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Factors that Minimize Curative Resection for Gallbladder Adenocarcinoma: an Analysis of Clinical Decision-Making and Survival

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Gallbladder adenocarcinoma has a poor prognosis as it is often diagnosed incidentally, and patients have a high risk for residual and occult metastatic disease. Expert guidelines recommend definitive surgery for ≥T1b tumors; however, surgical management is inconsistent. This study evaluates the factors that affect the completion of radical resection with portal lymphadenectomy and its impact on survival.

Methods

A retrospective review of patients who underwent surgery for gallbladder cancer from 2008 to 2017 at an academic institution was performed. Patients were analyzed based on whether they underwent definitive surgical resection. Patient factors and clinical decision-making were analyzed; overall survival was compared using Kaplan-Meier analysis.

Results

Seventy-five patients with ≥T1b tumors were identified, of who 32 (42.7%) underwent definitive resection. Fifty-four (72%) patients had gallbladder cancer identified as an incidental diagnosis following laparoscopic cholecystectomy. Among patients who did not undergo definitive resection, the underlying factors were varied. Only 24 (55.8%) patients in the non-definitive resection group were seen by surgical oncology. Among patients who underwent re-operation for definitive resection, 12 (38.7%) were upstaged on final pathology. Of the 43 patients who did not undergo definitive resection, 4 (9.3%) had metastatic disease identified during attempted re-resection. Patients who underwent definitive resection had a significantly longer median overall survival compared to those who did not (4.3 v. 1.9 years, p = 0.02).

Conclusions

Patients undergoing definitive resection have a significantly improved survival, including as part of a re-operative strategy. Universal referral to a surgical specialist is a modifiable factor resulting in increased definitive resection rates.

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References

  1. Goetze TO. Gallbladder carcinoma: Prognostic factors and therapeutic options. World J Gastroenterol. 2015;21(43):12211-12217. doi: https://doi.org/10.3748/wjg.v21.i43.12211.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Toyonaga T, Chijiiwa K, Nakano K, et al. Completion radical surgery after cholecystectomy for accidentally undiagnosed gallbladder carcinoma. World J Surg. 2003;27(3):266-271. doi: https://doi.org/10.1007/s00268-002-6609-9.

    Article  PubMed  Google Scholar 

  3. Romano F, Franciosi C, Caprotti R, et al. Laparoscopic cholecystectomy and unsuspected gallbladder cancer. Eur J Surg Oncol. 2001;27(3):225-228.

    Article  CAS  Google Scholar 

  4. Lau CSM, Zywot A, Mahendraraj K, Chamberlain RS. Gallbladder carcinoma in the united states: A population based clinical outcomes study involving 22,343 patients from the surveillance, epidemiology, and end result database (1973-2013). HPB Surg. 2017;2017:1532835. doi: https://doi.org/10.1155/2017/1532835.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Pawlik TM, Gleisner AL, Vigano L, 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. doi: https://doi.org/10.1007/s11605-007-0309-6.

    Article  PubMed  Google Scholar 

  6. Lundgren L, Muszynska C, Ros A, et al. Management of incidental gallbladder cancer in a national cohort. Br J Surg. 2019;106(9):1216-1227. doi: https://doi.org/10.1002/bjs.11205.

    Article  CAS  PubMed  Google Scholar 

  7. Bartlett DL, Fong Y, Fortner JG, Brennan MF, Blumgart LH. Long-term results after resection for gallbladder cancer. implications for staging and management. Ann Surg. 1996;224(5):639-646. doi: https://doi.org/10.1097/00000658-199611000-00008.

  8. Goetze TO, Paolucci V. Adequate extent in radical re-resection of incidental gallbladder carcinoma: Analysis of the german registry. Surg Endosc. 2010;24(9):2156-2164. doi: https://doi.org/10.1007/s00464-010-0914-4.

    Article  PubMed  Google Scholar 

  9. Hickman L, Contreras C. Gallbladder cancer: Diagnosis, surgical management, and adjuvant therapies. Surg Clin North Am. 2019;99(2):337-355.

