Outcome of the Surgical Treatment of Gallbladder Cancer: A 10-year Single Center Experience
Dumronggittigule W, MD1, Tovikkai C, MD, PhD1, Sangserestid P, MD1, Pongpaibul A, MD2, Kositamongkol P, MD1, Mahawithitwong P, MD1, Limsrichamrern S, MD1, Sirivatanauksorn Y, MD, MSc, PhD1
Affiliation : 1 Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : Gallbladder cancer (GBC) is a rare cancer with extremely poor prognosis due to a usual late presentation with an advanced
stage. Surgical resection is the only curative treatment. The present study aimed to analyze the outcome after curative resection and
to identify the factors affecting prognosis in a single tertiary hospital.
Materials and Methods : A retrospective analysis of GBC patients who underwent surgical resection from 2006 to 2015 at Siriraj
Hospital was performed. The clinical characteristics, operative data, and pathological results were reviewed. Survival and prognostic
factors were analyzed with the Kaplan–Meier method and Cox proportional hazards model, respectively.
Results : In total, 69 GBC patients underwent surgery during the study period. Among these, 55 cases (80%) underwent resection
with curative intent, while unresectable disease was found intraoperatively in 14 patients (20%). Preoperative hyperbilirubinemia
was associated with unresectable disease. Among those who underwent curative resection, 37 cases (67%) achieved R0 resection,
and 18 cases (33%) presented with a positive margin (R1 resection). The median disease-free survival (DFS) and overall survival
(OS) were 18 and 24 months, respectively. The 1-year and 5-year DFS rates were 56% and 27%. The 1-year and 5-year OS rates
were 72% and 29% respectively. Factors affecting the outcome according to univariate analysis included the completeness of
resection, tumor stage, presence of perineural and lymphovascular invasion on the pathology, and the type of histopathology.
Multivariate analysis identified the type of histopathology as an independent prognostic factor for OS (p = 0.008). The completeness
of resection margin also showed a trend toward predicting OS, but this did not reach statistical significance (p = 0.079).
Conclusion : The prognosis of GBC is dismal. Adenocarcinoma is associated with a better survival rate than non-adenocarcinoma.
Keywords : Gallbladder cancer, Carcinoma of gallbladder, Radical cholecystectomy, Predictive factor, Survival
