Advertisement

The role of extra-hepatic bile duct resection in patients with gallbladder carcinoma with peri-neural invasion: A ten-year experience in China

  • Author Footnotes
    1 authors contribute equally.
    Tian-Run Lv
    Footnotes
    1 authors contribute equally.
    Affiliations
    Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
    Search for articles by this author
  • Author Footnotes
    1 authors contribute equally.
    Hai-Jie Hu
    Footnotes
    1 authors contribute equally.
    Affiliations
    Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
    Search for articles by this author
  • Author Footnotes
    1 authors contribute equally.
    Fei Liu
    Footnotes
    1 authors contribute equally.
    Affiliations
    Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
    Search for articles by this author
  • Wen-Jie Ma
    Affiliations
    Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
    Search for articles by this author
  • Author Footnotes
    2 co-corresponding author
    Yan-Wen Jin
    Footnotes
    2 co-corresponding author
    Affiliations
    Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
    Search for articles by this author
  • Author Footnotes
    2 co-corresponding author
    Fu-Yu Li
    Correspondence
    Corresponding author.
    Footnotes
    2 co-corresponding author
    Affiliations
    Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
    Search for articles by this author
  • Author Footnotes
    1 authors contribute equally.
    2 co-corresponding author
Published:December 30, 2022DOI:https://doi.org/10.1016/j.ejso.2022.12.018

      Abstract

      Background

      Peri-neural invasion (PNI) in gallbladder carcinoma (GBC) has been demonstrated as a vital prognostic factor. However, whether PNI in patients with GBC can be regarded as a surgical indication of bile duct resection (BDR) remains controversial.

      Methods

      GBC patients with pathologically-confirmed PNI between September 2010 and September 2020 were retrospectively reviewed. Comparative analyses were performed in patients with PNI according to the performance of BDR. SPSS 25.0 software and Graph pad PRISMA 7.0 software were used for statistical analyses.

      Results

      A total of 70 patients GBC patients with PNI were incorporated. The results of comparative analyses indicated that patients who received BDR were generally in a more advanced stage and often required a more extended radical cholecystectomy. Higher incidences of preoperative jaundice (48.6% vs 2.9%, P < 0.0001), major hepatectomy (25.7% vs 8.6%, P = 0.055), combined multi-visceral resections (48.6% vs 5.7%, P < 0.0001), combined major vascular reconstruction (22.9% vs 2.9%, P = 0.014), and a lower R0 rate (68.6% vs 88.6%, P = 0.039) were detected in patients who received BDR. Even after propensity score matching (PSM), BDR still had no significant survival advantage but only increased the length of postoperative stay and the frequency of postoperative morbidities.

