discuss the value of surgery in the management of advanced gallbladder cancer infiltrating the hilar bile duct.
METHODS: The clinical data for 30 patients with advanced gallbladder cancer infiltrating the hilar bile duct who underwent surgery were analyzed retrospectively, and the survival of patients with and without surgical management was compared.
RESULTS: The median survival time for patients undergoing extended radical resection was longer than that for patients undergoing palliative resection, bile duct drainage or conservative treatment (16 mo ± 6.1 mo vs 16 mo ± 1.1 mo, 6 mo ± 0.77 mo, 2 mo ± 0.45 mo, all P < 0.01). Decline in bilirubin and improvement of nutrition were better in patients undergoing palliative resection than in those undergoing bile duct drainage.
CONCLUSION: Extended radical resection should be considered for patients with advanced gallbladder cancer infiltrating the hilar bile duct since it could offer a chance for prolonged survival. Palliative resection did not contribute to long-term survival but could better improve the quality of life of patients with advanced gallbladder cancer infiltrating the hilar bile duct than bile duct drainage.
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Lee SE, Jang JY, Lim CS, Kang MJ, Kim SW. Systematic review on the surgical treatment for T1 gallbladder cancer. World J Gastroenterol 2011; 17:174-80. [PMID: 21245989 PMCID: PMC3020370 DOI: 10.3748/wjg.v17.i2.174] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 09/09/2010] [Accepted: 09/16/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the efficacy of simple and extended cholecystectomy for mucosa (T1a) or muscularis (T1b) gallbladder (GB) cancer.
METHODS: Original studies on simple and extended cholecystectomy for T1a or T1b GB cancer were searched from MEDLINE (PubMed), Cochrane Library, EMBase, and CancerLit using the search terms of GB, cancer/carcinoma/tumor/neoplasm.
RESULTS: Twenty-nine out of the 2312 potentially relevant publications met the eligibility criteria. Of the 1266 patients with GB cancer included in the publications, 706 (55.8%) and 560 (44.2%) had T1a and T1b GB cancer, respectively. Simple cholecystectomy for T1a and T1b GB cancer was performed in 590 (83.6%) and 375 (67.0%) patients, respectively (P < 0.01). In most series, the treatment of choice was simple cholecystectomy for T1a GB cancer patients with a 5-year survival rate of 100%. Lymph node metastasis was detected in 10.9% of the T1b GB cancer patients and in 1.8% of the T1a GB cancer patients, respectively (P < 0.01). Eight patients (1.1%) with T1a GB cancer and 52 patients (9.3%) with T1b GB cancer died of recurrent GB cancer (P < 0.01).
CONCLUSION: Simple cholecystectomy represents the adequate treatment of T1a GB cancer. There is no definite evidence that extended cholecystectomy is advantageous over simple cholecystectomy for T1b GB cancer.
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Reply to Letter to the Editor. World J Surg 2010. [DOI: 10.1007/s00268-010-0540-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Choi SB, Han HJ, Kim CY, Kim WB, Song TJ, Suh SO, Kim YC, Choi SY. Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg 2010; 33:2657-63. [PMID: 19823903 DOI: 10.1007/s00268-009-0249-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the treatment of choice for benign gallbladder disease. Gallbladder cancers have been found following LC. The aim of the present study was to evaluate the survival outcome and prognosis of incidental gallbladder cancer diagnosed after LC. METHODS From January 2002 to December 2007, 3,145 patients underwent LC at the Department of Surgery, Korea University Medical Center. Of these, 33 patients (1.05%) were diagnosed with gallbladder cancer after LC. Clinicopathological characteristics were retrospectively reviewed in this study. RESULTS Of the 33 patients studied, 9 were men and 24 were women. Laparoscopic cholecystectomy alone was performed in 26 patients, and additional radical surgery was performed in 7 others. Regarding tumor staging, there were 2 Tis, 6 T1a, 4 T1b, 17 T2, and 4 T3 tumors. Male patients had a significantly higher incidence of moderately and poorly differentiated tumors (P < 0.001), T2 and T3 tumors (P = 0.02), additional second operations (P = 0.046), and recurrence (P = 0.016). The cumulative 1-, 3-, and 5-year survival rates were 87.2, 73.1, and 47.0%, respectively. Univariate analysis revealed that significant prognostic factors for poorer survival were male gender (P = 0.026), age older than 65 years (P = 0.013), the presence of inflammation (P = 0.009), moderately or poorly differentiated tumor (P < 0.001), nonpolypoid gross type (P = 0.003), and pT stage (P < 0.001). Tumor differentiation was a significantly independent predictor of poor prognosis. CONCLUSIONS Male patients exhibited aggressive tumor characteristics. Laparoscopic cholecystectomy is an adequate treatment for pT1 tumors. For pT2 and pT3 patients, additional radical surgery might be needed to achieve a tumor-free surgical margin, along with lymph node dissection.
