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

Abstract

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.

Comparison of clinicopathological characteristics and long-term survival between patients with gallbladder adenosquamous carcinoma and pure gallbladder adenocarcinoma after curative-intent surgery: a single-center experience in China and a meta-analysis

“…The inconsistencies of tumor biological features, tumor stage, and the extent of resections mentioned above can partially illustrate the worse survival as well as a higher recurrence rate in patients with GBASC. Lymph node metastasis has been proven to be an independent prognostic factor for patients with GBC ( 17 ). A negative margin (R0) has also been validated as an independent prognostic factor for patients with GBC ( 17 , 18 ).…”

Puzzle and Challenge in Routine Extrahepatic Bile Duct Resection for Advanced Gallbladder Carcinoma

“…However, it remains controversial whether routine resection of the extrahepatic bile duct (EHBD) is needed in advanced GBC. 1 - 10 …”

“…From the above studies, it is unclear whether the routine resection of the EHBD can improve survival in patients with GBC. However, in a study reported recently by our team, 9 213 advanced GBC patients were analyzed, and 87 patients underwent EHBD resection. We used a propensity score matching analysis to reduce the selection bias inherent in retrospective observational studies.…”

“…However, it remains controversial whether routine resection of the extrahepatic bile duct (EHBD) is needed in advanced GBC. [1][2][3][4][5][6][7][8][9][10] Shimizu et al 1 analyzed 50 advanced GBC patients with radical resection (including EHBD resection); 30 patients had hepatoduodenal ligament invasion (HDLI), of whom 24 lacked preoperative obstructive jaundice. They found that advanced GBC patients had a higher frequency of HDLI and that invasion was difficult to diagnosis before surgery.…”

The significance of countable and treatable metastatic liver disease in patients with gallbladder carcinoma after curative‐intent surgery: A 10‐year experience in China

“…Due to lack of symptomatic clinical manifestations in the early phase of the disease, the majority of cases with GBC were diagnosed in an advanced stage and therefore lost the opportunity of receiving curative surgery 1 . Simple cholecystectomy is especially effective in achieving tumor clearance among T1a GBC patients with a reported 5‐year survival rate reaching 100% 2 . For patients with T1b or more advanced disease, the radical cholecystectomy, including simple cholecystectomy, partial hepatectomy, and a regional or more extended lymphadenectomy, has always been regarded as the gold standard in the management of patients with GBC.…”