Identification of patients who may benefit the most from adjuvant chemotherapy following resection of incidental gallbladder carcinoma

Xiang, Jun; Zhang, Xufeng; Weber, Sharon M.; Poultsides, George A.; Fields, Ryan C.; Hatzaras, Ioannis; Weiss, Matthew; Scoggins, Charles R.; Idrees, Kamron; Shen, Perry; Maithel, Shishir K.; Pawlik, Timothy M.

doi:10.1002/jso.26389

Cited by 8 publications

(2 citation statements)

References 30 publications

(37 reference statements)

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“…The SEER (Surveillance, Epidemiology, and End Results) database documented the benefits of chemoradiation over chemotherapy alone in the selected group of GBC patients [ 24 ]. The chance of tumor breach/bile spill during the initial surgery is an additional factor that justifies the use of adjuvant treatment in IGBC to prevent early recurrence [ 25 ]. As the patients of IGBC often undergo an index cholecystectomy at a remote center, the sequence of intra-operative events remains elusive.…”

Section: Discussionmentioning

confidence: 99%

Does Timing of Completion Radical Cholecystectomy Determine the Survival Outcome in Incidental Carcinoma Gallbladder: A Single-Center Retrospective Analysis

Rahul¹,

Haldenia²,

Singh³

et al. 2022

Cureus

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Incidental discovery of gallbladder cancer (GBC) on postoperative histopathology or intra-operative suspicion is becoming increasingly frequent since laparoscopic cholecystectomy became the standard of care for gallstone disease. Incidental GBC (IGBC) portends a better survival than primarily detected GBC. Various factors affect the outcome of re-resection with the timing of re-intervention an important determinant of survival. MethodsAll patients of IGBC who underwent curative resection from January 2009 to December 2018 were considered for analysis. Details of demographic profile, index surgery, and operative findings on re-resection, histopathology and follow-up were retrieved from the prospectively maintained database. Patients were evaluated in three groups based on the interval between index cholecystectomy and re-resection: Early (<4 weeks), Intermediate (4-12 weeks) and Late (>12 weeks), using appropriate statistical tests. ResultsNinety-one patients were admitted with IGBC during the study period of which 48 underwent re-resection with curative intent. The median age of presentation was 55 years (31-77 years). The median duration of follow-up was 40.6 months (Range: 1.2-130.6 months). Overall and disease-free survival among the abovementioned three groups was the best in the early group (104 and 102 months) as compared to the intermediate (84 and 83 months) and late groups (75 and 73 months), though the difference failed to achieve statistical significance (p=0.588 and 0.581). On univariate analysis, factors associated with poor outcome were node metastasis, need for common bile duct (CBD) excision and high-grade tumor. However, on multivariate analysis, poor differentiation was the only independent factor affecting survival. ConclusionEarly surgery, preferably within four weeks, possibly entails better survival in incidentally detected GBC. The grade of a tumor, however, is the most important determinant of survival in IGBC.

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Section: Discussionmentioning

confidence: 99%

Does Timing of Completion Radical Cholecystectomy Determine the Survival Outcome in Incidental Carcinoma Gallbladder: A Single-Center Retrospective Analysis

Rahul¹,

Haldenia²,

Singh³

et al. 2022

Cureus

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“…Gallbladder cancer (GBC) is the most common malignant tumor (about 80% to 95%) in the biliary tract and causes approximately 40,700 deaths worldwide annually in China [1,2]. The prognosis of GBC is extremely poor although it is a rare incident (about 1.2% of all cancers), and the median survival time of all patients is only around 6 months [3][4][5]. Surgery is the main stream intervention for GBC, especially for the radical cholecystectomy with R0 resection has displayed certain benefits in prognosis [6,7].…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Value of Preoperative Fibrinogen in Patients with Radical Cholecystectomy

Zhang

Qian

et al. 2022

Advanced Gut & Microbiome Research

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Background and Aims. There is currently a lack of suitable hematological markers as a complement to pathological factors in predicting the prognosis of patients with gallbladder cancer. The study aimed to investigate the clinical value of preoperative fibrinogen levels in assessing the prognosis of patients with gallbladder cancer after radical surgery. Methods. The study retrospectively analyzed 260 gallbladder cancer patients who underwent radical resection. Time-dependent receiver operating characteristic (ROC) curves were used to calculate the optimal cut-off values of carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and fibrinogen. Besides, univariate and multivariate analyses of disease-free survival (DFS) and overall survival (OS) were performed to determine independent markers in peripheral blood. Then, subgroup analyses of fibrinogen in different degrees of differentiation, age, gender, and BMI were performed by log-rank test. Result. The cut-off values of fibrinogen, CEA, and CA19-9 were set at 2.97 g/L, 2.17 ng/mL, and 41.1 U/mL, respectively. The results showed that the preoperative fibrinogen level was associated with tumor size, degree of differentiation, TNM stage, and CA19-9 levels. Multivariate analyses indicated that advanced TNM stage, excessive fibrinogen, CEA, and CA19-9 levels were independent risk factors for postoperative DFS. And gallbladder neck tumors, poor differentiation, cancer nodules, advanced TNM stage, excessive fibrinogen, and CEA levels were independent adverse factors for postoperative OS. Notably, the preoperative excessive fibrinogen was an independent adverse factor for both DFS ( p = 0.044 , HR = 1.629 , 95% CI = 1.014 − 2.618 ) and OS ( p = 0.006 , HR = 2.328 , 95% CI = 1.272 − 4.261 ) in patients with gallbladder cancer. The subgroup analyses further indicated that patients with high-level of fibrinogen had both poorer DFS ( p = 0.002 ) and OS ( p = 0.005 ) than patients with poorly-differentiated gallbladder cancer. And for well-differentiated gallbladder cancer, patients with high fibrinogen levels had poorer OS ( p = 0.004 ), but no significant difference in DFS ( p = 0.062 ). Besides, fibrinogen was more significant in GBC patients with higher BMI (>22.62) or older age (>60 yrs) and was not affected by gender. Conclusion. Elevated preoperative fibrinogen level was independently associated with poor postoperative DFS and OS in patients with gallbladder cancer, especially for poor differentiation.

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Gallbladder Cancer

Al Hamidy,

Ahmed,

Abdulraheem

et al. 2024

McQs in General Surgical Oncology

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Identification of patients who may benefit the most from adjuvant chemotherapy following resection of incidental gallbladder carcinoma

Cited by 8 publications

References 30 publications

Does Timing of Completion Radical Cholecystectomy Determine the Survival Outcome in Incidental Carcinoma Gallbladder: A Single-Center Retrospective Analysis

Does Timing of Completion Radical Cholecystectomy Determine the Survival Outcome in Incidental Carcinoma Gallbladder: A Single-Center Retrospective Analysis

The Prognostic Value of Preoperative Fibrinogen in Patients with Radical Cholecystectomy

Gallbladder Cancer

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