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Updates on Gallbladder Cancer Management

  • Gastrointestinal Cancers (J Meyer, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We will review the current standard of care management for metastatic gallbladder cancer (GBC), recommendations for resection of incidentally or non-incidentally diagnosed GBC, and developments in preoperative risk stratification and adjuvant chemotherapy.

Recent Findings

Gemcitabine-cisplatin is the standard of care therapy for advanced-stage disease. Patients with incidentally diagnosed GBC should undergo re-resection for T1b, T2, or T3 disease. The presence of residual disease is associated with decreased survival. Diagnostic laparoscopy should be used in select patients to avoid unnecessary laparotomy. Major hepatectomy and common bile duct excision should only be performed in select cases. Current standard of care for adjuvant therapy includes 6 months of oral capecitabine.

Summary

Gallbladder cancer continues to carry high mortality rates due to its aggressive course and early spread. Recent developments in preoperative risk stratification, surgical resection, and chemotherapy have greatly shaped management of this malignancy in the current era.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Butte JM, Matsuo K, Gönen M, D’Angelica MI, Waugh E, Allen PJ, et al. Gallbladder cancer: differences in presentation, surgical treatment, and survival in patients treated at centers in three countries. J Am Coll Surg. 2011;212(1):50–61. https://doi.org/10.1016/j.jamcollsurg.2010.09.009.

    Article  PubMed  Google Scholar 

  2. Duffy A, Capanu M, Abou-Alfa GK, Huitzil D, Jarnagin W, Fong Y, et al. Gallbladder cancer (GBC): 10-year experience at memorial Sloan-Kettering cancer Centre (MSKCC). J Surg Oncol. 2008;98(7):485–9. https://doi.org/10.1002/jso.21141.

    Article  CAS  PubMed  Google Scholar 

  3. Miller G, Jarnagin WR. Gallbladder carcinoma. Eur J Surg Oncol. 2008 Mar;34(3):306–12. https://doi.org/10.1016/j.ejso.2007.07.206.

    Article  CAS  PubMed  Google Scholar 

  4. Kapoor VK, Pradeep R, Haribhakti SP, Singh V, Sikora SS, Saxena R, et al. Intrahepatic segment III cholangiojejunostomy in advanced carcinoma of the gallbladder. Br J Surg. 1996;83(12):1709–11. https://doi.org/10.1002/bjs.1800831215.

    Article  CAS  PubMed  Google Scholar 

  5. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, et al. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med. 2010;362(14):1273–81. https://doi.org/10.1056/NEJMoa0908721.

    Article  CAS  PubMed  Google Scholar 

  6. Valle JW, Furuse J, Jitlal M, Beare S, Mizuno N, Wasan H, et al. Cisplatin and gemcitabine for advanced biliary tract cancer: a meta-analysis of two randomised trials. Ann Oncol. 2014;25(2):391–8. https://doi.org/10.1093/annonc/mdt540.

    Article  CAS  PubMed  Google Scholar 

  7. Agarwal R, Sendilnathan A, Siddiqi NI, Gulati S, Ghose A, Xie C, et al. Advanced biliary tract cancer: clinical outcomes with ABC-02 regimen and analysis of prognostic factors in a tertiary care center in the United States. J Gastrointest Oncol. 2016;7(6):996–1003. https://doi.org/10.21037/jgo.2016.09.10.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kameda R, Ando T, Kobayashi S, Ueno M, Ohkawa S. A retrospective study of chemotherapy with cisplatin plus gemcitabine after the failure of gemcitabine monotherapy for biliary tract cancer. Jpn J Clin Oncol. 2013 Jun;43(6):636–40. https://doi.org/10.1093/jjco/hyt059.

    Article  PubMed  Google Scholar 

  9. Morise Z, Sugioka A, Tanahashi Y, Okabe Y, Ikeda M, Kagawa T, et al. Treatment of patients with unresectable advanced carcinoma of biliary tract—chemotherapy and surgical resection. Anticancer Res. 2009;29(5):1783–6.

    CAS  PubMed  Google Scholar 

  10. Ina S, Tani M, Kawai M, Hirono S, Miyazawa M, Nishioka R, et al. Phase 2 trial of oral S-1 combined with low-dose cisplatin for unresectable advanced pancreatic cancer. Anticancer Res. 2008;28(4C):2373–7.

    CAS  PubMed  Google Scholar 

  11. AJCC. Cancer Staging Manual. 8th ed. 2017.

  12. Principe A, Del Gaudio M, Ercolani G, Golfieri R, Cucchetti A, Pinna AD. Radical surgery for gallbladder carcinoma: possibilities of survival. Hepato-Gastroenterology. 2006;53(71):660–4.

    PubMed  Google Scholar 

  13. Pawlik TM, Gleisner AL, Vigano L, Kooby DA, Bauer TW, Frilling A, et al. Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection. J Gastrointest Surg. 2007;11(11):1478–86; discussion 1486-7. https://doi.org/10.1007/s11605-007-0309-6.

