Extra-Hepatic Bile Duct Resection: an Insight in the Management of Gallbladder Cancer

Pandey, Durgatosh; Garg, Pankaj Kumar; Manjunath, N; Sharma, Jyoti

doi:10.1007/s12029-015-9737-9

Cited by 10 publications

(6 citation statements)

References 32 publications

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“…Whether EHBD resection should be routinely performed in patients with gallbladder cancer remains controversial [5]. Some studies suggested that EHBD resection should be performed routinely during radical cholecystectomy [6, 15, 16], whereas others reported that EHBD resection did not improve prognosis [17–19]. D’ Angelica et al suggested EHBD resection is appropriate when necessary to clear disease but are not mandatory in all cases [20].…”

Section: Discussionmentioning

confidence: 99%

Indications for extrahepatic bile duct resection due to perineural invasion in patients with gallbladder cancer

et al. 2019

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BackgroundThe indications for extrahepatic bile duct (EHBD) resection remain a major controversy in the surgical management of patients with gallbladder cancer. On the other hand, perineural invasion (PNI) was reported as an important factor in patients with gallbladder cancer because gallbladder cancer cells frequently spread to the tissues surrounding the EHBD via perineural routes. We assessed the correlation of PNI with clinicopathological factors in patients with gallbladder cancer to elucidate EHBD resection indications specifically in patients with PNI.MethodsThis retrospective study assessed the PNI status of 50 patients with gallbladder cancer who underwent curative resection and examined the correlation between the presence of PNI and clinicopathological factors.ResultsThirteen patients (26%) were PNI positive. PNI was significantly correlated with male sex, proximal-type tumor, lymphatic and vascular invasion, and advanced T stage. Multivariate analysis found that PNI positivity (p < 0.001), lymphatic invasion (p = 0.007), and nodal stage (p < 0.001) were independent prognostic factors. PNI was never observed in patients with stage T1 cancer. Conversely, PNI was detected rarely in distal-type tumors, all of whom developed various types of recurrences.ConclusionsThese results clearly demonstrated the prognostic impact of PNI in patients with gallbladder cancer. We suggest that EHBD resection in combination with cholecystectomy may not be useful for distal-type tumors from a perspective of PNI.

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Section: Discussionmentioning

confidence: 99%

Indications for extrahepatic bile duct resection due to perineural invasion in patients with gallbladder cancer

et al. 2019

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“…Microscopic hepatic infiltration was observed in 47.0% (8/17) of patients and CBD invasion in 76.5% (13/17) of patients. Median overall survival was 26 months (95% CI: 7.7 - 44.2 months) [17]. …”

Section: Resultsmentioning

confidence: 99%

To Resect or Not to Resect Extrahepatic Bile Duct in Gallbladder Cancer?

2017

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The indications for and limitations of extrahepatic bile duct resection (EHBDR) in the context of gallbladder (GB) cancer are unclear. The purpose of this review was to examine the current literature to determine the impact of EHBDR on loco-regional recurrence and survival in GB cancer. The EMBASE and Medline databases were searched up to February 2016 using the terms: extrahepatic bile duct resection and gallbladder cancer. Studies published in the last 20 years were eligible for inclusion. Given the heterogeneity of the population and the study methodologies employed, qualitative data synthesis in the form of meta-analysis was deemed implausible. Twenty-four studies fulfilled the inclusion criteria. The selected studies include 6,722 (55%) EHBDRs in a total of 12,251 GB cancer operations. The 25 studies were categorized into seven groups: 1) cancer survival all stages; 2) hepatoduodenal ligament invasion; 3) outcome in EHBDR and EHBDNR; 4) pT1b tumors; 5) pT2 tumors; 6) pT3/T4 tumors; and 7) incidental GB cancer. Radical cholecystectomy with EHBDR should be used as a standard operation for tumors involving the neck or the cystic duct of the GB (either macroscopically or microscopically). In all other cases, operative strategy should be individualized to the patient.

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“…According to previous reports, the oncological benefit of prophylactic resection combined EHBD resection for locally advanced GBC without EHBD involvement is controversial [12, 21, 22]. In the current study, we analysed the clinical impact of combined EHBD resection for advanced GBC.…”

Section: Discussionmentioning

confidence: 97%

Is combined extra-hepatic bile-duct resection justified for advanced gallbladder carcinoma?

Wang

et al. 2019

Gastroenterology Report

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BackgroundWhether the extra-hepatic bile duct (EHBD) should be routinely resected for gallbladder carcinoma (GBC) remains controversial. The current study aimed to determine the clinical impact of combined EHBD resection during curative surgery for advanced GBC.MethodsIn total, 213 patients who underwent curative surgery for T2, T3 or T4 GBC were enrolled. The clinicopathological features were compared between the patients treated with EHBD resection and those without EHBD resection. Meanwhile, univariable and multivariable Cox-proportional hazards regression models were used to identify risk factors for overall survival (OS).ResultsAmong the 213 patients identified, 87 (40.8%) underwent combined EHBD resection. Compared with patients without EHBD resection, patients with EHBD resection suffered more post-operative complications (33.3% vs. 21.4%, P = 0.046). However, the median OS of the EHBD resection group was longer than that of the non-EHBD resection group (25 vs. 11 months, P = 0.008). Subgroup analyses were also performed according to tumor (T) category and lymph-node metastasis. The median OS was significantly longer in the EHBD resection group than in the non-EHBD resection group for patients with T3 lesion (15 vs. 7 months, P = 0.002), T4 lesion (11 vs. 6 months, P = 0.021) or lymph-node metastasis (12 vs. 7 months, P < 0.001). No survival benefit of EHBD resection was observed in GBC patients with T2 lesion or without lymph-node metastasis. T category, lymph-node metastasis, margin status, pre-operative CA19-9 level and EHBD resection were identified as independent prognostic factors for OS of patients with advanced GBC (all P values <0.05). Conclusions EHBD resection can independently affect the OS in advanced GBC. For GBC patients with T3 lesion, T4 lesion and lymph-node metastasis, combined EHBD resection is justified and may improve OS.

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Extra-Hepatic Bile Duct Resection: an Insight in the Management of Gallbladder Cancer

Abstract: Extrahepatic bile duct resection to achieve R'0' resection in the management of advanced gallbladder cancer is safe with acceptable postoperative morbidity and has potential to improve survival.

Cited by 10 publications

References 32 publications

Indications for extrahepatic bile duct resection due to perineural invasion in patients with gallbladder cancer

Indications for extrahepatic bile duct resection due to perineural invasion in patients with gallbladder cancer

To Resect or Not to Resect Extrahepatic Bile Duct in Gallbladder Cancer?

Is combined extra-hepatic bile-duct resection justified for advanced gallbladder carcinoma?

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