Aggressive Surgery for Locally Advanced Gallbladder Cancer with Obstructive Jaundice: Result of a Prospective Study

Abstract

Objective: The aim of this study was to clarify the clinical impact of our departmental policy for advanced gallbladder cancer (GBC) even with obstructive jaundice. Methods: Obstructive jaundice was defined as serum T-bil ≥2.0 mg/dl. Between 1998 and 2008, 112 patients with GBC were scheduled for surgical resection with curative intent. Thirty-six patients were converted to palliative surgery or exploration alone because of advanced disease. After excluding pathological T1 (UICC) patients (n = 11), the remaining 65 patients were divided into 2 groups; jaundiced group (n = 37) and non-jaundiced group (n = 28). Surgical procedures were conducted based on our departmental guidelines concerning each type of infiltration of GBC. Results: Bile duct resection and major hepatectomy were performed more frequently in patients with jaundice. Although patients in jaundiced group had more advanced disease, 5-year overall survival rates of the patients with or without jaundice were 27 vs. 31% (p = 0.742), which was not statistically significant. Conclusions: Aggressive surgery might improve long-term survival in patients with locally advanced GBC even in the condition of obstructive jaundice with no distant metastasis.

Outcomes of surgical resection of gallbladder cancer in patients presenting with jaundice: A systematic review and meta‐analysis

“…Among the 168 studies that met the initial search criteria, eight studies were selected for the meta‐analysis. Figure illustrates a PRISMA diagram delineating the study selection process.…”

“…A funnel plot (Figure ) indicated no publication bias and an Egger’s test was nonsignificant ( P = 0.276). However, there were two outliers . Nasu et al reported comparable long‐term survival among patients who did and did not present with jaundice (5‐year survival of 31% vs 27% [ P = 0.742]).…”

“…However, there were two outliers . Nasu et al reported comparable long‐term survival among patients who did and did not present with jaundice (5‐year survival of 31% vs 27% [ P = 0.742]). Feng et al reported postresection survival only in a subgroup of patients who had stage III and IV disease and noted that the difference in survival among jaundiced and non‐jaundiced patients was smaller than in the cohort as a whole.…”

“…When the primary outcome of patient survival was not reported as hazard ratios, the method suggested by Parmar et al was used to estimate these ratios from Kaplan‐Meier curves. In cases in which numbers at risk were reported, the curves were evaluated at the corresponding points, and the resulting pairs of values were used in the estimation. For studies without numbers at risk, the curves were evaluated at 6‐month intervals and constant censoring was assumed .…”

Long-Term Outcomes and Prognostic Factors in Advanced Gallbladder Cancer: Focus on the Advanced T Stage

“…Thus preoperative jaundice should be considered a relative contraindication to radical resection for GBC [33]. However, recent reports have demonstrated declared that although preoperative jaundice indicates poor prognosis and high postoperative morbidity, it does not preclude radical resection, especially in highly selected patients (N0) [34,35], and aggressive surgery might improve long-term survival in advanced GBC patients with obstructive jaundice [36]. In this study, patients with obstructive jaundice who underwent curative resection had overall survival that were similar to those in patients without obstructive jaundice, and jaundice at diagnosis showed no prognostic impact once R0 was achieved.…”