Predictors of survival in patients with carcinoma of the gallbladder

Abstract

Background. The role of resectional surgery in patients with advanced stages of gallbladder carcinoma has not been fully defined. It is generally believed that the survival depends on the stage of the disease, rather than on the treatment option. Methods. Seventeen selected risk factors were analyzed using univariate and multivariate analyses to predict survival in 87 patients with gallbladder carcinoma who had undergone some form of surgical treatment. Similarly, a subset of 55 patients with American Joint Committee on Cancer Stage IV disease also was analyzed separately. Results. Palpable mass, tumor (T) status, local infiltration, lymph node involvement, distant metastasis, TNM stage, and the type of surgical treatment (laparotomy alone, bypass, or resection) were significant risk factors by univariate analysis. In addition to palpable mass and the type of surgical treatment, age was also a significant predictor of survival by multivariate analysis. Multivariate analysis of patients with Stage IV disease revealed the same three factors to be significant. In this subset of patients, the median survival after resectional surgery was 16.3 months; after biliary and/or gastric bypass, 4.8 months; and after laparotomy alone, 1.6 months. Conclusions. The type of surgical treatment significantly influenced survival. Resectional surgery was associated with better survival compared with biliary and/or gastric bypass or laparotomy alone for patients with all stages of the disease, including those with advanced carcinoma of the gallbladder.

Management of carcinoma of the gallbladder: A single‐institution experience in 16 years

“…It was reported that resectional surgery [18], early T-stage [2,19,20], stage of disease [19], highly differentiated cancer [2] papillary adenocarcinoma [20,21], and well-differentiated adenocarcinoma [20,21] were associated with a better survival. On the other hand, age >60 [18] and palpable mass [18] had a negative impact on survival. However, the small number of patients in most of these studies limited their clinical impact on the management of gallbladder cancer.…”

“…Subsequently, it was reported that resection, compared with bypass surgery, was associated with a better survival in advanced carcinoma of the gallbladder [18]. A better 3-year survival was also demonstrated in stage IV disease without distant metastases or portal vein involvement [36].…”

Practical Guidelines for the Surgical Treatment of Gallbladder Cancer

“…If biliary atresia or gastric outlet obstruction are concurrently present, bypass surgery would also improve patient quality of life. Surgeons should therefore decide the optimal treatment modality in view of the patient status involved (43, 44) (Level of evidence 3, Level of recommendation C). Table 7 summarizes the recommendations for palliative surgery in patients who are not indicated for radical surgery.…”

Prognostic factors and long-term results after surgery for gallbladder carcinoma: a retrospective study of 127 patients

“…If the pathology report reveals a Tis or T1 gallbladder cancer, prognosis is good in the case of unviolated gallbladder and negative resection margins. The corresponding 5-year survival rates are 79-100% after simple cholecystectomy [1,6,7,28,29]. However, some authors [30] recommend extended cholecystectomy in the pT1b stage due to suspected venous, lymphatic, or perineural tumor invasion, although lymph node involvement in Tis or T1 tumors is extremely rare [28].…”

“…Some authors even advocate nonradical surgery in such cases, as this improves survival compared to only bypass operations [29]. The same authors further recommend the wide use of gastrojejunostomy because of gastric outlet obstruction in one third of the patients submitted to surgery [40].…”