Locally advanced gallbladder cancer: Contemporary outcomes for aggressive surgical management.

Abstract

420 Background: Patients with gallbladder cancer (GBCA) often present at advanced stages and their prognosis is dismal. Surgery for locally advanced (LA) disease has been controversial and the optimal indication for resection needs to be defined. Methods: Patients who underwent curative resection for GBCA of T1b or greater with curative intent at our institution from Jan. 2006 through Jun. 2017 were included. “Locally advanced disease” was defined as GBCA deemed to invade the hepatic hilum, or the extrahepatic organs either by the preoperative imaging. Perioperative management, operative procedures, and the short- and long-term for the patients with LA-GBCA were evaluated and compared with those for the patients with localized GBCA (L-GBCA). Results: Total 102 patients were identified and 35 patients were with LA-GBCA. Nineteen patients (54%) with LA-GBCA presented with jaundice, and all of them had biliary stent placed preoperatively. Preoperative portal embolization was performed for 22 patients (63%). Extended resections included hepatopancreaticoduodenectomy (n = 14, 40%), major hepatectomy (lobectomy or greater, n = 29, 83%), with partial duodenectomy (n = 7, 20%), with partial colectomy (n = 6, 17%), and with major vascular resection/reconstruction (n = 9, 26%). R0 resection was achieved in 87% of the patients with LA-GBCA by extended resection, while it was achieved in 91% of those with L-GBCA by standard radical cholecystectomy ( p= 0.13). The 5-year recurrence-free and overall survival (RFS and OS) rates for the patients with LA-GBCA were 19% and 26%, compared with 57% and 66% for those with L-GBCA ( p< 0.001 for RFS, and p < 0.001 for OS, respectively). In the multivariate analysis for all the patients with GBCA, T3 or greater, nodal metastasis and R1 resection remained as significant risk factors for both recurrence and death after resection with curative intent. Conclusions: Although extended resection for locally advanced cancer is safe and feasible, its long-term outcomes remained poor. Appropriate patient selection criteria needs be established to avoid aggressive operation without benefit for the patients with LA-GBCA.