Re-resection in Incidental Gallbladder Cancer: Survival and the Incidence of Residual Disease

Lohman, Elise A J de Savornin; Geest, Lydia G. van der; Bitter, Tessa J. J. de; Nagtegaal, Irıs D.; Laarhoven, Cornelis J. H. M. van; Boezem, Peter van den; Post, Chella S. van der; Reuver, Philip R. de

doi:10.1245/s10434-019-08074-4

Cited by 42 publications

(27 citation statements)

References 26 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although current NCCN guidelines recommend radical surgery for all patients with GBC at stages T1b and above [18], several studies have concluded that patients with T1b and T2 stages might not require radical surgery [21][22][23][24]. However, some studies have shown that LNM is closely related to malignant phenotype of early stage GBC [25,26], we believe that patients diagnosed with LNM preoperatively should receive more aggressive surgical treatment and more extensive lymph node dissection than patients without LNM.…”

Section: Discussionmentioning

confidence: 87%

A predictive nomogram for lymph node metastasis of incidental gallbladder cancer: a SEER population-based study

Yang

Cai

et al. 2020

BMC Cancer

View full text Add to dashboard Cite

Background: Existing imaging techniques have a low ability to detect lymph node metastasis (LNM) of gallbladder cancer (GBC). Gallbladder removal by laparoscopic cholecystectomy can provide pathological information regarding the tumor itself for incidental gallbladder cancer (IGBC). The purpose of this study was to identify the risk factors associated with LNM of IGBC and to establish a nomogram to improve the ability to predict the risk of LNM for IGBC. Methods: A total of 796 patients diagnosed with stage T1/2 GBC between 2004 and 2015 who underwent surgery and lymph node evaluation were enrolled in this study. We randomly divided the dataset into a training set (70%) and a validation set (30%). A logistic regression model was used to construct the nomogram in the training set and then was verified in the validation set. Nomogram performance was quantified with respect to discrimination and calibration. Results: The rates of LNM in T1a, T1b and T2 patients were 7, 11.1 and 44.3%, respectively. Tumor diameter, T stage, and tumor differentiation were independent factors affecting LNM. The C-index and AUC of the training set were 0.718 (95% CI, 0.676-0.760) and 0.702 (95% CI, 0.659-0.702), respectively, demonstrating good prediction performance. The calibration curves showed perfect agreement between the nomogram predictions and actual observations. Decision curve analysis showed that the LNM nomogram was clinically useful when the risk was decided at a possibility threshold of 2-63%. The Cindex and AUC of the validation set were 0.73 (95% CI: 0.665-0.795) and 0.692 (95% CI: 0.625-0.759), respectively. Conclusion: The nomogram established in this study has good prediction ability. For patients with IGBC requiring reresection, the model can effectively predict the risk of LNM and make up for the inaccuracy of imaging.

show abstract

Section: Discussionmentioning

confidence: 87%

A predictive nomogram for lymph node metastasis of incidental gallbladder cancer: a SEER population-based study

Yang

Cai

et al. 2020

BMC Cancer

View full text Add to dashboard Cite

show abstract

“…Factors reported to be prognostic in patients with GBC have included invasion to the bile duct [ 8 ], hepatic invasion [ 9 ], ≥4 regional lymph node metastases [ 10 ], lymph node ratio, total lymph node count [ 11 , 12 ], number of negative lymph nodes [ 13 ], sarcopenia [ 14 ], jaundice [ 15 ], incidental [ 5 ], volume-based PET/CT parameters of total tumor burden of malignancy [ 16 ], intraoperative bile spillage [ 6 ], T stage [ 17 ], stage [ 18 ], and resectability [ 19 ]. However, the circumstances of each research report present difficulties when attempting to generalize the results due to the limitations of each study.…”

Section: Discussionmentioning

confidence: 99%

“…As summarized in Table 2, the univariate and multivariate analyses of the risk factors for overall survival showed that blood loss ≥1400 g (vs. <1400 g, hazard ratio [5]: 2.19), histologically poorly differentiated tumors or others (vs. well-or moderately-differentiated, HR: 2.26), liver invasion ≥5 mm (vs. no invasion, HR: 2.42), ≥4 regional lymph node metastases (vs. no lymph node metastasis [6], HR: 2.25), and treatment without adjuvant chemotherapy (vs. with, HR: 1.93) were independent risk factors. Invasion of the left margin or the entire area of the HDL (vs. no invasion, HR: 1.64, p = 0.053) and postoperative morbidity Clavien-Dindo Classification ≥3 (vs. ≤2, HR: 1.64, p = 0.054) were marginally insignificant.…”

Section: Prognostic Factors In Patients With Stage 3/4 Gbc Without DImentioning

confidence: 99%

Examination of Prognostic Factors Affecting Long-Term Survival of Patients with Stage 3/4 Gallbladder Cancer without Distant Metastasis

Higuchi

Yazawa

Uemura

et al. 2020

Cancers

View full text Add to dashboard Cite

In advanced gallbladder cancer (GBC) radical resection, if multiple prognostic factors are present, the outcome may be poor; however, the details remain unclear. To investigate the poor prognostic factors affecting long-term surgical outcome, we examined 157 cases of resected stage 3/4 GBC without distant metastasis between 1985 and 2017. Poor prognostic factors for overall survival and treatment outcomes of a number of predictable preoperative poor prognostic factors were evaluated. The surgical mortality was 4.5%. In multivariate analysis, blood loss, poor histology, liver invasion, and ≥4 regional lymph node metastases (LNMs) were independent prognostic factors for poor surgical outcomes; invasion of the left margin or the entire area of the hepatoduodenal ligament and a Clavien–Dindo classification ≥3 were marginal factors. The analysis identified outcomes of patients with factors that could be predicted preoperatively, such as liver invasion ≥5 mm, invasion of the left margin or the entire area of the hepatoduodenal ligament, and ≥4 regional LNMs. Thus, the five-year overall survival was 54% for zero factors, 34% for one factor, and 4% for two factors (p < 0.05). A poor surgical outcome was likely when two or more factors were predicted preoperatively; therefore, new treatment strategies are required for such patients.

show abstract

“…In a study of patients from the Netherlands Cancer Registry, de Savornin Lohman et al . found residual disease in 35% of patients with iGBC who subsequently underwent further resection, most often located in the lymph nodes 16 …”

Section: Discussionmentioning

confidence: 97%

Gallbladder carcinoma outcomes in an Australian tertiary referral hospital

Wietsma

Molloy

Bhimani

et al. 2021

ANZ Journal of Surgery

View full text Add to dashboard Cite

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.

show abstract

Re-resection in Incidental Gallbladder Cancer: Survival and the Incidence of Residual Disease

Cited by 42 publications

References 26 publications

A predictive nomogram for lymph node metastasis of incidental gallbladder cancer: a SEER population-based study

A predictive nomogram for lymph node metastasis of incidental gallbladder cancer: a SEER population-based study

Examination of Prognostic Factors Affecting Long-Term Survival of Patients with Stage 3/4 Gallbladder Cancer without Distant Metastasis

Gallbladder carcinoma outcomes in an Australian tertiary referral hospital

Contact Info

Product

Resources

About