Locally advanced gallbladder cancer: which patients benefit from resection?

Area of Science:

• Surgical Oncology
• Gastrointestinal Oncology
• Gallbladder Cancer Research

Background:

• Advanced gallbladder cancers (T3-4 GBC) present significant surgical challenges.
• A notable percentage of patients with T3-4 GBC have N2 lymph node metastases.
• Identifying optimal candidates for resection in advanced GBC is crucial for improving outcomes.

Purpose of the Study:

• To determine which patients with T3-4 gallbladder cancer (GBC) benefit from surgical resection.
• To evaluate the impact of lymph node (LN) metastasis status on survival after resection.
• To assess the outcomes of extended surgical procedures in advanced GBC.

Main Methods:

• Retrospective analysis of 78 consecutive patients with T3-4 GBC who underwent resection between 1990 and 2011.
• Data collected on surgical procedures, including common bile duct (CBD) resection, pancreatoduodenectomy, and major hepatectomy.
• Evaluation of in-hospital mortality, morbidity, R0 resection rates, and long-term survival based on clinicopathological factors.

Main Results:

• The overall 5-year survival rate was 17%, with improved survival observed after 2002 (26% vs. 9%).
• R0 resection was achieved in 86% of patients and was strongly associated with better survival (32% vs. 0% for R1).
• N2 metastases did not significantly impact survival outcomes compared to N0/N1, and extended resections (pancreatoduodenectomy, gastric, colonic) were associated with 0% 3-year survival.

Conclusions:

• Surgical resection for T3-4 GBC is indicated when R0 (complete) resection is feasible.
• Outcomes for advanced GBC have improved in recent years, suggesting advancements in surgical techniques or patient selection.
• N2 lymph node metastasis should not be a contraindication for surgery, but extensive organ resections may not improve survival.