Abstract
Background
Gallbladder cancer (GBC) is an aggressive disease with dismal results of surgical treatment mainly because of advanced stage at presentation. The objective of this study was to investigate whether aggressive surgical treatment can be associated with reasonable survival for patients with GBC at acceptable morbidity and mortality.
Methods
A total of 113 patients with proven or presumptive diagnosis of GBC were recruited prospectively over a period of 2 years and evaluated for diagnosis and staging by appropriate investigations. Seven out of 113 patients were found to have benign pathology either intraoperatively or on histopathological examination hence excluded from follow-up and survival analysis. Out of 32 potentially resectable patients, only 21 patients could finally be resected with curative intent. Patients found unresectable/metastatic disease intraoperatively (n = 11) were treated with palliative chemotherapy if eligible for the same. Short-term morbidity, perioperative mortality, disease-free survival (DFS), and median overall survival (OS) of surgically resected patients were analyzed. Median OS of resected patients was compared with that of unresectable patients.
Results
Overall resectability rate in this study cohort was 19.8 % (21/106). Overall mortality was 4.7 % and morbidity was 42.8 %. Stage distribution of resected patients was as follows: stage II (3), stage IIIA (9), stage IIIB (8), and stage IVA (1). DFS at 12 and 18 months was found to be 82.5 and 73.3 %, respectively. Mean DFS was 19.9 months (SE 1.42, 95 % CI). Mean OS for resected patients was 21 months and that for unresectable patients was 11.3 months only. Both groups were compared using log rank (Mantel-cox) test and statistically significant difference in OS was observed (p value <0.0001).
Conclusion
Since curative resection is the only chance of cure, aggressive surgical approach adopted by us is justified with acceptable mortality and morbidity and encouraging overall survival.
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References
Piehler JM, Crichlow RW. Primary carcinoma of the gallbladder. Surg Gynecol Obstet. 1978;147:929–42.
Cubertafond P, Gainant A, Cucchiaro G. Surgical treatment of 724 carcinomas of the gallbladder: results of the French Surgical Association Survey. Ann Surg. 1994;219:275–80.
Wilkinson DS. Carcinoma of the gall-bladder: an experience and review of the literature. Aust N Z J Surg. 1995;65:724–7.
Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg. 1999;230:309–18.
Jarnagin WR, Gonen M, Fong Y, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1803 consecutive cases over the past decade. Ann Surg. 2002;236:397–406.
Taylor M, Forster J, Langer B, et al. A study of prognostic factors for hepatic resection for colorectal metastases. Am J Surg. 1997;173:467–71.
Bartlett DL, Fong Y, Fortner JG, et al. Long-term results after resection for gallbladder cancer: implications for staging and management. Ann Surg. 1996;224:639–46.
Kondo S, Nimura Y, Hayakawa N, et al. Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br J Surg. 2000;87:418–22.
Kondo S, Nimura Y, Hayakawa N, et al. Extensive surgery for carcinoma of the gallbladder. Br J Surg. 2002;89:179–84.
Kondo S, Nimura Y, Kamiya J, et al. Mode of tumor spread and surgical strategy in gallbladder carcinoma. Langenbecks Arch Surg. 2002;387:222–8.
Kondo S, Nimura Y, Kamiya J, et al. Five-year survivors after aggressive surgery for stage IV gallbladder cancer. J Hepatobiliary Pancreat Surg. 2001;8:511–7.
Shirai Y, Ohtani T, Tsukada K, et al. Radical surgery is justified for locally advanced gallbladder carcinoma if complete resection is feasible. Am J Gastroenterol. 1997;92:181–2.
Shirai Y, Ohtani T, Tsukada K, et al. Pancreaticoduodenectomy for gallbladder cancer with peripancreatic nodal metastases. Hepatogastroenterology. 1997;44:376–7.
Shirai Y, Ohtani T, Tsukada K, et al. Combined pancreaticoduodenectomy and hepatectomy for patients with locally advanced gallbladder carcinoma: long term results. Cancer. 1997;80:1904–9.