    Article  Google Scholar 

  10. Aloia TA, Járufe N, Javle M, et al. Gallbladder cancer: Expert consensus statement. HPB (Oxford). 2015;17(8):681-690. doi: https://doi.org/10.1111/hpb.12444.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wright BE, Lee CC, Iddings DM, Kavanagh M, Bilchik AJ. Management of T2 gallbladder cancer: Are practice patterns consistent with national recommendations? Am J Surg. 2007;194(6):820-5; discussion 825-6.

    Article  Google Scholar 

  12. Jensen EH, Abraham A, Jarosek S, et al. Lymph node evaluation is associated with improved survival after surgery for early stage gallbladder cancer. Surgery. 2009;146(4):706-11; discussion 711-3. doi: https://doi.org/10.1016/j.surg.2009.06.056.

    Article  PubMed  Google Scholar 

  13. Wise PE, Shi YY, Washington MK, et al. Radical resection improves survival for patients with pT2 gallbladder carcinoma. Am Surg. 2001;67(11):1041-1047.

    CAS  PubMed  Google Scholar 

  14. Foster JM, Hoshi H, Gibbs JF, et al. Gallbladder cancer: Defining the indications for primary radical resection and radical re-resection. Ann Surg Oncol. 2007;14(2):833-840. doi: https://doi.org/10.1245/s10434-006-9097-6.

    Article  PubMed  Google Scholar 

  15. Watson H, Dasari B, Wyatt J, et al. Does a second resection provide a survival benefit in patients diagnosed with incidental T1b/T2 gallbladder cancer following cholecystectomy? HPB (Oxford). 2017;19(2):104-107.

    Article  Google Scholar 

  16. Hueman MT, Vollmer CM Jr, Pawlik TM. Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol. 2009;16(8):2101-2115. doi: https://doi.org/10.1245/s10434-009-0538-x.

    Article  PubMed  Google Scholar 

  17. Geng ZM, Cai ZQ, Zhang Z, et al. Estimating survival benefit of adjuvant therapy based on a bayesian network prediction model in curatively resected advanced gallbladder adenocarcinoma. World J Gastroenterol. 2019;25(37):5655-5666. doi: https://doi.org/10.3748/wjg.v25.i37.5655.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kasumova GG, Tabatabaie O, Najarian RM, et al. Surgical management of gallbladder cancer: Simple versus extended cholecystectomy and the role of adjuvant therapy. Ann Surg. 2017;266(4):625-631. doi: https://doi.org/10.1097/SLA.0000000000002385.

    Article  PubMed  Google Scholar 

  19. Tran Cao HS, Zhang Q, Sada YH, Chai C, Curley SA, Massarweh NN. The role of surgery and adjuvant therapy in lymph node-positive cancers of the gallbladder and intrahepatic bile ducts. Cancer. 2018;124(1):74-83. doi: https://doi.org/10.1002/cncr.30968.

    Article  PubMed  Google Scholar 

  20. Bergquist JR, Shah HN, Habermann EB, et al. Adjuvant systemic therapy after resection of node positive gallbladder cancer: Time for a well-designed trial? (results of a US-national retrospective cohort study). Int J Surg. 2018;52:171-179.

    Article  Google Scholar 

  21. Shih SP, Schulick RD, Cameron JL, et al. Gallbladder cancer: The role of laparoscopy and radical resection. Ann Surg. 2007;245(6):893-901.

    Article  Google Scholar 

  22. Melillo A, Linden K, Spitz F, Atabek U, Gaughan J, Hong YK. Disparities in treatment for gallbladder carcinoma: Does treatment site matter? J Gastrointest Surg. 2020;24(5):1071-1076. doi: https://doi.org/10.1007/s11605-019-04389-5.

    Article  CAS  PubMed  Google Scholar 

  23. Liu C, Rein L, Clarke C, et al. Comparison of overall survival in gallbladder carcinoma at academic versus community cancer centers: An analysis of the national cancer data base. J Surg Oncol. 2020. doi: https://doi.org/10.1002/jso.25907.

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Correspondence to Toms Augustin.

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Prior Presentation: Americas Hepato-Pancreato-Biliary Association Annual Meeting; March 5–8, 2020

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Perlmutter, B.C., Naples, R., Hitawala, A. et al. Factors that Minimize Curative Resection for Gallbladder Adenocarcinoma: an Analysis of Clinical Decision-Making and Survival. J Gastrointest Surg 25, 2344–2352 (2021). https://doi.org/10.1007/s11605-021-04942-1

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