Ann Hepatobiliary Pancreat Surg.  2023 May;27(2):180-188. 10.14701/ahbps.22-111.

Radical surgery for stage IV gallbladder cancers: Treatment strategies in patients with limited metastatic burden

• Patkar S
• Patel S
• Kazi M
• Goel M

• KMID: 2542582
• DOI: http://doi.org/10.14701/ahbps.22-111

Abstract

Backgrounds/Aims
The present study looked at the role of radical surgery in gallbladder cancers (GBC) with limited metastatic disease.
Methods
The retrospective observational study was conducted to screen the database from 1st January 2010 to 31st December 2019. Patients of GBC found to have low-volume metastatic disease upon surgical exploration were included.
Results
Of the 1,040 patients operated for GBC, 234 patients had low-volume metastatic disease (microscopic disease in station 16b1 node or N2 disease isolated port-site metastases, or low burden peritoneal disease with deposits less than 1 cm, in adjacent omentum or adjacent diaphragm or Morrison’s pouch or a solitary discontinuous liver metastasis in adjacent liver parenchyma) detected intraoperative. Of these, 62 patients underwent radical surgery for R-0 metastatic disease followed by systemic therapy, while the remaining 172 patients did not undergo radical surgery and were given palliative systemic chemotherapy. Patients who underwent radical surgery had significantly superior overall survival (19 months versus 12 months, p < 0.01) and superior progression-free survival (10 months versus 5 months, p < 0.01) when compared to the rest. This difference in survival was more significant amongst patients when operated on after neoadjuvant chemotherapy. Regression analysis showed that a sub-group of patients with incidental GBC with limited metastases showed more favorable outcomes with radical surgery.
Conclusions
Authors suggest a possible role for radical treatment of advanced GBC with a limited metastatic burden. Neoadjuvant chemotherapy can be used for preferentially selecting patients of favorable disease biology for curative treatment.

Keyword

Gallbladder cancer; Cholecystectomy; Metastases

Figure

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  Fig. 1 Cohort diagram. GBC, gallbladder cancer.

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  Fig. 2 Survival analysis of radical surgery versus systemic therapy alone, in the setting of low-volume metastatic disease. (A) Overall survival (OS); (B) disease-free survival (DFS).

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  Fig. 3 Survival analysis about the use of neoadjuvant chemotherapy (NACT): Overall survival (OS) (A, B) and disease-free survival (DFS) (C, D).

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