Shirai Y, Yoshida K, Tsukada K, et al. Radical surgery for gallbladder carcinoma: long-term results. Ann Surg. 1992;216:565–8.
Todoroki T, Kawamoto T, Takahashi H, et al. Treatment of gallbladder cancer by radical resection. Br J Surg. 1999;86:622–7.
Todoroki T, Takahashi H, Koike N, et al. Outcomes of aggressive treatment of stage IV gallbladder cancer and predictors of survival. Hepatogastroenterology. 1999;46:2114–21.
Doty JR, Cameron JL, Yeo CJ, et al. Cholecystectomy, liver resection, and pylorus-preserving pancreaticoduodenectomy for gallbladder cancer: report of five cases. J Gastrointest Surg. 2002;6:776–80.
Fong Y, Jarnagin W, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg. 2000;232:557–69.
Nishio H, Nagino M, Ebata T, Yokoyama Y, Tsuyoshi I, Yuji N. Aggressive surgery for stage IV gallbladder carcinoma; what are the contraindications? J Hepatobiliary Pancreat Surg. 2007;14:351–7.
Yokomizo H, Yamane T, Hirata T, et al. Surgical treatment of pT2 gallbladder carcinoma: a reevaluation of the therapeutic effect of hepatectomy and extrahepatic bile duct resection based on the long-term outcome. Ann Surg Oncol. 2007;14:1366–73.
Nair CK, Kothari KC. Role of diagnostic laparoscopy in assessing operability in borderline resectable gastrointestinal cancers. J Min Access Surg. 2012;8:45–9.
Agarwal AK, Kalayarasan R, Javed A, et al. The role of staging laparoscopy in primary gall bladder cancer—an analysis of 409 patients: a prospective study to evaluate the role of staging laparoscopy in the management of gallbladder cancer. Ann Surg. 2013;258(2):318–23.
Misra S, Chaturvedi A, Misra NC, Sharma ID. Carcinoma of the gallbladder. Lancet Oncol. 2003;4:167–76.
Tsukada K, Kurosaki I, Uchida K, et al. Lymph node spread from carcinoma of the gallbladder. Cancer. 1997;80:661–7.
Shimada H, Endo I, Togo S, Nakano A, Izumi T, Nakagawara G. The role of lymph node dissection in the treatment of gallbladder carcinoma. Cancer. 1997;79:892–9.
Yoshio S, Toshifumi W, Jun S, Katsuyoshi H. Regional lymphadenectomy for gallbladder cancer: rational extent, technical details, and patient outcomes. World J Gastroenterol. 2012;18(22):2775–83. June 14.
Shukla PJ, Barreto G, Kakade A, Shrikhande SV. Revision surgery for incidental gallbladder cancer: factors influencing operability and further evidence for T1b tumors. HPB (Oxford). 2008;10:43–7.
D’Angelica M, Dalal KM, et al. Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncol. 2009;16(4):806–16.
Shirai Y, Ohtani T, Tsukada K, Hatakeyama K. Combined pancreaticoduodenectomy and hepatectomy for patients with locally advanced gallbladder carcinoma. Long Term Results Cancer. 1997;80:1904–9.
Shimizu Y, Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, et al. Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer? Surgery. 2004;136:1012–7.
Giuliante F, Ardito F, Vellone M, Clemente G, Nuzzo G. Port-sites excision for gallbladder cancer incidentally found after laparoscopic cholecystectomy. Am J Surg. 2006;191:114–6.
DeVita, Hellman and Rosenberg. Principles and practice of oncology.9th Edition. Lippincott Williams & Wilkins 2011: Table 85.17.
Tsukada K, Hatakamaya K, Kurosaki I, et al. Outcome of radical surgery for carcinoma of the gallbladder according to TNM stage. Surgery. 1996;120:816–20.
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Singh, S.K., Talwar, R., Kannan, N. et al. Aggressive Surgical Approach for Gallbladder Cancer: a Single-Center Experience from Northern India. J Gastrointest Canc 46, 399–407 (2015). https://doi.org/10.1007/s12029-015-9766-4
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DOI: https://doi.org/10.1007/s12029-015-9766-4