Abstract
Purpose
The aim was to evaluate prognostic factors and factors associated with the resectability of advanced gallbladder cancer (GBC).
Methods
This was a single-institution retrospective review of 274 consecutive surgically-treated cases of advanced GBC (excluding incidental GBC and early GBC). Univariate and multivariate analysis were performed to assess prognostic variables. R0 resection and survival rates were investigated for each local extension factor.
Results
Long-term survival was uncommon among patients with multiple liver metastases (H2–3: n = 22; 2-year survival, 0 %), dissemination (P1–3: n = 16; 3-year survival, 0 %), invasion through the hepatoduodenal ligament (Binf3: n = 45; 5-year survival, 4.6 %), or group 3 lymph node (LN) metastasis including of the para-aortic LN (N3: n = 52; 13.7 %). Long-term survival rates did not differ significantly between patients who did and did not undergo bile duct resection or pancreaticoduodenectomy. Survival did not differ significantly according to the type of hepatectomy performed.
Conclusion
Surgery may not be indicated for patients with multiple liver metastasis, dissemination, Binf3, or visible para-aortic LN metastasis. Furthermore, it is important to achieve R0 surgery in cases of GBC.
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Acknowledgment
The authors are indebted to Prof. Naohito Yamaguchi (Department of Public Health, Tokyo Women’s Medical University), who performed a statistical review of this manuscript.
Disclosure
Ryota Higuchi, Takehiro Ota, Tatsuo Araida, Hideki Kajiyama, Takehisa Yazawa, Toru Furukawa, Tatsuya Yoshikawa, Ken Takasaki, and Masakazu Yamamoto have no commercial interests, financial support, or material support to declare.
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Higuchi, R., Ota, T., Araida, T. et al. Surgical Approaches to Advanced Gallbladder Cancer. Ann Surg Oncol 21, 4308–4316 (2014). https://doi.org/10.1245/s10434-014-3885-1
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DOI: https://doi.org/10.1245/s10434-014-3885-1