    Article  PubMed  Google Scholar 

  14. Butte JM, Kingham TP, Gönen M, D’Angelica MI, Allen PJ, Fong Y, et al. Residual disease predicts outcomes after definitive resection for incidental gallbladder cancer. J Am Coll Surg. 2014 Sep;219(3):416–29. https://doi.org/10.1016/j.jamcollsurg.2014.01.069.

    Article  PubMed  PubMed Central  Google Scholar 

  15. • Aloia TA, Járufe N, Javle M, Maithel SK, Roa JC, Adsay V, et al. Gallbladder cancer: expert consensus statement. HPB (Oxford). 2015;17(8):681–90. https://doi.org/10.1111/hpb.12444. This is a recently published consensus statement on the management of gallbladder cancer across multiple disciplines addressing current standards of care and areas of controversy.

    Article  PubMed Central  Google Scholar 

  16. • Ethun CG, Postlewait LM, Le N, Pawlik TM, Buettner S, Poultsides G, et al. A novel pathology-based preoperative risk score to predict locoregional residual and distant disease and survival for incidental gallbladder cancer: a 10-institution study from the U.S. extrahepatic biliary malignancy consortium. Ann Surg Oncol. 2017;24(5):1343–50. https://doi.org/10.1245/s10434-016-5637-x. This study represents one of several studies published from a recent multi-institutional biliary malignancy collaborative analyzing clinicopathologic variables and outcomes.

    Article  PubMed  Google Scholar 

  17. Butte JM, Gönen M, Allen PJ, D’Angelica MI, Kingham TP, Fong Y, et al. The role of laparoscopic staging in patients with incidental gallbladder cancer. HPB (Oxford). 2011;13(7):463–72. https://doi.org/10.1111/j.1477-2574.2011.00325.

    Article  Google Scholar 

  18. Viganò L, Ferrero A, Amisano M, Russolillo N, Capussotti L. Comparison of laparoscopic and open intraoperative ultrasonography for staging liver tumours. Br J Surg. 2013;100(4):535–19. https://doi.org/10.1002/bjs.9025.

    Article  PubMed  Google Scholar 

  19. 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. 2009;16(4):806–16. https://doi.org/10.1245/s10434-008-0189-3.

    Article  PubMed  Google Scholar 

  20. Pawlik TM, Choti MA. Biology dictates prognosis following resection of gallbladder carcinoma: sometimes less is more. Ann Surg Oncol. 2009;16(4):787–8. https://doi.org/10.1245/s10434-009-0319-6.

    Article  PubMed  Google Scholar 

  21. Dixon E, Vollmer CM Jr, Sahajpal A, Cattral M, Grant D, Doig C, et al. An aggressive surgical approach leads to improved survival in patients with gallbladder cancer: a 12-year study at a North American Center. Ann Surg. 2005;241(3):385–94. https://doi.org/10.1097/01.sla.0000154118.07704.ef.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gani F, Buettner S, Margonis GA, Ethun CG, Poultsides G, Tran T, et al. Assessing the impact of common bile duct resection in the surgical management of gallbladder cancer. J Surg Oncol. 2016;114(2):176–80. https://doi.org/10.1002/jso.24283.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ito H, Ito K, D’Angelica M, Gonen M, Klimstra D, Allen P, et al. Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg. 2011;254(2):320–5. https://doi.org/10.1097/SLA.0b013e31822238d8.

    Article  PubMed  Google Scholar 

  24. Paolucci V. Port site recurrences after laparoscopic cholecystectomy. J Hepato-Biliary-Pancreat Surg. 2001;8(6):535–43. Review. https://doi.org/10.1007/s005340100022.

    Article  CAS  Google Scholar 

  25. Varshney S, Butturini G, Gupta R. Incidental carcinoma of the gallbladder. Eur J Surg Oncol. 2002;28(1):4–10. Review. Erratum in: Eur J Surg Oncol. 2006 Nov;32(9):II. Buttirini, G [corrected to Butturini, G]. https://doi.org/10.1053/ejso.2001.1175.

    Article  CAS  PubMed  Google Scholar 

  26. Rathanaswamy S, Misra S, Kumar V, Chintamani PJ, Agarwal A, Gupta S. Incidentally detected gallbladder cancer- the controversies and algorithmic approach to management. Indian J Surg. 2012;74(3):248–54. https://doi.org/10.1007/s12262-012-0592-7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Maker AV, Butte JM, Oxenberg J, Kuk D, Gonen M, Fong Y, et al. Is port site resection necessary in the surgical management of gallbladder cancer? Ann Surg Oncol. 2012;19(2):409–17. https://doi.org/10.1245/s10434-011-1850-9.

    Article  PubMed  Google Scholar 

  28. Ethun CG, Postlewait LM, Le N, Pawlik TM, Poultsides G, Tran T, et al. Routine port-site excision in incidentally discovered gallbladder cancer is not associated with improved survival: a multi-institution analysis from the US Extrahepatic Biliary Malignancy Consortium. J Surg Oncol. 2017;115(7):805–11. https://doi.org/10.1002/jso.24591.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Fuks D, Regimbeau JM, Pessaux P, Bachellier P, Raventos A, Mantion G, et al. Is port-site resection necessary in the surgical management of gallbladder cancer? J Visc Surg. 2013;150(4):277–84. https://doi.org/10.1016/j.jviscsurg.2013.03.006.

