Comparison of different surgical treatments for early-stage gallbladder cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Gang , ZHANG Longhui , ZHANG Changkun , ZHU Jiye , LENG Xisheng ,  WANG Dong

Department of Hepatobillary Surgery, Peking University People’s Hospital, Beijing 100044, P. R. China;

Corresponding author：

WANG Dong, Email: wangdong@pkuph.edu.cn

Keywords：

gallbladder cancer; early-stage; radical resection; radiofrequency ablation; clinical effect

DOI：

10.7507/1007-9424.201704032

Video：

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Objective To compare the clinical efficacy and safety of different surgical methods in the treatment of early-stage gallbladder carcinoma (GBC). Methods The clinical data of 43 patients with early-stage GBC who received treatment in Peking University People’s Hospital from Jan. 2010 to Dec. 2016 were retrospectively analyzed. According to the surgical methods, the patients were divided into laparoscopic cholecystectomy (LC)+lymph node dissection (LND)+radiofrequency ablation (RA) group, open cholecystectomy (OC)+LND+RA group, and OC+LND+liver resection (LA) group. Operation duration, intraoperative blood loss, postoperative hospital stay, surgical complications, and long-term survival were compared among the 3 groups. Results All the 43 patients performed successful surgery without perioperative death. ① Operation duration and postoperative hospital stay. The differences of operation duration and postoperative hospital stay among the 3 groups were statistically significant (P<0.05). Compared with the LC+LND+RA group, operation duration and postoperative hospital stay of the OC+LND+RA group and the OC+LND+LR group were longer (P<0.017), but there was no statistically significant difference between the OC+LND+RA group and the OC+LND+LR group (P>0.017). ② Intraoperative blood loss. The difference of intraoperative blood loss among the 3 groups was statistically significant (P<0.001). Compared with the OC+LND+LR group, the intraoperative blood loss was lower in the LC+LND+RA group and the OC+LND+RA group (P<0.017), but there was no significant difference between the LC+LND+RA group and the OC+LND+RA group (P=0.172). ③ Postoperative complications. There was no significant difference in the incidence of postoperative complications among the 3 groups (P=0.326). ④ Long-term survival. There was no significant difference in survival curves among the 3 groups (P=0.057). Conclusions The method of cholecystectomy combined with LND and RA of gallbladder bed can achieve the radical effect on early-stage GBC (Tis–T2). Laparoscopic surgery, in particular, has shorter operation duration and faster recovery.

Citation： WANG Gang, ZHANG Longhui, ZHANG Changkun, ZHU Jiye, LENG Xisheng, WANG Dong. Comparison of different surgical treatments for early-stage gallbladder cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(10): 1220-1225. doi: 10.7507/1007-9424.201704032 Copy

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2.	Wernberg JA, Lucarelli DD. Gallbladder cancer. Surg Clin North Am, 2014, 94(2): 343-360.
3.	Benson AB 3^rd, D’Angelica MI, Abrams TA, et al. Hepatobiliary cancers, version 2.2014. J Natl Compr Canc Netw, 2014, 12(8): 1152-1182.
4.	Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
5.	Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol, 2014, 6: 99-109.
6.	邹声泉, 张林. 全国胆囊癌临床流行病学调查报告. 中国实用外科杂志, 2000, 20(1): 43-46.0.
7.	徐松, 曹农. 原发性胆囊癌的高危因素及诊断研究进展. 中国普外基础与临床杂志, 2014, 21(1): 121-125.0.
8.	Schnelldorfer T. Porcelain gallbladder: a benign process or concern for malignancy? J Gastrointest Surg, 2013, 17(6): 1161-1168.
9.	Cunningham SC, Alexander HR. Porcelain gallbladder and cancer: ethnicity explains a discrepant literature? Am J Med, 2007, 120(4): e17-e18.
10.	Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer, 2006, 118(7): 1591-1602.
11.	Gallahan WC, Conway JD. Diagnosis and management of gallbladder polyps. Gastroenterol Clin North Am, 2010, 39(2): 359-367.
12.	Nomura T, Shirai Y, Sandoh N, et al. Cholangiographic criteria for anomalous union of the pancreatic and biliary ducts. Gastrointest Endosc, 2002, 55(2): 204-208.
13.	Gonzalez-Escobedo G, Marshall JM, Gunn JS. Chronic and acute infection of the gall bladder by Salmonella Typhi: understanding the carrier state. Nat Rev Microbiol, 2011, 9(1): 9-14.
14.	Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver, 2012, 6(2): 172-187.
15.	中华医学会外科学分会胆道外科学组. 胆囊癌诊断和治疗指南(2015 版). 中华消化外科杂志, 2015, 14(11): 881-890.0.
16.	Chen MS, Li JQ, Zheng Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg, 2006, 243(3): 321-328.
17.	Lau WY, Leung TW, Yu SC, et al. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg, 2003, 237(2): 171-179.
18.	Cho YK, Kim JK, Kim MY, et al. Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology, 2009, 49(2): 453-459.
19.	Lau WY, Lai EC. The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review. Ann Surg, 2009, 249(1): 20-25.
20.	Lee SE, Jang JY, Lim CS, et al. Systematic review on the surgical treatment for T1 gallbladder cancer. World J Gastroenterol, 2011, 17(2): 174-180.
21.	Isambert M, Leux C, Métairie S, et al. Incidentally-discovered gallbladder cancer: When, why and which reoperation? J Visc Surg, 2011, 148(2): e77-e84.
22.	Goetze TO, Paolucci V. The prognostic impact of positive lymph nodes in stages T1 to T3 incidental gallbladder carcinoma: results of the German Registry. Surg Endosc, 2012, 26(5): 1382-1389.
23.	Shirai Y, Wakai T, Sakata J, et al. Regional lymphadenectomy for gallbladder cancer: rational extent, technical details, and patient outcomes. World J Gastroenterol, 2012, 18(22): 2775-2783.
24.	Goetze T, Paolucci V. Does laparoscopy worsen the prognosis for incidental gallbladder cancer? Surg Endosc, 2006, 20(2): 286-293.
25.	Koh CY, Demirjian AN, Chen WP, et al. Validation of revised American Joint Committee on Cancer staging for gallbladder cancer based on a single institution experience. Am Surg, 2013, 79(10): 1045-1049.
26.	耿智敏, 王林, 陈晨, 等. 438 例胆囊癌外科治疗及预后因素分析. 中华消化外科杂志, 2016, 15(4): 346-352.0.
27.	Amini N, Kim Y, Wilson A, et al. Prognostic implications of lymph node status for patients with gallbladder cancer: a multi-institutional study. Ann Surg Oncol, 2016, 23(9): 3016-3023.
28.	Mekeel KL, Hemming AW. Surgical management of gallbladder carcinoma: a review. J Gastrointest Surg, 2007, 11(9): 1188-1193.

