Gallbladder carcinoma outcomes in an Australian tertiary referral hospital

Abstract

Background This study aimed to examine the presentation, treatment, and long‐term outcomes of patients with gallbladder carcinoma (GBC) managed in a surgical unit of an Australian tertiary referral hospital of a 19‐year period. Methods A retrospective review of prospectively collected data of patients with GBC managed in the Royal North Shore Upper GI Surgical department from October 1999 to March 2018. Results A total of 104 patients with GBC were identified: 36 patients underwent palliative treatment, 61 patients with gallbladder adenocarcinoma underwent resection with curative intent. Seven patients were excluded. ‘Simple cholecystectomy’ was undertaken in eight patients, ‘standard radical cholecystectomy’ in 37 and ‘extended radical resection’ in 16. The median survival in these patients was 35 months (95% confidence interval (CI) 21.29–55.10), with a median follow up of 60 months (95% CI 38.18–78.39). This compares with an overall median survival of only 4.00 months (95% CI 2.79–6.24) in patients who did not undergo a potentially curative resection. Independent predictors of poor long‐term survival included an elevated preoperative serum tumour marker, advanced tumour stage (T3/T4) or node positive disease (N1/N2). Conclusion The biology and stage of GBC at presentation are major factors in determining patient outcome. There is a need for better pre‐ and post‐operative predictors to improve risk stratification, and these are likely to be in the form of molecular markers. Although the focus of surgery should be to ensure an R0 resection, patients with advanced stage disease need to be carefully selected for surgical intervention, and ideally should be managed by a multidisciplinary team in a specialist centre.

Epidemiological trends of gallbladder cancer in Australia between 1982 to 2018: A population-based study utilizing the Australian Cancer Database

“…This is substantially better than other worldwide estimates. The 2018 GLOBOCAN data published an estimated worldwide mortality rate of 1.6/100,000 for males and 1.8/100,000 for females (compared to 0.9 [males] and 1.0 [females] in Australia) [ 29 ]. This is likely attributable to the advanced healthcare system in Australia which facilitates early diagnosis, advanced surgical techniques (liver resection and lymph node dissection), and progressive adjuvant therapy.…”

“…This is likely attributable to the advanced healthcare system in Australia which facilitates early diagnosis, advanced surgical techniques (liver resection and lymph node dissection), and progressive adjuvant therapy. Although survival data were not available for analysis in our study, single institution data from an Australian tertiary referral hospital demonstrated a median survival of 35 months [ 29 ] for GBC patients treated at their center.…”

Development and External Validation of a Model to Predict Overall Survival in Patients With Resected Gallbladder Cancer

“…Data on patient characteristics, surgical treatment and survival of this cohort has been published elsewhere. 18…”

New trends in diagnosis and management of gallbladder carcinoma

“…Likewise, a study in Japan of 200 GB carcinoma patients who underwent surgical resection reported the following 5-year overall survival rates: Stage I, 90.8%; stage IIA, 94.4%; stage IIB, 73.6%; stage IIIA, 33.7%; stage IIIB, 57.7%; stage IVA, 14.3%; and stage IVB, 11.8%[ 88 ]. A study conducted in Australia including 104 patients with GB carcinoma and a median follow-up of 60 mo found a median overall survival of 35 mo in those with intended curative resection and 4 mo in inoperable cases with palliative treatment[ 36 ]. For a T1b follow-up of 69.9 mo, the disease-free survival was 92%[ 50 ].…”