Published online Sep 27, 2020. doi: 10.4254/wjh.v12.i9.641
Peer-review started: March 9, 2020
First decision: May 5, 2020
Revised: July 10, 2020
Accepted: July 18, 2020
Article in press: July 18, 2020
Published online: September 27, 2020
Processing time: 196 Days and 13.1 Hours
Gallbladder cancer (GBC) is the most common biliary malignancy and has the worst prognosis, but aggressive surgeries [e.g., resection of the extrahepatic bile duct (EHBD), major hepatectomy and lymph node (LN) dissection] may improve long-term survival. GBC may be suspected preoperatively, identified intraoperatively, or discovered incidentally on histopathology.
To present our data together with a discussion of the therapeutic strategies for GBC.
We retrospectively investigated nineteen GBC patients who underwent surgical treatment.
Nearly all symptomatic patients had poor outcomes, while suspicious or incidental GBCs at early stages showed excellent outcomes without the need for two-stage surgery. Lymph nodes around the cystic duct were reliable sentinel nodes in suspicious/incidental GBCs. Intentional LN dissection and EHBD resection prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic LNs or invasion of the nerve plexus. All patients with positive surgical margins (e.g., the biliary cut surface) showed poor outcomes. Hepatectomies were performed in sixteen patients, nearly all of which were minor hepatectomies. Metastases were observed in the left-sided liver but not in the caudate lobe. We may need to reconsider the indications for major hepatectomy, minimizing its use except when it is required to accomplish negative bile duct margins. Only a few patients received neoadjuvant or adjuvant chemoradiation. There were significant differences in overall and disease-free survival between patients with stages ≤ IIB and ≥ IIIA disease. The median overall survival and disease-free survival were 1.66 and 0.79 years, respectively.
Outcomes for GBC patients remain unacceptable, and improved therapeutic strategies, including neoadjuvant chemotherapy, optimal surgery and adjuvant chemotherapy, should be considered for patients with advanced GBCs.
Core Tip: Gallbladder cancer (GBC) has a poor prognosis. Our GBC patients who underwent surgeries were retrospectively evaluated. Lymphadenectomy and resection of the extrahepatic bile duct prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic lymph nodes or invasion of the nerve plexus. We should reconsider the indications for major hepatectomy, when it is required to achieve negative bile duct margins. There were significant differences in overall and disease-free survival between patients with stages ≤ IIB and ≥ IIIA disease. The median overall survival and disease-free survival were 1.66 and 0.79 years, respectively. Postoperative outcome remains unacceptable.