Introduction: The localized gallbladder cancer can be cured when it is radically resected. But even in this favorable form of disease, tumoral recurrence will occur in some cases. The aim of this retrospective study is the recognize factors that are associated with tumoral recurrence. Material and Method: All tumors that do not extend the serous layer of the gallbladder wall and are treated with radical surgery were included in this retrospective study. Several factors, such as clinical, biological and histological, were retrospectively analyzed. We divided patients into two groups: group A with recurrence and group B without recurrence. Results: One hundred-twenty-two patients were included. The group A was constituted by twenty-nine patients (23.8%) and ninety-three patients constituted the group B. Univariate analysis of the 2 groups shows that lymph node involvement, serosal involvement, the presence of vascular emboli, the presence of perineural sheathing, and capsular rupture of the lymph nodes have a negative impact on tumor recurrence. In multivariate analysis, only 4 elements favor the risk of recurrence which are lymph node involvement with a number of lymph nodes equal to or greater than 4 nodes, a high CA 19.9 rate, serosa involvement (pT3) and stage III of the ASA classification. Near all recurrences (96.6%) were located in the peritoneal cavity and their four sites are represented by peritoneal carcinomatosis, the main bile duct, hepatic metastases and lymph nodes. The 5-year survival is 3.4% in group A (patient died 85 months after her recurrence and after palliative secondary resection) and 83.7% in group B. Conclusion: The 4 factors predicting tumoral recurrence isolated in our study, can help to provide a new approach in the radical surgery of the localized form of gallbladder cancer to improve its prognosis. We propose to add efficacious adjuvant therapy for patients with these predicting factors of recurrence after radical surgery.
References
[1]
Cubertafond, P., Gainant, A. and Cucchiaro, G. (1994) Surgical Treatment of 724 Carcinomas of the Gallbladder Results of the French Surgical Association Survey. Annals of Surgery, 219, 275-280. https://doi.org/10.1097/00000658-199403000-00007
[2]
Dixon, E., Vollmer, C.M., Sahajpal, A., Cattral, M., Grant, D., Doig, C., et al. (2005) An Aggressive Surgical Approach Leads to Improved Survival in Patients with Gallbladder Cancer. Annals of Surgery, 241, 385-394. https://doi.org/10.1097/01.sla.0000154118.07704.ef
[3]
Higuchi, R., Ono, H., Matsuyama, R., Takemura, Y., Kobayashi, S., Otsubo, T., et al. (2022) Examination of the Characteristics of Long-Term Survivors among Patients with Gallbladder Cancer with Liver Metastasis Who Underwent Surgical Treatment: A Retrospective Multicenter Study (ACRoS1406). BMC Gastroenterology, 22, Article No. 152. https://doi.org/10.1186/s12876-022-02234-9
[4]
Ogura, Y., Mizumoto, R., Isaji, S., Kusuda, T., Matsuda, S. and Tabata, M. (1991) Radical Operations for Carcinoma of the Gallbladder: Present Status in Japan. World Journal of Surgery, 15, 337-343. https://doi.org/10.1007/bf01658725
[5]
Jarnagin, W.R., Ruo, L., Little, S.A., Klimstra, D., D’Angelica, M., DeMatteo, R.P., etal. (2003) Patterns of Initial Disease Recurrence after Resection of Gallbladder Carcinoma and Hilar Cholangiocarcinoma. Cancer, 98, 1689-1700. https://doi.org/10.1002/cncr.11699
[6]
Wiggers, J.K., Groot Koerkamp, B., Ovadia, Z., Busch, O.R.C., Gouma, D.J. and van Gulik, T.M. (2014) Patterns of Recurrence after Resection of Gallbladder Cancer without Routine Extrahepatic Bile Duct Resection. HPB, 16, 635-640. https://doi.org/10.1111/hpb.12188
[7]
Ouchi, K., Susuki, S., Saijo, K. and Matsuno, I.S. (1993) Do Recent Advances in Diagnosis and Operative Management Improve the Outcome of Gallbladder Carcinoma? Surgery, 113, 324-329.
[8]
Chijiiwa, K., Noshiro, H., Nakano, K., Okido, K., Sugitani, A., Yamaguchi, K. and Tanaka, M. (2000) Role of Surgery for Gallbladder Carcinoma with Special Reference to Lymph Node Metastasis and Using Western and Japanese Classification System. World Journal of Surgery, 24, 1271-1276.
