Surgery Versus No Surgery in Stage IV Gallbladder Carcinoma: A Propensity Score-matched Analysis

Overview

Journal Turk J Surg

Specialty General Surgery

Date 2023 Nov 29

PMID 38026908

Authors

Phani Nekarakanti

Sugumaran K

Hirdaya Nag

Affiliations

Soon will be listed here.

Abstract

Objectives: Patients with stage IV gallbladder cancer (GBC) have a dismal prognosis. Mostly, they are not amenable to surgical treatment. However, in some of them, a potentially curative surgical resection is possible. There is paucity of the literature comparing survival of patients with surgically resectable stage IV GBC to the patients with unresectable stage IV GBC.

Material And Methods: This retrospective study was conducted on patients with AJCC stage IV GBC who were managed by a surgical unit at a tertiary care center from May 2009 to March 2021. Patients were grouped into either surgery group (cases) or no surgery group (control). Cases were compared to controls for demographic characteristics, clinical parameters, and survival rates. A comparison was made in both unmatched and matched (propensity score matching 1:1 with covariates age, gender, ECOG, chemotherapy, and TNM staging) groups.

Results: The total number of patients with stage IV GBS was 120, out of that, 29 were cases, and 91 were controls. After matching, each group had 28 cases (28 + 28= 56). Post-matching AJCC stage, chemotherapy, and other parameters were equally distributed between the groups (p= 1.00). However, cases had more patients with N2 metastasis (p <0.001), and controls had more patients with distant metastasis (p <0.001). Cases vs. controls, overall survival before matching was 22 vs. seven months (p= 0.001) and after matching was 22 vs. 11 months (p= 0.005).

Conclusion: Patients with stage IV GBC amenable to potentially curative surgical resection (R0) have significantly better survival than patients with non-surgical treatment. Therefore, it may be more appropriate to classify these group differently.

Citing Articles

Comparison of treatment models for single primary advanced gallbladder cancer.

Li R, Chen X, Wang B, Ai B, Min F, Cao D Front Immunol. 2024; 15:1500091.

PMID: 39606221 PMC: 11599203. DOI: 10.3389/fimmu.2024.1500091.

FROM THE EDITOR'S DESK.

Saribeyoglu K Turk J Surg. 2023; 39(2):viii.

PMID: 38026917 PMC: 10681100. DOI: 10.47717/turkjsurg.2023.230201.

References

Acharya M, Patkar S, Parray A, Goel M . Management of gallbladder cancer in India. Chin Clin Oncol. 2019; 8(4):35. DOI: 10.21037/cco.2019.07.03. View

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Uesaka K . Extensive surgery for carcinoma of the gallbladder. Br J Surg. 2002; 89(2):179-84. DOI: 10.1046/j.0007-1323.2001.02001.x. View

Groot Koerkamp B, Fong Y . Outcomes in biliary malignancy. J Surg Oncol. 2014; 110(5):585-91. DOI: 10.1002/jso.23762. View

Chaudhary R, Higuchi R, Yazawa T, Uemura S, Izumo W, Furukawa T . Surgery in node-positive gallbladder cancer: The implication of an involved superior retro-pancreatic lymph node. Surgery. 2018; 165(3):541-547. DOI: 10.1016/j.surg.2018.09.003. View

Wakabayashi H, Ishimura K, Hashimoto N, Otani T, Kondo A, Maeta H . Analysis of prognostic factors after surgery for stage III and IV gallbladder cancer. Eur J Surg Oncol. 2004; 30(8):842-6. DOI: 10.1016/j.ejso.2004.06.001. View

Giannis D, Cerullo M, Moris D, Shah K, Herbert G, Zani S . Validation of the 8th Edition American Joint Commission on Cancer (AJCC) Gallbladder Cancer Staging System: Prognostic Discrimination and Identification of Key Predictive Factors. Cancers (Basel). 2021; 13(3). PMC: 7867111. DOI: 10.3390/cancers13030547. View

Boerma E . Towards an oncological resection of gall bladder cancer. Eur J Surg Oncol. 1994; 20(5):537-44. View

Kang M, Song Y, Jang J, Han I, Kim S . Role of radical surgery in patients with stage IV gallbladder cancer. HPB (Oxford). 2012; 14(12):805-11. PMC: 3521908. DOI: 10.1111/j.1477-2574.2012.00544.x. View

10.

Paimela H, Karppinen A, Hockerstedt K, Perhoniemi V, VAITTINEN E, Kivilaakso E . Poor prognosis of gallbladder cancer persists regardless of improved diagnostic methods. Incidence and results of surgery during 20 years in Helsinki. Ann Chir Gynaecol. 1997; 86(1):13-7. View

11.

Wagholikar G, Behari A, Krishnani N, Kumar A, Sikora S, Saxena R . Early gallbladder cancer. J Am Coll Surg. 2002; 194(2):137-41. DOI: 10.1016/s1072-7515(01)01136-x. View

12.

Fong Y, Malhotra S . Gallbladder cancer: recent advances and current guidelines for surgical therapy. Adv Surg. 2001; 35:1-20. View

13.

Kondo S, Nimura Y, Kamiya J, Nagino M, Kanai M, Uesaka K . Five-year survivors after aggressive surgery for stage IV gallbladder cancer. J Hepatobiliary Pancreat Surg. 2002; 8(6):511-7. DOI: 10.1007/s005340100018. View

14.

Jiang W, Zhao B, Li Y, Qi D, Wang D . Modification of the 8th American Joint Committee on Cancer staging system for gallbladder carcinoma to improve prognostic precision. BMC Cancer. 2020; 20(1):1129. PMC: 7682115. DOI: 10.1186/s12885-020-07578-7. View

15.

McNamara M, Metran-Nascente C, Knox J . State-of-the-art in the management of locally advanced and metastatic gallbladder cancer. Curr Opin Oncol. 2013; 25(4):425-31. DOI: 10.1097/CCO.0b013e3283620fd8. View

16.

Shimizu H, Kimura F, Yoshidome H, Ohtsuka M, Kato A, Yoshitomi H . Aggressive surgical approach for stage IV gallbladder carcinoma based on Japanese Society of Biliary Surgery classification. J Hepatobiliary Pancreat Surg. 2007; 14(4):358-65. DOI: 10.1007/s00534-006-1188-z. View

17.

Chijiiwa K, Kai M, Nagano M, Hiyoshi M, Ohuchida J, Kondo K . Outcome of radical surgery for stage IV gallbladder carcinoma. J Hepatobiliary Pancreat Surg. 2007; 14(4):345-50. DOI: 10.1007/s00534-006-1186-1. View

18.

Ishikawa T, Horimi T, Shima Y, Okabayashi T, Nishioka Y, Hamada M . Evaluation of aggressive surgical treatment for advanced carcinoma of the gallbladder. J Hepatobiliary Pancreat Surg. 2003; 10(3):233-8. DOI: 10.1007/s00534-003-0848-5. View

19.

Miller G, Jarnagin W . Gallbladder carcinoma. Eur J Surg Oncol. 2007; 34(3):306-12. DOI: 10.1016/j.ejso.2007.07.206. View

20.

Yang Y, Tu Z, Ye C, Cai H, Yang S, Chen X . Site-specific metastases of gallbladder adenocarcinoma and their prognostic value for survival: a SEER-based study. BMC Surg. 2021; 21(1):59. PMC: 7825172. DOI: 10.1186/s12893-021-01068-8. View