Reuters Health Information (2011-04-27): Surgery effective for advanced gallbladder cancer involving adjacent organs
Surgery effective for advanced gallbladder cancer involving adjacent organs
Last Updated: 2011-04-27 16:06:28 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Surgery should be considered for gallbladder cancer even when there is biliary invasion, researchers from Japan report in the Annals of Surgery, online April 14.
Surgical resection offers the only chance of long-term survival after gallbladder cancer, but many surgeons consider jaundice (evidence of invasive disease beyond the gallbladder proper) to be a contraindication to resection.
Dr. Masato Nagino and colleagues from Nagoya University Graduate School of Medicine analyzed their 30-year experience treating advanced gallbladder cancer in 100 patients in order to clarify the value of resecting cancer that involves the extrahepatic bile duct.
Nine patients, eight of whom had pathologic extrahepatic bile duct invasion (pEBI), died of postoperative complications. Intraoperative blood loss was the only independent predictor of postoperative mortality.
Overall survival rates were 41% at 3 years and 31% at 5 years, and the median survival time was 2.1 years. Five-year survival and median survival time were significantly worse for the 73 patients with pEBI (23% and 1.5 years, respectively) than for the 27 patients without pEBI (54% and 15.4 years, respectively).
Even among patients with pEBI, survival was significantly better after resection than among unresected patients.
Combined resection of adjacent organs other than the liver and extrahepatic bile duct and the presence of microscopic/macroscopic residual tumor (R1/2 resection) were independent predictors of worse long-term survival.
"Patients with advanced gallbladder cancer with pEBI are candidates for resection when distant metastases are absent and R0 (no residual tumor) resection is achievable," the researchers conclude.
"When combined resection of adjacent organs other than the liver and extrahepatic bile duct is unnecessary, surgical resection should be aggressively planned," they add. "When combined resection of adjacent organs is necessary, patients should be carefully selected."
The investigators note, "Further study is necessary to clarify contraindications to resection in such patients."
Ann Surg 2011.