The significance of anatomic tumor location in gallbladder cancer.
Aged
Biliary Tract Surgical Procedures
/ adverse effects
Carcinoma in Situ
/ pathology
Female
Follow-Up Studies
Gallbladder Neoplasms
/ pathology
Hepatectomy
/ adverse effects
Humans
Jaundice
/ etiology
Male
Middle Aged
Postoperative Complications
/ etiology
Prognosis
Retrospective Studies
Survival Rate
anatomic location
body
fundus
gallbladder cancer
neck tumor
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
24
08
2020
revised:
03
12
2020
accepted:
04
12
2020
pubmed:
29
12
2020
medline:
11
3
2021
entrez:
28
12
2020
Statut:
ppublish
Résumé
Current management guidelines recognize the impact of hepatic versus peritoneal sided gallbladder cancers (GBC) on survival. However, no data exist regarding the significance of anatomic tumor location within the gallbladder. We retrospectively analyzed all GBC that underwent surgical resection with curative intent in our health system from 2007 to 2017. We evaluated the effect of anatomic pathologic tumor location (fundus/body, neck, and multifocal) on clinicopathologic, perioperative, and oncologic outcomes. About 97 patients met criteria; 63% fundus/body, 22% multifocal, and 15% neck. Compared with fundus/body, neck tumors more frequently presented with preoperative jaundice (53% vs. 13%, p < .001), were smaller (20 mm vs. 30 mm, p = .068) and had significantly more biliary tree invasion (33% vs. 13%, p = .030) on histopathology. Although tumor characteristics (pTNM stage, liver invasion, lymphovascular invasion, prognostic nutritional index, and grade) were similar, neck tumors had significantly higher rates of R0 resection (53% vs. 11%, p < .001). Rates of adjuvant therapy were similar. Median PFS was similar between cohorts (p = .356). However, median overall survival (OS) was significantly shorter in neck (21 months) than fundus/body tumors (NR > 109 months), p = .015. Neck tumors were rare, small and more likely to result in jaundice secondary to biliary tree invasion. Despite higher R0 resection rates, these tumors had significantly worse OS.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
Current management guidelines recognize the impact of hepatic versus peritoneal sided gallbladder cancers (GBC) on survival. However, no data exist regarding the significance of anatomic tumor location within the gallbladder.
METHODS
METHODS
We retrospectively analyzed all GBC that underwent surgical resection with curative intent in our health system from 2007 to 2017. We evaluated the effect of anatomic pathologic tumor location (fundus/body, neck, and multifocal) on clinicopathologic, perioperative, and oncologic outcomes.
RESULTS
RESULTS
About 97 patients met criteria; 63% fundus/body, 22% multifocal, and 15% neck. Compared with fundus/body, neck tumors more frequently presented with preoperative jaundice (53% vs. 13%, p < .001), were smaller (20 mm vs. 30 mm, p = .068) and had significantly more biliary tree invasion (33% vs. 13%, p = .030) on histopathology. Although tumor characteristics (pTNM stage, liver invasion, lymphovascular invasion, prognostic nutritional index, and grade) were similar, neck tumors had significantly higher rates of R0 resection (53% vs. 11%, p < .001). Rates of adjuvant therapy were similar. Median PFS was similar between cohorts (p = .356). However, median overall survival (OS) was significantly shorter in neck (21 months) than fundus/body tumors (NR > 109 months), p = .015.
CONCLUSIONS
CONCLUSIONS
Neck tumors were rare, small and more likely to result in jaundice secondary to biliary tree invasion. Despite higher R0 resection rates, these tumors had significantly worse OS.
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
932-938Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer. 2006;118(7):1591-602.
Miyakawa S, Ishihara S, Horiguchi A, Takada T, Miyazaki M, Nagakawa T. Biliary tract cancer treatment: 5,584 results from the Biliary Tract Cancer Statistics Registry from 1998 to 2004 in Japan. J Hepatobiliary Pancreat Surg. 2009;16(1):1-7.
Jung W, Jang JY, Kang MJ, et al. Effects of surgical methods and tumor location on survival and recurrence patterns after curative resection in patients with T2 gallbladder cancer. Gut Liver. 2016;10(1):140-146.
