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2019, Number 3

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Cir Cir 2019; 87 (3)

Extension of surgical treatment and adjuvant chemotherapy in patients with incidental gallbladder cancer

Manterola C, Grande L, Otzen T, Conejeros R

Language: Spanish
References: 58
Page: 313-320
PDF size: 260.91 Kb.


ABSTRACT

Objective: To describe the results of the extension of surgical treatment and adjuvant chemotherapy (ACT) in incidental gallbladder cancer (CVB), in terms of postoperative morbidity (POM) and 5-year overall survival rate. Method: Case series of patients operated on for incidental GBC in Clínica Mayor, Temuco, Chile (2001-2016). All cases were treated by partial hepatectomy (segments IVb and V), and regional lymphadenectomy. The minimum follow-up time was 12 months. Outcome variables were MPO and 5-year overall survival rate. Other variables of interest were: infiltration depth in vesicular wall, lymph nodes and resected liver; surgical time, need for reoperation, hospital stay, follow-up and mortality. Descriptive statistics were applied as well as bivariate analysis applying Fisher’s exact and t-test and non-parametrical tests for continuous variables and Kaplan Meier curves. Results: The series was composed of 50 patients, whose average age was 58.6 ± 9.6 years; 68.0% of which were women. The mean surgical time and hospital stay were 224 ± 93 min (90 to 480) and 6.9 ± 2.9 days (4 to 20), respectively. POM was 28.0%. 5-year overall survival rate was 47%. There were no reoperations or mortality. Conclusions: The results verified in terms of POM and 5-year overall survival rate are similar to previously reported series.


REFERENCES

  1. Itriago L, Silva N, Cortés G. Cáncer en Chile y el mundo: una mirada epidemiológica, presente y futuro. Rev Med Clin Condes. 2013;24:531-52.

  2. American Cancer Society. Estadísticas de supervivencia para el cáncer de vesícula biliar, según la etapa. (Consultado el 31 de enero de 2018.) Disponible en: https://www.cancer.org/es/cancer/cancer-de-vesicula-biliar/ deteccion-diagnostico-clasificacion-por-etapas/tasas-de-supervivencia.html

  3. He XD, Li JJ, Liu W, Qu Q, Hong T, Xu XQ, et al. Surgical procedure determination based on tumor-node-metastasis staging of gallbladder cancer. World J Gastroenterol. 2015;21:4620-6.

  4. Maluenda F, Díaz JC, Aretxabala X, Burdiles P, Csendes A, Contreras L. Strategies for the surgical treatment of gallbladder cáncer. Rev Med Chil. 2005;133:723-8.

  5. Roa I, Ibacache G, Muñoz S, de Aretxabala X. Gallbladder cancer in Chile: pathologic characteristics of survival and prognostic factors: analysis of 1,366 cases. Am J Clin Pathol. 2014;141:675-82.

  6. Lee W, Jeong CY, Jang JY, Kim YH, Roh YH, Kim KW, 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;162:515-24.

  7. Shindoh J, de Aretxabala X, Aloia TA, Roa JC, Roa I, Zimmitti G, et al. Tumor location is a strong predictor of tumor progression and survival in t2 gallbladder cancer: an international multicenter study. Ann Surg. 2015;261:733-9.

  8. Ahn Y, Park CS, Hwang S, Jang HJ, Choi KM, Lee SG. Incidental gallbladder cancer after routine cholecystectomy: when should we suspect it preoperatively and what are predictors of patient survival? Ann Surg Treat Res. 2016;90:131-8.

  9. Tian YH, Ji X, Liu B, Yang GY, Meng XF, Xia HT, et al. Surgical treatment of incidental gallbladder cancer discovered during or following laparoscopic cholecystectomy. World J Surg. 2015;39:746-52.

  10. Roa JC, Tapia O, Manterola C, Villaseca M, Guzmán P, Araya JC, et al Early gallbladder carcinoma has a favorable outcome but Rokitansky-Aschoff sinus involvement is an adverse prognostic factor. Virchows Arch. 2013;463:651-61.

  11. Ethun CG, Postlewait LM, Le N, Pawlik TM, Buettner S, Poultsides G, et al. A novel pathology-based preoperative risk score to predict locoregional residual and distant disease and survival for incidental gallbladder cancer: a 10-institution study from the U.S. Extrahepatic Biliary Malignancy Consortium. Ann Surg Oncol. 2017;24:1343-50.

  12. Piccolo G, Di Vita M, Cavallaro A, Fisichella R, Zanghì A, Spartà D, et al. Lymph node evaluation in gallbladder cancer: which role in the prognostic and therapeutic aspects. Update of the literature. Eur Rev Med Pharmacol Sci. 2014;18(2 Suppl):47-53.

  13. Shirai Y, Wakai T, Sakata J, Hatakeyama K. Regional lymphadenectomy for gallbladder cancer: rational extent, technical details, and patient outcomes. World J Gastroenterol. 2012;18:2775-83.