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Affiliation(s)
- Sae Byeol Choi
- Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Korea University Guro Hospital, 80 Gurodong, Guro-gu, Seoul, Korea.
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Kohya N, Kitahara K, Miyazaki K. Rational therapeutic strategy for T2 gallbladder carcinoma based on tumor spread. World J Gastroenterol 2010; 16:3567-72. [PMID: 20653066 PMCID: PMC2909557 DOI: 10.3748/wjg.v16.i28.3567] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the adequacy of surgical treatment of T2 gallbladder carcinoma (GBCa) according to tumor spread in the subserosal layer.
METHODS: A series of 84 patients with GBCa were treated at Saga University Hospital, Japan between April 1989 and October 2008. The tumor stage was graded according to the TNM staging for GBCa from the American Joint Committee on Cancer Manual 6th edition. Tumor staging revealed 30 patients with T2 tumors. T2 GBCa was divided into three groups histologically by the extent of tumor spread in the subserosal layer, using a score of ss minimum (ss min), ss medium (ss med) or ss massive (ss mas).
RESULTS: For ss min GBCa, there was no positive pathological factor and patient survival was satisfactory with simple cholecystectomy, with or without extra-hepatic bile duct resection. For ss med GBCa, some pathological factors, h-inf (hepatic infiltration), ly (lymphatic invasion) and n (lymph node metastasis), were positive. For ss mas GBCa, there was a high incidence of positive pathological factors. The patient group with extra-hepatic bile duct resection with D2 lymph node dissection (BDR with D2) and those with S4a5 hepatectomy had significantly better survival rates.
CONCLUSION: We suggest that radical surgery is not necessary for ss min GBCa, and partial hepatectomy and BDR are necessary for both ss med and ss mas GBCa.
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Choi SB, Han HJ, Kim CY, Kim WB, Song TJ, Suh SO, Kim YC, Choi SY. Surgical outcomes and prognostic factors for T2 gallbladder cancer following surgical resection. J Gastrointest Surg 2010; 14:668-78. [PMID: 20033339 DOI: 10.1007/s11605-009-1132-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 12/04/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Depth of tumor invasion is an important prognostic factor for gallbladder cancer. The aim of this study was to investigate the clinicopathological prognostic factors of T2 gallbladder cancer. METHODS We retrospectively reviewed the clinicopathological data and survival for 83 patients with T2 gallbladder cancers who underwent surgical resection between January 1995 and December 2007. RESULTS The overall survival rates were 48.9% at 3 years and 29.3% at 5 years. Univariate analysis revealed that R0 resection (P < 0.001), extended surgery (P = 0.028), lymph node dissection (P = 0.024), non-infiltrative tumors (P = 0.001), well differentiation (P = 0.001), absence of lymphatic (P = 0.025), perineural (P = 0.001), and vascular (P = 0.025) invasion, absence of lymph node metastasis (P = 0.001), negative resection margin (P = 0.016), and stage (P = 0.002) were significantly better predictors for survival. A significant difference in survival between Rx and R1 was not found. R0 resection, lymph node dissection, well differentiation, and absence of perineural and vascular invasion were significantly independent prognostic factors for overall survival. Recurrence occurred in 48 patients (57.8%). Age older than 65 years, R0 resection, non-infiltrative tumors, and good differentiation were significant independent predictors of disease-free survival by multivariate analysis. CONCLUSIONS For T2 tumors, radical surgery including lymph node dissection should be performed to achieve R0 resection. Tumors with infiltrative types and suspicious lymph node metastasis in the intraoperative findings were candidates for aggressive surgical management to improve patient survival.
