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Resectional surgery in gallbladder cancer with jaundice—how to improve the outcome?

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Abstract

Purpose

To evaluate the surgical outcomes of patients with gallbladder cancer (GBC) with jaundice due to as-yet unelucidated prognostic factors.

Methods

A total of 348 GBC patients underwent resection at our institute between 1985 and 2016. Of these, 67 had jaundice (serum total bilirubin ≥ 2 mg/dL). Preoperative biliary drainage was performed, with portal vein embolization as required. All patients underwent radical surgery. We retrospectively evaluated the outcomes, performed multivariate analysis for overall survival, and compared our findings to those reported in the literature.

Results

The 5-year survival rate of M0 (no distant metastasis) GBC patients with jaundice, who underwent resectional surgery, was 21.9%, versus 68.3% in those without jaundice (p < 0.05). Since 2000, surgical mortality in GBC patients with jaundice has decreased from 12 to 6.8%. Patients with jaundice had more advanced disease and underwent major hepatectomies and vascular resections; however, preoperative jaundice alone was not a prognostic factor. Multivariate analysis of jaundiced patients revealed that percutaneous biliary drainage (PTBD) (vis-à-vis endoscopic drainage [EBD], hazard ratio [HR] 2.82), postoperative morbidity (Clavien–Dindo classification ≥ 3, HR 2.31), and distant metastasis (HR 1.85) were predictors of poor long-term survival. The 5-year survival and peritoneal recurrence rates in M0 patients with jaundice were 16% and 44%, respectively, for patients with PTBD and 39% (p < 0.05) and 13% (p = 0.07) for those with EBD.

Conclusion

M0 GBC patients with jaundice should undergo surgery if R0 resection is possible. Preoperative EBD may be superior to PTBD in M0 GBC patients with jaundice, although further studies are needed.

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Funding

This work was supported by the JSPS KAKENHI (grant number 18K08632).

Author information

Authors and Affiliations

  1. Department of Surgery, Institute of Gastroenterology, Tokyo Womens’ Medical University Hospital, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Rahul K. Chaudhary, Ryota Higuchi, Takehisa Yazawa, Shuichirou Uemura, Wataru Izumo, Yutaro Matsunaga, Erika Nagano & Masakazu Yamamoto

  2. Department of Public Health, Tokyo Women’s Medical University Hospital, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Yasuto Sato

  3. Department of Surgery, Ebara Hospital, Higashiyukigaya, Ota-ku, Tokyo, 145-0065, Japan

    Takehiro Ota

  4. Department of Investigative Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai, 980-8575, Japan

    Toru Furukawa

Authors
  1. Rahul K. Chaudhary
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  2. Ryota Higuchi
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  11. Masakazu Yamamoto
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Contributions

RKC, RH, and MY conceptualized the study design and wrote the article. TY, SU, WI, YM, EN, and TO helped with data collection and surgeries, along with RH, MY, and RKC. TF helped with pathology. YS provided advice on the statistics.

Corresponding author

Correspondence to Ryota Higuchi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was approved by the institutional review board of Tokyo Women’s Medical University (approval number: 4328-R). The study was a retrospective analysis of a prospectively maintained database. The procedures followed were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate

The need for informed consent was waived because this was a retrospective chart review analysis.

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Summary

In this study, we present our experience of over 40 years in managing patients with gallbladder cancer with jaundice who underwent resectional surgery. The importance of this article is that it focusses on identifying patients and practices that may result in long-term survival in these patients.

Supplementary information

Supplemental Table 1

Univariate and multivariate analyses of prognostic factors for overall survival in patients with gallbladder cancer (GBC) (DOCX 19 kb).

Supplemental Table 2

Background in M0 gallbladder cancer (GBC) patients with jaundice without surgical mortality depending on the type of drainage (DOCX 22 kb).

Supplemental Table 3

Postoperative recurrence in M0 gallbladder cancer (GBC) patients with jaundice excluding surgical mortality depending on the type of drainage (DOCX 16 kb).

Supplemental Table 4

Details of long-term survivors among patients with jaundice (DOCX 16 kb).

Supplementary Figure 1

Overall survival in patients with gallbladder cancer with jaundice depending on the time of the surgery (JPG 67 kb).

Supplementary Figure 2

Overall survival in M0 patients with gallbladder cancer with jaundice depending on the time of the surgery (JPG 72 kb).

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Cite this article

Chaudhary, R.K., Higuchi, R., Yazawa, T. et al. Resectional surgery in gallbladder cancer with jaundice—how to improve the outcome?. Langenbecks Arch Surg 406, 791–800 (2021). https://doi.org/10.1007/s00423-020-02075-8

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  • DOI: https://doi.org/10.1007/s00423-020-02075-8

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