1. Boutros C, Gary M, Baldwin K, et al. Gallbladder cancer: past, present and an uncertain future. Surg Oncol, 2012, 21(4): e183-e191.
2. Wernberg JA, Lucarelli DD. Gallbladder cancer. Surg Clin North Am, 2014, 94(2): 343-360.
3. Benson AB 3^rd, D’Angelica MI, Abrams TA, et al. Hepatobiliary cancers, version 2.2014. J Natl Compr Canc Netw, 2014, 12(8): 1152-1182.
4. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
5. Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol, 2014, 6: 99-109.
6. 邹声泉, 张林. 全国胆囊癌临床流行病学调查报告. 中国实用外科杂志, 2000, 20(1): 43-46.0.
7. 徐松, 曹农. 原发性胆囊癌的高危因素及诊断研究进展. 中国普外基础与临床杂志, 2014, 21(1): 121-125.0.
8. Schnelldorfer T. Porcelain gallbladder: a benign process or concern for malignancy? J Gastrointest Surg, 2013, 17(6): 1161-1168.
9. Cunningham SC, Alexander HR. Porcelain gallbladder and cancer: ethnicity explains a discrepant literature? Am J Med, 2007, 120(4): e17-e18.
10. Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer, 2006, 118(7): 1591-1602.
11. Gallahan WC, Conway JD. Diagnosis and management of gallbladder polyps. Gastroenterol Clin North Am, 2010, 39(2): 359-367.
12. Nomura T, Shirai Y, Sandoh N, et al. Cholangiographic criteria for anomalous union of the pancreatic and biliary ducts. Gastrointest Endosc, 2002, 55(2): 204-208.
13. Gonzalez-Escobedo G, Marshall JM, Gunn JS. Chronic and acute infection of the gall bladder by Salmonella Typhi: understanding the carrier state. Nat Rev Microbiol, 2011, 9(1): 9-14.
14. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver, 2012, 6(2): 172-187.
15. 中华医学会外科学分会胆道外科学组. 胆囊癌诊断和治疗指南(2015 版). 中华消化外科杂志, 2015, 14(11): 881-890.0.
16. Chen MS, Li JQ, Zheng Y, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg, 2006, 243(3): 321-328.
17. Lau WY, Leung TW, Yu SC, et al. Percutaneous local ablative therapy for hepatocellular carcinoma: a review and look into the future. Ann Surg, 2003, 237(2): 171-179.
18. Cho YK, Kim JK, Kim MY, et al. Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology, 2009, 49(2): 453-459.
19. Lau WY, Lai EC. The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review. Ann Surg, 2009, 249(1): 20-25.
20. Lee SE, Jang JY, Lim CS, et al. Systematic review on the surgical treatment for T1 gallbladder cancer. World J Gastroenterol, 2011, 17(2): 174-180.
21. Isambert M, Leux C, Métairie S, et al. Incidentally-discovered gallbladder cancer: When, why and which reoperation? J Visc Surg, 2011, 148(2): e77-e84.
22. Goetze TO, Paolucci V. The prognostic impact of positive lymph nodes in stages T1 to T3 incidental gallbladder carcinoma: results of the German Registry. Surg Endosc, 2012, 26(5): 1382-1389.
23. Shirai Y, Wakai T, Sakata J, et al. Regional lymphadenectomy for gallbladder cancer: rational extent, technical details, and patient outcomes. World J Gastroenterol, 2012, 18(22): 2775-2783.
24. Goetze T, Paolucci V. Does laparoscopy worsen the prognosis for incidental gallbladder cancer? Surg Endosc, 2006, 20(2): 286-293.
25. Koh CY, Demirjian AN, Chen WP, et al. Validation of revised American Joint Committee on Cancer staging for gallbladder cancer based on a single institution experience. Am Surg, 2013, 79(10): 1045-1049.
26. 耿智敏, 王林, 陈晨, 等. 438 例胆囊癌外科治疗及预后因素分析. 中华消化外科杂志, 2016, 15(4): 346-352.0.
27. Amini N, Kim Y, Wilson A, et al. Prognostic implications of lymph node status for patients with gallbladder cancer: a multi-institutional study. Ann Surg Oncol, 2016, 23(9): 3016-3023.
28. Mekeel KL, Hemming AW. Surgical management of gallbladder carcinoma: a review. J Gastrointest Surg, 2007, 11(9): 1188-1193.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of different surgical treatments for early-stage gallbladder cancer

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