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Affiliation(s)
- Sae Byeol Choi
- Department of Surgery, Korea University College of Medicine, Korea University Guro Hospital, 80 Gurodong, Guro-gu, Seoul, Korea
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Goetze TO, Paolucci V. Adequate extent in radical re-resection of incidental gallbladder carcinoma: analysis of the German Registry. Surg Endosc 2010; 24:2156-64. [PMID: 20177938 DOI: 10.1007/s00464-010-0914-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 10/09/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND Complete surgical resection is the only potentially curative treatment of gallbladder cancer. Gallbladder carcinoma is suspected preoperatively in 30% of patients, and 70% are incidentally discovered by the pathologist (incidental gallbladder carcinoma, IGBC). If IGBC is detected postoperatively, a re-resection, including liver resection and lymph node dissection, in T2 tumor cases and more advanced stages is recommended. It remains unclear whether the prognosis of wedge resection (2-3-cm margin) of the gallbladder bed is the same as that of resection of segments IVb/V. METHODS The German Registry, founded in 1997, aims to prospectively record all IGBC cases in Germany. In this study patients with a radical re-resection were treated according to the S3 Guidelines in Germany. The aim of this study was to clarify whether different techniques of liver re-resection show comparable results or if they differ depending on the tumor stage in IGBC patients (n = 624). RESULTS A significant survival advantage in patients who have an early re-resection was observed. There was a trend of better survival in T1 tumor stage patients who undergo the less radical re-resection, especially the wedge-resection technique of 3 cm in the gallbladder bed. In T2 tumor stage patients there is a tendency for better survival with the IVb/V-resection technique compared to the 3-cm wedge resection in the gallbladder bed, and a significant survival benefit for these two techniques compared to less radical resection was evident. T3 tumor cases showed better survival with the more radical resection techniques. CONCLUSIONS The wedge-resection technique combined with lymph node dissection may be the surgical strategy of choice in T1 tumor cases. For T2 tumors, IVb/V resection combined with lymph node dissection of the hepatoduodenal ligament appears to be the minimum volume of resection required. More radical procedures are needed for tumors infiltrating the serosa or beyond.
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Dai M, Fong Y, Lowy A. Treatment of T3 gallbladder cancer. J Gastrointest Surg 2009; 13:2040-2. [PMID: 19194769 DOI: 10.1007/s11605-009-0810-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 01/12/2009] [Indexed: 02/06/2023]
Abstract
Until recently, advanced stage gallbladder cancer has been viewed with great pessimism and many patients abandoned as without potentially curative treatment option. Recent results have significantly improved due to a number of advances. Improvements in radiologic staging including positron emission tomography now allow selection of patients with disease treatable by local regional resection. With improvements in surgical and anesthetic techniques, aggressive surgery has proven T3 and T4 tumors to be resectable with safety and result in long-term survival.
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Affiliation(s)
- Menghua Dai
- Department of Surgery, Peking Union Medical College Hospital, Tsinghua University, Beijing, People's Republic of China
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Pilgrim CHC, Usatoff V, Evans P. Consideration of anatomical structures relevant to the surgical strategy for managing gallbladder carcinoma. Eur J Surg Oncol 2009; 35:1131-6. [PMID: 19297118 DOI: 10.1016/j.ejso.2009.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 01/24/2009] [Accepted: 02/02/2009] [Indexed: 12/12/2022] Open
Abstract
AIMS Gallbladder carcinoma usually presents late with advanced disease. It develops in an anatomically complex area. Consideration is given to resection of relevant local structures with respect to outcome. METHODS A comprehensive literature review was performed, searching Medline for articles published since 2000, using the MeSH heading of 'gallbladder cancer' and 'surgery'. Abstracts were reviewed and articles retrieved if the main focus of the article centred on the surgical management of gallbladder carcinoma. OBSERVATIONS Hepatic resection is advocated and tailored to pathological T stage. Lymph node dissection and bile duct resection, as well as en bloc resection of other viscera, remain areas of controversy. CONCLUSIONS Eastern and Western practice standards of care differ, but hepatic resection with some lymph node dissection is present in both approaches. Philosophy regarding aggression with respect to en bloc resection of adjacent organs and actual extent of lymphatic resection remains disparate.