  14. Muratore A, Amisano M, Viganò L, Massucco P, Capussotti L. Gallbladder cancer invading the perimuscular connective tissue: results of reresection after prior non-curative operation. J Surg Oncol. 2003;83:212-5.

  15. Sikora SS, Singh RK. Surgical strategies in patients with gallbladder cancer: nihilism to optimism. J Surg Oncol. 2006;93:670-81.

  16. Sternby Eilard M, Lundgren L, Cahlin C, Strandell A, Svanberg T, Sandström P. Surgical treatment for gallbladder cancer — a systematic literature review. Scand J Gastroenterol. 2017;52:505-14.

  17. Shirai Y, Wakai T, Hatakeyama K. Radical lymph node dissection for gallbladder cancer: indications and limitations. Surg Oncol Clin N Am. 2007;16:221-32.

  18. de Aretxabala X, Roa I, Berrios M, Hepp J, Gallardo J, Cordova A, et al. Chemoradiotherapy in gallbladder cancer. J Surg Oncol. 2006;93:699-704.

  19. Foster JM, Hoshi H, Gibbs JF, Iyer R, Javle M, Chu Q, et al. Gallbladder cancer: Defining the indications for primary radical resection and radical re-resection. Ann Surg Oncol. 2007;14:833-40.

  20. Yamaguchi J, Kaneoka Y, Maeda A, Takayama Y, Onoe S, Isogai M. Benefit of extended radical surgery for incidental gallbladder carcinoma. Surg Today. 2016;46:453-9.

  21. Manterola C, Otzen T. Checklist for reporting results using observational descriptive studies as research designs. The MInCir Initiative. Int J Morphol. 2017;35:72-6.

  22. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187-96.

  23. Manterola C, Vial M, Roa JC. Survival of a cohort of patients with intermediate and advanced gall bladder cancer treated with a prospective therapeutic protocol. Acta Cir Bras. 2010;25:225-30.

  24. Manterola C, Conejeros R, Yáñez E. ¿Cuál es el rol de la cirugía en el tratamiento de un paciente con cáncer de la vesícula biliar estadio IIIb? Int J Morphol. 2015;33:653-9.

  25. Helsinki Statement of the Worldwide Medical Association. Ethical principles for the medical researches in human beings. Amended by 52a General Assembly, Edinburgh, Scotland; October 2000.

  26. Goetze TO. Gallbladder carcinoma: prognostic factors and therapeutic options. World J Gastroenterol. 2015; 21:12211-7.

  27. Wang JD, Liu YB, Quan ZW, Li SG, Wang XF, Shen J. Role of regional lymphadenectomy in different stage of gallbladder carcinoma. Hepatogastroenterology. 2009;56 593-6.

  28. Birnbaum DJ, Viganò L, Russolillo N, Langella S, Ferrero A, Capussotti L. Lymph node metastases in patients undergoing surgery for a gallbladder cancer. Extension of the lymph node dissection and prognostic value of the lymph node ratio. Ann Surg Oncol. 2015;22:811-8.

  29. Giuliante F, Ardito F, Vellone M, Clemente G, Nuzzo G. Port-sites excision for gallbladder cancer incidentally found after laparoscopic cholecystectomy. Am J Surg. 2006;191:114-6.

  30. Hamila F, Letaief R, Khnissi M, Derbel F, Mazhoud J, Ben Ali A, et al. Port site recurrence after laparoscopic cholecystectomy. Tunis Med. 2006;84:697-700.

  31. Paolucci V. Port site recurrences after laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg. 2001;8 535-43.

  32. Goetze TO, Paolucci V. Incidental T1b-T3 gallbladder carcinoma. Extended cholecystectomy as an underestimated prognostic factor-results of the German registry. Chirurg. 2014;85:131-8.

  33. 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;398:1137-44.

  34. Kawahara R, Shirahama T, Arai S, Muroya D, Nomura Y, Fukutomi S, et al. Evaluation of surgical procedures for T2 gallbladder cancer in terms of recurrence and prognosis. Kurume Med J. 2017;63:15-22.

  35. Utsumi M, Aoki H, Kunitomo T, Mushiake Y, Yasuhara I, Arata T, et al. Evaluation of surgical treatment for incidental gallbladder carcinoma diagnosed during or after laparoscopic cholecystectomy: single center results. BMC Res Notes. 2017;10:56.

  36. Lee SE, Kim KS, Kim WB, Kim IG, Nah YW, Ryu DH, et al.; Korean Association of Hepato-Biliary and Pancreas Surgery. Practical guidelines for the surgical treatment of gallbladder cancer. J Korean Med Sci. 2014;29:1333-40.

  37. Cavallaro A, Piccolo G, Di Vita M, Zanghì A, Cardì F, Di Mattia P, et al. Managing the incidentally detected gallbladder cancer: algorithms and controversies. Int J Surg. 2014;12(Suppl 2):S108-19.