    Article  CAS  PubMed  Google Scholar 

  30. Chen GL, Akmal Y, DiFronzo AL, Vuong B, O’Connor V. Porcelain gallbladder: no longer an indication for prophylactic cholecystectomy. Am Surg. 2015;81(10):936–40.

    PubMed  Google Scholar 

  31. Babu BI, Dennison AR, Garcea G. Management and diagnosis of gallbladder polyps: a systematic review. Langenbeck’s Arch Surg. 2015;400(4):455–62. https://doi.org/10.1007/s00423-015-1302-2.

    Article  Google Scholar 

  32. Hawkins WG, DeMatteo RP, Jarnagin WR, Ben-Porat L, Blumgart LH, Fong Y. Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer. Ann Surg Oncol. 2004;11(3):310–5. https://doi.org/10.1245/ASO.2004.03.011.

    Article  PubMed  Google Scholar 

  33. Tran TB, Norton JA, Ethun CG, Pawlik TM, Buettner S, Schmidt C, et al. Gallbladder cancer presenting with jaundice: uniformly fatal or still potentially curable? J Gastrointest Surg. 2017;21(8):1245–53. https://doi.org/10.1007/s11605-017-3440-z.

    Article  PubMed  Google Scholar 

  34. Jarnagin WR, Ruo L, Little SA, Klimstra D, D’Angelica M, DeMatteo RP, et al. Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer. 2003;98(8):1689–700. https://doi.org/10.1002/cncr.11699.

    Article  PubMed  Google Scholar 

  35. Kim WS, Choi DW, You DD, Ho CY, Heo JS, Choi SH. Risk factors influencing recurrence, patterns of recurrence, and the efficacy of adjuvant therapy after radical resection for gallbladder carcinoma. J Gastrointest Surg. 2010;14(4):679–87. https://doi.org/10.1007/s11605-009-1140-z.

    Article  PubMed  Google Scholar 

  36. Margonis GA, Gani F, Buettner S, Amini N, Sasaki K, Andreatos N, et al. Rates and patterns of recurrence after curative intent resection for gallbladder cancer: a multi-institution analysis from the US Extra-hepatic Biliary Malignancy Consortium. HPB. 2016;18(11):872–8. https://doi.org/10.1016/j.hpb.2016.05.016.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Mayo SC, Shore AD, Nathan H, Edil B, Wolfgang CL, Hirose K, et al. National trends in the management and survival of surgically managed gallbladder adenocarcinoma over 15 years: a population-based analysis. J Gastrointest Surg. 2010;14(10):1578–91. https://doi.org/10.1007/s11605-010-1335-3.

    Article  PubMed  Google Scholar 

  38. Takada T, Amano H, Yasuda H, Nimura Y, Matsushiro T, Kato H, et al. Study group of surgical adjuvant therapy for carcinomas of the pancreas and biliary tract. Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma? A phase III multicenter prospective randomized controlled trial in patients with resected pancreaticobiliary carcinoma. Cancer. 2002;95(8):1685–95. https://doi.org/10.1002/cncr.10831.

    Article  PubMed  Google Scholar 

  39. Ma N, Cheng H, Qin B, Zhong R, Wang B. Adjuvant therapy in the treatment of gallbladder cancer: a meta-analysis. BMC Cancer. 2015;15(1):615. https://doi.org/10.1186/s12885-015-1617-y.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Edelin J, et al. Gemox versus surveillance following surgery of localized biliary tract cancer: results of the PRODIGE 12-ACCORD 18 (UNICANCER GI) phase III trial. J Clin Oncol. 2017;35(Suppl 4):225. https://doi.org/10.1200/JCO.2017.35.4_suppl.225.

    Article  Google Scholar 

  41. • Primrose JN. et al. Adjuvant capecitabine for biliary tract cancer: The BILCAP randomized study. J Clin Oncol. 2017;35(Suppl 15): 4006-4006. This is a recently reported phase III randomized control trial of patients treated with adjuvant capecitabine demonstrating an improvement in median OS and RFS compared to observation alone.

  42. Wang J, Narang AK, Sugar EA, Luber B, Rosati LM, Hsu CC, et al. Evaluation of adjuvant radiation therapy for resected gallbladder carcinoma: a multi-institutional experience. Ann Surg Oncol. 2015;22(Suppl 3):S1100–6. https://doi.org/10.1245/s10434-015-4685-y.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, 1365C Clifton Road NE Building C, 2nd Floor, Atlanta, GA, 30322, USA

    Mohammad Yahya Zaidi & Shishir K. Maithel

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  1. Mohammad Yahya Zaidi
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  2. Shishir K. Maithel
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Correspondence to Shishir K. Maithel.

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Mohammad Yahya Zaidi and Shishir K. Maithel declare they have no conflict of interest.

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This article is part of the Topical Collection on Gastrointestinal Cancers

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Zaidi, M.Y., Maithel, S.K. Updates on Gallbladder Cancer Management. Curr Oncol Rep 20, 21 (2018). https://doi.org/10.1007/s11912-018-0664-3

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