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Affiliation(s)
- Charles H C Pilgrim
- The Alfred Hospital, Upper Gastrointestinal Surgery, Commercial Rd, Melbourne, VIC 3000, Australia.
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Pilgrim C, Usatoff V, Evans PM. A review of the surgical strategies for the management of gallbladder carcinoma based on T stage and growth type of the tumour. Eur J Surg Oncol 2009; 35:903-7. [PMID: 19261430 DOI: 10.1016/j.ejso.2009.02.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 12/18/2008] [Accepted: 02/02/2009] [Indexed: 02/06/2023] Open
Abstract
AIMS Surgery for gallbladder carcinoma is a technically challenging exercise. The extent of resection varies based on a number of factors, and controversy exists regarding what constitutes an acceptable resection. A review of current recommendations and practice was undertaken. METHODS A comprehensive literature review was performed, searching Medline for articles published since 2000, using the MeSH heading of 'gallbladder cancer' and 'surgery'. Abstracts were reviewed and articles retrieved if the main focus of the article centred on the surgical management of gallbladder carcinoma. OBSERVATIONS The extent of hepatic resection and lymph node dissection required varies in particular with T stage. Growth pattern and anatomical location of the tumour within the gallbladder also influence surgical management. CONCLUSIONS Discrepancy exists between the Eastern and Western literature in terms of what constitutes an acceptable limit of resection, and these issues are discussed.
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Affiliation(s)
- C Pilgrim
- The Alfred Hospital, Upper Gastrointestinal Surgery, Commercial Rd, Melbourne, VIC 3000, Australia.
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D'Angelica M, Dalal KM, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR. Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncol 2008; 16:806-16. [PMID: 18985272 DOI: 10.1245/s10434-008-0189-3] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Revised: 09/22/2008] [Accepted: 09/22/2008] [Indexed: 02/06/2023]
Abstract
Gallbladder cancer has historically been considered an incurable malignancy; although, extended resection has been associated with cure in selected patients. However, the optimal extent of resection is unknown. The objective of this study was to analyze the impact of the extent of resection for gallbladder adenocarcinoma on disease-specific survival (DSS) and perioperative morbidity. Analysis of a prospective hepatobiliary surgery database identified patients undergoing surgical resection for gallbladder adenocarcinoma from 1990 to 2002. Clinicopathologic factors including extent of resection were analyzed for their association with DSS and perioperative morbidity. Long-term outcome was evaluable in 104 patients. With median follow-up of 58 months for survivors, the actuarial 5-year DSS was 42%. Thirty-six patients (35%) underwent major hepatectomy, but in 15 this was not mandatory to clear all disease. Sixty-eight patients (65%) underwent common bile duct (CBD) excision, but 32 were performed empirically. Twenty-one patients (20%) underwent en bloc resection of adjacent organs other than the liver. The performance of a major hepatectomy or a CBD excision was not associated with other clinicopathologic variables or long-term survival. Resection of adjacent organs were associated with advanced T stage but not with survival. T stage, N stage, histologic differentiation, and CBD involvement were independently associated with survival. Major hepatectomy and CBD excision were significantly associated with perioperative morbidity. We conclude that tumor biology and stage, rather than extent of resection, predict outcome after resection for gallbladder cancer. Major hepatic resections, including major hepatectomy and CBD excision, are appropriate when necessary to clear disease but are not mandatory in all cases.
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Affiliation(s)
- Michael D'Angelica
- Hepatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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