  38. Aloia TA, Járufe N, Javle M, Maithel SK, Roa JC, Adsay V, et al. Gallbladder cancer: expert consensus statement. HPB (Oxford). 2015;17 681-90.

  39. Shroff RT, Knox J, Dixon E. Consensus conference on gallbladder cancer. HPB (Oxford). 2015;17 664-5.

  40. Liu Q, Wu N, Zhou N. Port-site resection in surgical management of incidental gallbladder cancer: a still unresolved question. Ann Surg Oncol. 2017;24(Suppl 3):646.

  41. Jang JY, Heo JS, Han Y, Chang J, Kim JR, Kim H, et al. Impact of type of surgery on survival outcome in patients with early gallbladder cancer in the era of minimally invasive surgery: oncologic safety of laparoscopic surgery. Medicine (Balt.). 2016;95:e3675.

  42. Sheikh MR, Osman H, Cheek S, Hunter S, Jeyarajah DR. T2 Gallbladder cancer-aggressive therapy is warranted. Am Surg. 2016;82:518-21.

  43. de Aretxabala X, Roa I, Burgos L. Gallbladder cancer, management of early tumors. Hepatogastroenterology. 1999;46:1547-51.

  44. Lee J, Park SH, Chang HM, Kim JS, Choi HJ, Lee MA, et al. Gemcitabine and oxaliplatin with or without erlotinib in advanced biliary-tract cancer: a multicentre, open-label, randomised, phase 3 study. Lancet Oncol. 2012;13:181-8.

  45. Chen L, Chen C, Yen Y, Tam KW. Chemotherapy for advanced biliary tract carcinoma: a meta-analysis of randomized controlled trials. Medicine (Balt.). 2016;95:e4584.

  46. Creasy JM, Goldman DA, Dudeja V, Lowery MA, Cercek A, Balachandran VP, et al. Systemic chemotherapy combined with resection for locally advanced gallbladder carcinoma: surgical and survival outcomes. J Am Coll Surg. 2017;224:906-16.

  47. Eckel F, Schmid RM. Chemotherapy and targeted therapy in advanced biliary tract carcinoma: a pooled analysis of clinical trials. Chemotherapy. 2014;60:13-23.

  48. Lee KJ, Yi SW, Cha J, Seong J, Bang S, Song SY, et al. A pilot study of concurrent chemoradiotherapy with gemcitabine and cisplatin in patients with locally advanced biliary tract cancer. Cancer Chemother Pharmacol. 2016;78:841-6.

  49. Mantripragada KC, Hamid F, Shafqat H, Olszewski AJ. Adjuvant therapy for resected gallbladder cancer: analysis of the National Cancer Data Base. J Natl Cancer Inst. 2016;109(2). pii: djw202.

  50. Nakamura M, Nakashima H, Abe T, Ensako T, Yoshida K, Hino K. Gemcitabine-based adjuvant chemotherapy for patients with advanced gallbladder cancer. Anticancer Res. 2014;34:3125-9.

  51. Neoptolemos JP, Moore MJ, Cox TF, Valle JW, Palmer DH, McDonald AC, et al. Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial. JAMA. 2012;308:147-56.

  52. Sohn BS, Yuh YJ, Kim KH, Jeon TJ, Kim NS, Kim SR. Phase II trial of combination chemotherapy with gemcitabine, 5-fluorouracil and cisplatin for advanced cancers of the bile duct, gallbladder, and ampulla of Vater. Tumori. 2013;99:139-44.

  53. Wang SJ, Lemieux A, Kalpathy-Cramer J, Ord CB, Walker GV, Fuller CD, et al. Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer. J Clin Oncol. 2011;29:4627-32.

  54. Yamashita Y, Taketomi A, Fukuzawa K, Yoshizumi T, Uchiyama H, Simada M, et al. Gemcitabine combined with 5-fluorouracil and cisplatin (GFP) in patients with advanced biliary tree cancers: a pilot study. Anticancer Res. 2006;26:771-5.

  55. Yang R, Wang B, Chen YJ, Li HB, Hu JB, Zou SQ. Efficacy of gemcitabine plus platinum agents for biliary tract cancers: a meta-analysis. Anticancer Drugs. 2013;24:871-7.

  56. Hezel AF, Deshpande V, Zhu AX. Genetics of biliary tract cancers and emerging targeted therapies. J Clin Oncol. 2010;28:3531-40.

  57. Marino D, Leone F, Cavalloni G, Cagnazzo C, Aglietta M. Biliary tract carcinomas: from chemotherapy to targeted therapy. Crit Rev Oncol Hematol. 2013;85:136-48.

  58. Zhu AX, Hezel AF. Development of molecularly targeted therapies in biliary tract cancers: reassessing the challenges and opportunities. Hepatology. 2011;53:695-704.




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