Lee W, Jeong CY, Jang JY, et al. Do hepatic-sided tumors require more extensive resection than peritoneal-sided tumors in patients with T2 gallbladder cancer? Results of a retrospective multicenter study. Surgery. 2017;162(3):515-524.
Shindoh J, de Aretxabala X, Aloia TA, et al. Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study. Ann Surg. 2015;261(4):733-739.
Aretxabala X, Roa I, Hepp J, et al. Early gallbladder cancer: is further treatment necessary? J Surg Oncol. 2009;100(7):589-593.
Aloia TA, Járufe N, Javle M, et al. Gallbladder cancer: expert consensus statement. HPB (Oxford). 2015;17(8):681-690.
Chun YS, Pawlik TM, Vauthey JN. 8th Edition of the AJCC Cancer Staging Manual: pancreas and hepatobiliary cancers. Ann Surg Oncol. 2018;25(4):845-847.
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th Edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17(6):1471-1474.
Clavien PA, Barkun J, Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187-196.
Lee H, Choi DW, Park JY, et al. Surgical strategy for T2 gallbladder cancer according to tumor location. Ann Surg Oncol. 2015;22(8):2779-2786.
Nishio H, Ebata T, Yokoyama Y, Igami T, Sugawara G, Nagino M. Gallbladder cancer involving the extrahepatic bile duct is worthy of resection. Ann Surg. 2011;253(5):953-960.
D'Angelica M, Dalal KM, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR. Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncol. 2009;16(4):806-816.
Kaneoka Y, Yamaguchi A, Isogai M, Harada T, Suzuki M. Hepatoduodenal ligament invasion by gallbladder carcinoma: histologic patterns and surgical recommendation. World J Surg. 2003;27(3):260-265.
Suzuki S, Yokoi Y, Kurachi K, et al. Appraisal of surgical treatment for pT2 gallbladder carcinomas. World J Surg. 2004;28(2):160-165.
Sakamoto Y, Kosuge T, Shimada K, et al. Clinical significance of extrahepatic bile duct resection for advanced gallbladder cancer. J Surg Oncol. 2006;94(4):298-306.
Kurahara H, Maemura K, Mataki Y, et al. Indication of extrahepatic bile duct resection for gallbladder cancer. Langenbecks Arch Surg. 2018;403(1):45-51.
Araida T, Higuchi R, Hamano M, et al. Hepatic resection in 485 R0 pT2 and pT3 cases of advanced carcinoma of the gallbladder: results of a Japanese Society of Biliary Surgery survey: a multicenter study. J Hepatobiliary Pancreat Surg. 2009;16(2):204-215.
Wiggers JK, Groot Koerkamp B, Ovadia Z, Busch OR, Gouma DJ, Gulik TM. Patterns of recurrence after resection of gallbladder cancer without routine extrahepatic bile duct resection. HPB (Oxford). 2014;16(7):635-640.
Fujii Y, Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T. Significance of bile duct resection for advanced gallbladder cancer without biliary infiltration. Am J Surg. 2018;216(6):1122-1126.
Kosuge T, Sano K, Shimada K, Yamamoto J, Yamasaki S, Makuuchi M. Should the bile duct be preserved or removed in radical surgery for gallbladder cancer? Hepatogastroenterology. 1999;46(28):2133-2137.
Shimizu Y, Ohtsuka M, Ito H, et al. Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer? Surgery. 2004;136(5):1012-1017.
Choi SB, Han HJ, Kim WB, Song TJ, Suh SO, Choi SY. Surgical strategy for T2 and T3 gallbladder cancer: is extrahepatic bile duct resection always necessary? Langenbecks Arch Surg. 2013;398(8):1137-1144.
Zhang W, Hong HJ, Chen YL. Establishment of a gallbladder cancer-specific survival model to predict prognosis in non-metastatic gallbladder cancer patients after surgical resection. Dig Dis Sci. 2018;63(9):2251-2258.
Yadav S, Tella SH, Kommalapati A, et al. A novel clinically based staging system for gallbladder cancer. J Natl Compr Canc Netw. 2020;18(2):151-159.
Fong Y, Jarnagin W, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg. 2000;232(4):557-569.