GALLBLADDER CANCER: CONTEMPORARY OUTCOMES OF SURGICAL MANAGEMENT FOR ADVANCED DISEASE WITH T3 OR GREATER
Hiromichi Ito*, Atsushi Oba, Yoshihiro Ono, Takafumi Sato, Yosuke Inoue, Yu Takahashi
Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Background: Patients with gallbladder cancer (GBCA) often present at their advanced stages and their prognosis is dismal. The aggressive surgery for such advanced disease has been controversial and the optimal indication for resection needs to be defined.
Method: Patients who underwent curative resection for GBCA with curative intent at our institution from Jan. 2006 through Jun. 2019 were included. The patients who underwent simple cholecystectomy were excluded. Advanced disease was defined as T3/4 disease. Types of operation and their short- and long-term outcomes for the patients with advanced disease were compared with those with T1/2 disease. Median follow-up for the entire cohort was 29 months.
Result: Total 120 patients were identified and 49 patients (41%) had advanced GBCA. The patients with advanced disease more commonly presented with jaundice (37% vs 6%, p<0.001) and more likely required concomitant organ resection other than liver or bile duct (51% vs 4%, p<0.001). The additional organ resections for advanced disease included pancreaticoduodenectomy (n=12, 25%), partial duodenectomy (n=9, 18%), partial colectomy (n=7, 14%), portal vein resection (n=9, 18%), hepatic artery resection and reconstruction (n=3, 6%). As a result, the post-operative complications were higher for patients with advanced disease (overall 42% vs 28%, CD-3a or greater 25% vs 7%, p=0.002) than those with non-advanced disease. The median recurrence-free and overall survival for the patients with advanced disease were 11 months and 22 months, compared with those with non-advanced disease (NR and 109 months, respectively, p<0.001 for RFS and p<0.001 for OS, Figure). In univariate and multivariate analysis, pT3 or greater emerged as the strongest predictor for both RFS and OS.
Conclusion: While patients with advanced gallbladder cancer T3 or greater requires more complex operations to achieve R0 resection, their long-term outcomes remain dismal compared with those with non-advanced disease. The multidisciplinary approach should be encouraged for advanced GBCA.
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