      Conclusion

      BDR seemed to have no significant survival advantage in GBC patients with PNI and was only correlated with a longer postoperative hospital stay and a higher rate of morbidities. PNI should not be regarded as a surgical indication of BDR in patients with GBC.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Surgical Oncology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Varshney S.
        • Butturini G.
        • Gupta R.
        Incidental carcinoma of the gallbladder.
        Eur J Surg Oncol : J Eur Soc Surg Oncol. Br Assoc Surg Oncol. 2002; 28: 4-10
        • Rakić M.
        • Patrlj L.
        • Kopljar M.
        • Kliček R.
        • Kolovrat M.
        • Loncar B.
        • et al.
        Gallbladder cancer.
        Hepatobiliary Surg Nutr. 2014; 3: 221-226
        • Ishihara S.
        • Miyakawa S.
        • Takada T.
        • Takasaki K.
        • Nimura Y.
        • Tanaka M.
        • et al.
        Status of surgical treatment of biliary tract cancer.
        Dig Surg. 2007; 24: 131-136
        • Wang J.K.
        • Ma W.J.
        • Wu Z.R.
        • Yang Q.
        • Hu H.J.
        • Liu F.
        • et al.
        Is combined extra-hepatic bile-duct resection justified for advanced gallbladder carcinoma?.
        Gastroenterology report. 2019; 7: 426-433
        • Suzuki S.
        • Yokoi Y.
        • Kurachi K.
        • Inaba K.
        • Ota S.
        • Azuma M.
        • et al.
        Appraisal of surgical treatment for pT2 gallbladder carcinomas.
        World J Surg. 2004; 28: 160-165
        • Chijiiwa K.
        • Nakano K.
        • Ueda J.
        • Noshiro H.
        • Nagai E.
        • Yamaguchi K.
        • et al.
        Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer.
        J Am Coll Surg. 2001; 192: 600-607
        • Endo I.
        • Shimada H.
        • Fujii Y.
        • Sugita M.
        • Masunari H.
        • Miura Y.
        • et al.
        Indications for curative resection of advanced gallbladder cancer with hepatoduodenal ligament invasion.
        J Hepato-Biliary-Pancreatic Surg. 2001; 8: 505-510
        • Araida T.
        • Higuchi R.
        • Hamano M.
        • Kodera Y.
        • Takeshita N.
        • Ota T.
        • et al.
        Hepatic resection in 485 R0 pT2 and pT3 cases of advanced carcinoma of the gallbladder: results of a Japanese Society of Biliary Surgery survey--a multicenter study.
        J Hepato-Biliary-Pancreatic Surg. 2009; 16: 204-215
        • Agarwal A.
        • et al.
        Biliary obstruction in gall bladder cancer is not sine qua non of inoperability.
        Ann Surg Oncol. 2007; 14: 2831-2837
        • Kohya N.
        • Miyazaki K.
        Hepatectomy of segment 4a and 5 combined with extra-hepatic bile duct resection for T2 and T3 gallbladder carcinoma.
        J Surg Oncol. 2008; 97: 498-502
        • Kai M.
        • Chijiiwa K.
        • Ohuchida J.
        • Nagano M.
        • Hiyoshi M.
        • Kondo K.
        A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma.
        J Gastrointest Surg. 2007; 11: 1025-1032
        • Sakamoto Y.
        • Kosuge T.
        • Shimada K.
        • Sano T.
        • Hibi T.
        • Yamamoto J.
        • et al.
        Clinical significance of extrahepatic bile duct resection for advanced gallbladder cancer.
        J Surg Oncol. 2006; 94: 298-306
        • Shimizu Y.
        • Ohtsuka M.
        • Ito H.
        • Kimura F.
        • Shimizu H.
        • Togawa A.
        • et al.
        Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer?.
        Surgery. 2004; 136 (discussion 8): 1012-1017
        • Gani F.
        • Buettner S.
        • Margonis G.A.
        • Ethun C.G.
        • Poultsides G.
        • Tran T.
        • et al.
        Assessing the impact of common bile duct resection in the surgical management of gallbladder cancer.
        J Surg Oncol. 2016; 114: 176-180
        • Donohue J.H.
        Present status of the diagnosis and treatment of gallbladder carcinoma.
        J Hepatobiliary Pancreat Surg. 2001; 8: 530-534
        • Kondo S.
        • Nimura Y.
        • Hayakawa N.
        • Kamiya J.
        • Nagino M.
        • Uesaka K.
        Extensive surgery for carcinoma of the gallbladder.
        Br J Surg. 2002; 89: 179-184
        • Lv T.R.
        • Liu F.
        • Hu H.J.
        • Regmi P.
        • Ma W.J.
        • Yang Q.
        • et al.
        The role of extra-hepatic bile duct resection in the surgical management of gallbladder carcinoma. A first meta-analysis.
        Eur J Surg Oncol : J Eur Soc Surg Oncol. Br Assoc Surg Oncol. 2022; 48: 482-491
        • Maruyama S.
        • Kawaida H.
        • Hosomura N.
        • Amemiya H.
        • Saito R.
        • Shimizu H.
        • et al.
        Indications for extrahepatic bile duct resection due to perineural invasion in patients with gallbladder cancer.
        World J Surg Oncol. 2019; 17: 200
        • Lee H.
        • Choi D.W.
        • Park J.Y.
        • Youn S.
        • Kwon W.
        • Heo J.S.
        • et al.
        Surgical strategy for T2 gallbladder cancer according to tumor location.
        Ann Surg Oncol. 2015; 22: 2779-2786
        • Suzuki S.
        • Yokoi Y.
        • Kurachi K.
        • Inaba K.
        • Ota S.
        • Azuma M.
        • et al.
        Appraisal of surgical treatment for pT2 gallbladder carcinomas.
        World J Surg. 2004; 28: 160-165
        • Soo K.C.
        • Carter R.L.
        • O'Brien C.J.
        • Barr L.
        • Bliss J.M.
        • Shaw H.J.
        Prognostic implications of perineural spread in squamous carcinomas of the head and neck.
        Laryngoscope. 1986; 96: 1145-1148
        • Takahashi T.
        • Ishikura H.
        • Motohara T.
        • Okushiba S.
        • Dohke M.
        • Katoh H.
        Perineural invasion by ductal adenocarcinoma of the pancreas.
        J Surg Oncol. 1997; 65: 164-170
        • Hawkins W.
        • DeMatteo R.
        • Jarnagin W.
        • Ben-Porat L.
        • Blumgart L.
        • Fong Y.
        Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer.
        Ann Surg Oncol. 2004; 11: 310-315
        • Dwivedi M.
        • Misra S.
        • Misra V.
        Clinical and ultrasonographic findings of carcinoma of gallbladder in Indian patients.
        J Assoc Phys India. 2000; 48: 192-195
        • D'Angelica M.
        • Dalal K.M.
        • DeMatteo R.P.
        • Fong Y.
        • Blumgart L.H.
        • Jarnagin W.R.
        Analysis of the extent of resection for adenocarcinoma of the gallbladder.
        Ann Surg Oncol. 2009; 16: 806-816
        • Sahara K.
        • Tsilimigras D.I.
        • Maithel S.K.
        • Abbott D.E.
        • Poultsides G.A.
        • Hatzaras I.
        • et al.
        Survival benefit of lymphadenectomy for gallbladder cancer based on the therapeutic index: an analysis of the US extrahepatic biliary malignancy consortium.
        J Surg Oncol. 2020; 121: 503-510
        • Igami T.
        • Ebata T.
        • Yokoyama Y.
        • Sugawara G.
        • Mizuno T.
        • Yamaguchi J.
        • et al.
        Combined extrahepatic bile duct resection for locally advanced gallbladder carcinoma: does it work?.
        World J Surg. 2015; 39: 1810-1817