J Korean Surg Soc.  2012 Oct;83(4):227-236. 10.4174/jkss.2012.83.4.227.

Prognostic factors for gallbladder cancer in the laparoscopy era

• Lee HY
• Kim YH
• Jung GJ
• Roh YH
• Park SY
• Kang NU
• Yoon SH
• Cho JH
• Roh MH
• Han SY
• Lee SW
• Baek YH
• Jeong JS

• KMID: 2212311
• DOI: http://doi.org/10.4174/jkss.2012.83.4.227

Abstract

PURPOSE
Hepatobiliary surgery has changed dramatically in recent decades with the advent of laparoscopic techniques. The aim of this retrospective study was to compare survival rates according to stages, adjusting for important prognostic factors.
METHODS
A retrospective study of a 17-year period from January 1994 to April 2011 was carried out. The cases studied were divided into two time period cohorts, those treated in the first 9-years (n = 109) and those treated in the last 7-years (n = 109).
RESULTS
An operation with curative intent was performed on 218 patients. The 5-year survival rates according to the depth of invasion were 86% (T1), 56% (T2), 45% (T3), and 5% (T4). The number of cases of incidental gallbladder cancer found during 3,919 laparoscopic cholecystectomies was 96 (2.4%). Incidental gallbladder cancer revealed a better survival rate (P = 0.003). Iatrogenic bile spillage was found in 20 perforations of the gallbladder during laparoscopic cholecystectomies, 16 preoperative percutaneous transhepatic gallbladder drainages and 16 percutaneous transhepatic biliary drainages; only percutaneous transhepatic biliary drainage patients showed a significantly lower survival rate than patients without iatrogenic bile spillage (P < 0.034). Chemoradiation appeared to improve overall survival (P < 0.001). Multivariate analysis also revealed that time period, type of surgery, surgical margin, lymphovascular invasion, lymph node involvement, and chemoradiation therapy had significant effects.
CONCLUSION
This study found that the prognosis of gallbladder cancer is still determined by the stage at presentation due to the aggressive biology of this tumor. Early diagnosis, radical resection and appropriate adjuvant therapy can increase overall survival.

Keyword

Gallbladder cancer; Laparoscopy; Prognosis

MeSH Terms

Bile
Biology
Cholecystectomy, Laparoscopic
Cohort Studies
Drainage
Early Diagnosis
Gallbladder
Gallbladder Neoplasms
Humans
Laparoscopy
Lymph Nodes
Multivariate Analysis
Prognosis
Retrospective Studies
Survival Rate

Figure

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  Fig. 1 Incidence by stage and group.

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  Fig. 2 Comparison of overall survival according to groups.

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  Fig. 3 Comparison of overall survival according to incidentality.

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  Fig. 4 Comparison of overall survival according to iatrogenic bile spillage. PTGBD, percutaneous transhepatic gallbladder drainage; PTBD, percutaneous transhepatic bile duct drainage.

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  Fig. 5 Comparison of overall survival according to chemoradiation therapy.

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