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Extended Resections for Advanced Gallbladder Cancer: Results from a Nationwide Cohort Study.

H Kuipers1, E A J de Savornin Lohman2, M van Dooren2

  • 1Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. h.kuipers01@umcg.nl.

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Summary
This summary is machine-generated.

Extended resections for advanced gallbladder cancer (GBC) show significant morbidity but offer long-term survival for some patients. Achieving R0 margins and avoiding liver invasion are key for recurrence-free survival.

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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery
  • Hepatobiliary Surgery

Background:

  • Extended resections for gallbladder cancer (GBC) are rarely performed due to inconclusive outcomes.
  • Western data on extended resections for GBC are limited.
  • This study investigates outcomes of extended resections for locally advanced GBC in the Netherlands.

Purpose of the Study:

  • To analyze the outcomes of extended resections for locally advanced gallbladder cancer (GBC).
  • To assess postoperative morbidity, mortality, and survival rates.
  • To identify factors associated with survival and recurrence.

Main Methods:

  • A Dutch multicenter cohort study identified 33 patients with GBC undergoing extended resection with curative intent (2000-2018).
  • Extended resection involved major hepatectomy (≥3 segments), pancreatoduodenectomy, or both.
  • Data on treatment, survival, morbidity, and recurrence were collected and analyzed.

Main Results:

  • R0 resection margins were achieved in 16 patients.
  • Postoperative complications (Clavien Dindo ≥3A) occurred in 19 patients, with 4 perioperative deaths.
  • Median overall survival was 12.8 months; 30% survived 2 years and 15% survived 5 years.
  • Factors associated with reduced survival included common bile duct, liver, perineural, and perivascular invasion, and jaundice.
  • Recurrence-free patients had R0 margins and no liver invasion.

Conclusions:

  • Extended resections for advanced GBC yield a median overall survival of 12.8 months.
  • Despite significant postoperative morbidity and mortality, long-term survival (≥2 years) is achievable for a subset of patients.
  • Gallbladder cancer requiring major surgery does not preclude long-term survival, indicating a benefit for select patients.