Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2021; 27(45): 7813-7830
Published online Dec 7, 2021. doi: 10.3748/wjg.v27.i45.7813
Multimodality management of gallbladder cancer can lead to a better outcome: Experience from a tertiary care oncology centre in North India
Shaifali Goel, Abhishek Aggarwal, Assif Iqbal, Vineet Talwar, Swarupa Mitra, Shivendra Singh
Shaifali Goel, Abhishek Aggarwal, Assif Iqbal, Shivendra Singh, Department of GI and HPB Oncosurgery, Rajiv Gandhi Cancer Institute and Research Center, Delhi 110085, Delhi, India
Vineet Talwar, Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi 110085, Delhi, India
Swarupa Mitra, Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Center, Delhi 110085, Delhi, India
Author contributions: Singh S was the guarantor and designed the study; Goel S, Aggarwal A, and Iqbal A participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Talwar V, Mitra S, and Singh S revised the article critically for important intellectual content.
Institutional review board statement: The local Institutional Review Board (IRB) approved the study on May 26, 2020 (No. RGCIRC/IRB-BHR/48/2020).
Informed consent statement: All patients provided informed consent prior to any intervention, chemotherapy, radiotherapy, or surgery.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shivendra Singh, MCh, MS, Chief and Senior consultant, Department of GI and HPB Oncosurgery, Rajiv Gandhi Cancer Institute and Research Center, Dinbandhu Choturam Marg, Sector 5, Delhi 110085, Delhi, India. shiven_24@yahoo.co.in
Received: April 26, 2021
Peer-review started: April 26, 2021
First decision: June 13, 2021
Revised: June 26, 2021
Accepted: September 2, 2021
Article in press: September 2, 2021
Published online: December 7, 2021
Abstract
BACKGROUND

Surgical resection is a treatment of choice for gallbladder cancer (GBC) patients but only 10% of patients have a resectable disease at presentation. Even after surgical resection, overall survival (OS) has been poor due to high rates of recurrence. Combination of surgery and systemic therapy can improve outcomes in this aggressive disease.

AIM

To summarize our single-center experience with multimodality management of resectable GBC patients.

METHODS

Data of all patients undergoing surgery for suspected GBC from January 2012 to December 2018 was retrieved from a prospectively maintained electronic database. Information extracted included demographics, operative and perioperative details, histopathology, neoadjuvant/adjuvant therapy, follow-up, and recurrence. To know the factors associated with recurrence and OS, univariate and multivariate analysis was done using log rank test and cox proportional hazard analysis for categorical and continuous variables, respectively. Multivariate analysis was done using multiple regression analysis.

RESULTS

Of 274 patients with GBC taken up for surgical resection, 172 (62.7%) were female and the median age was 56 years. On exploration, 102 patients were found to have a metastatic or unresectable disease (distant metastasis in 66 and locally unresectable in 34). Of 172 patients who finally underwent surgery, 93 (54%) underwent wedge resection followed by anatomical segment IVb/V resection in 66 (38.4%) and modified extended right hepatectomy in 12 (7%) patients. The postoperative mortality at 90 d was 4.6%. During a median follow-up period of 20 mo, 71 (41.2%) patients developed recurrence. Estimated 1-, 3-, and 5-years OS rates were 86.5%, 56%, and 43.5%, respectively. Estimated 1- and 3-year disease free survival (DFS) rates were 75% and 49.2%, respectively. On multivariate analysis, inferior OS was seen with pT3/T4 tumor (P = 0.0001), perineural invasion (P = 0.0096), and R+ resection (P = 0.0125). However, only pT3/T4 tumors were associated with a poor DFS (P < 0.0001).

CONCLUSION

Multimodality treatment significantly improves the 5-year survival rate of patients with GBC up to 43%. R+ resection, higher T stage, and perineural invasion adversely affect the outcome and should be considered for systemic therapy in addition to surgery to optimize the outcomes. Multimodality treatment of GBC has potential to improve the survival of GBC patients.

Keywords: Gallbladder cancer, Multimodality, Surgical resection, Adjuvant, Chemotherapy, Chemoradiotherapy

Core Tip: Gallbladder cancer (GBC) is an aggressive malignancy with only 10% of cases amenable to resection at presentation and a dismal overall 5-year survival rate of 5%-13% after curative surgery. Recently, several experts have recommended that multimodality treatment, including neoadjuvant and adjuvant therapies, can improve survival. In this study, we share our experience with multimodality approach in GBC. Five-year overall survival was approaching 50%, and therefore we suggest that such approach can improve survival in this aggressive malignancy.