胆道癌に対する肝臓拡大切除術の成績：西洋における単一施設の後ろ向きコホート研究

Gallbladder cancer (GBCa) is a rare disease in western countries and surgery remains the state of art, given the tumor is technically resectable. However, data for major liver resection in patients with advanced GBCa is scarce. Objective of this study was to analyze survival outcome measures of patients undergoing major liver resection for GBCa.

We conducted a single center retrospective cohort study in a high volume hepato-pancreato-biliary (HPB) center screening all patients with gallbladder cancer (GBCa) being treated between 2008-2023. Inclusion criteria were met when resection [major hepatectomy (MaH); minor hepatectomy (MiH)] or palliative chemotherapy (either after surgical exploration +EL/sPC or primarily -EL/pPC) was performed at the University Medical Center Mainz and diagnosis of GBCa was histologically confirmed. Survival analysis was conducted using Kaplan-Meier method. Univariate and multivariate analysis was performed to identify independent predictors of survival.

In total, 167 patients met the inclusion criteria, with 80 patients undergoing resection (MaH, n=20; MiH, n=60) and 87 patients undergoing palliative chemotherapy (n=68 after surgical exploration, n=19 primary palliative chemotherapy). The median survival for patients receiving a MaH or MiH were 11.96 months [95% confidence interval (CI): 1.11-22.81] and 25.1 months (95% CI: 19.37-30.85), respectively. MiH was associated with statistically significant improved survival compared to every other group (MiH vs. +EL/sPC, P<0.001; MiH vs. MaH, P=0.004; MiH vs. -EL/pPC, P<0.001). Two patients survived longer than 36 months after MaH. Conversely, median survival in the +EL/sPC group was 10.32 months (95% CI: 7.74-12.9), and statistically non-inferior to MaH (P=0.052). Patients receiving primary palliative treatment (-EL/pPC) survived median 7.26 months (95% CI: 0.0-15.4), showing no statistically significant discrepancy to MaH either (P=0.25). In a multivariate analysis of patients who underwent resection, MaH (P=0.04) and R-stage (P=0.02) were identified as independent predictors of worse overall survival.

MiH, if applicable, is associated with improved survival in GBCa, whereas only few patients benefited from major hepatectomies. This is, however, not attributable to the surgical technique, but rather to the advanced tumor necessitating major and/or extended resections. New neoadjuvant chemotherapy concepts are urgently needed to reduce preoperative tumor burden and improve survival outcomes.