[9]
Chijiiwa, K., Nakano, K., Ueda, J., Noshiro, H., Nagai, E., Yamaguchi, K., et al. (2001) Surgical Treatment of Patients with T2 Gallbladder Carcinoma Invading the Subserosal Layer. JournaloftheAmericanCollegeofSurgeons, 192, 600-607. https://doi.org/10.1016/s1072-7515(01)00814-6
[10]
Tsukada, K., Hatakeyama, K., Kurosaki, I., Uchida, K., Shirai, Y., Muto, T., et al. (1996) Outcome of Radical Surgery for Carcinoma of the Gallbladder According to the TNM Stage. Surgery, 120, 816-821. https://doi.org/10.1016/s0039-6060(96)80089-4
[11]
Kondo, S., Nimura, Y., Hayakawa, N., Kamiya, J., Nagino, M. and Uesaka, K. (2000) Regional and Para-Aortic Lymphadenectomy in Radical Surgery for Advanced Gallbladder Carcinoma. Journal of British Surgery, 87, 418-422. https://doi.org/10.1046/j.1365-2168.2000.01384.x
[12]
Chong, J.U. and Lee, W.J. (2019) Oncologic Outcomes of Extended Lymphadenectomy without Liver Resection for T1/T2 Gallbladder Cancer. Yonsei Medical Journal, 60, 1138-1145. https://doi.org/10.3349/ymj.2019.60.12.1138
[13]
Xiao, Z., Shi, Z., Hu, L., Gao, Y., Zhao, J., Liu, Y., et al. (2019) A New Nomogram from the SEER Database for Predicting the Prognosis of Gallbladder Cancer Patients after Surgery. Annals of Translational Medicine, 7, 738-738. https://doi.org/10.21037/atm.2019.11.112
[14]
Lin, J., Bai, D., Zhou, B., Chen, P., Qian, J., Jin, S., et al. (2018) Positive Relationship between Number of Negative Lymph Nodes and Duration of Gallbladder Cancer Cause-Specific Survival after Surgery. Cancer Management and Research, 10, 6961-6969. https://doi.org/10.2147/cmar.s187857
[15]
Liu, F., Hu, H., Ma, W., Yang, Q., Wang, J. and Li, F. (2019) Prognostic Significance of Neutrophil–Lymphocyte Ratio and Carbohydrate Antigen 19-9 in Patients with Gallbladder Carcinoma. Medicine, 98, e14550. https://doi.org/10.1097/md.0000000000014550
[16]
Wang, Y. (2014) Combined Detection Tumor Markers for Diagnosis and Prognosis of Gallbladder Cancer. World Journal of Gastroenterology, 20, 4085-4092. https://doi.org/10.3748/wjg.v20.i14.4085
[17]
Yuan, Y., Wang, Y., Zhang, N., Mao, X., Huang, Y., Huang, J., et al. (2021) Influence of American Society of Anesthesiologists Score on Oncologic Outcomes in Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy: A Large-Sample Study in Two Institutions. Frontiers in Oncology, 11, Article 723669. https://doi.org/10.3389/fonc.2021.723669
[18]
Cubillos, L., Gonzalez, S., Sepulveda, C., Rivero, S., Calvo, A., Caracci, M., et al. (1993) Immunological Evaluation of Patients with Invasive Carcinoma of the Gallbladder. Journal of Cancer Research and Clinical Oncology, 119, 497-500. https://doi.org/10.1007/bf01215932
[19]
Tharmalingam, S., Flemming, J., Richardson, H., Hurlbut, D., Cleary, S. and Nanji, S. (2022) Surgical Practice Patterns and Outcomes in T2 and T3 Gallbladder Cancer: A Population-Based Study. Canadian Journal of Surgery, 65, E16-E24. https://doi.org/10.1503/cjs.019719
[20]
Kim, W.S., Choi, D.W., You, D.D., Ho, C.Y., Heo, J.S. and Choi, S.H. (2010) Risk Factors Influencing Recurrence, Patterns of Recurrence, and the Efficacy of Adjuvant Therapy after Radical Resection for Gallbladder Carcinoma. Journal of Gastrointestinal Surgery, 14, 679-687. https://doi.org/10.1007/s11605-009-1140-z
[21]
Park, J.S., Yoon, D.S., Kim, K.S., Choi, J.S., Lee, W.J., Chi, H.S., et al. (2007) Actual Recurrence Patterns and Risk Factors Influencing Recurrence after Curative Resection with Stage II Gallbladder Carcinoma. Journal of Gastrointestinal Surgery, 11, 631-637. https://doi.org/10.1007/s11605-007-0109-z
[22]
Yamaguchi, R., Nagino, M., Oda, K., Kamiya, J., Uesaka, K. and Nimura, Y. (2002) Perineural Invasion Has a Negative Impact on Survival of Patients with Gallbladder Carcinoma. British Journal of Surgery, 89, 1130-1136. https://doi.org/10.1046/j.1365-2168.2002.02184.x
[23]
Ahn, Y., Park, C., Hwang, S., Jang, H., Choi, K. and Lee, S. (2016) Incidental Gallbladder Cancer after Routine Cholecystectomy: When Should We Suspect It Preoperatively and What Are Predictors of Patient Survival? Annals of Surgical Treatment and Research, 90, 131-138. https://doi.org/10.4174/astr.2016.90.3.131
[24]
Arakami, M., Matsumoto, T., Shibata, K., Himeno, Y., Yada, K., Hirano, S., Kawano, K. and Kitano, S. (2004) Factors Influencing Recurrence after Surgical Treatment for T2 Gallbladder Carcinoma. Hepatogastroenterology, 51, 1609-1611.
[25]
Mappanka, C. (2014) Gallbladder Cancer, Treatment Failure and Relapses: The Peritoneum in Gallbladder Cancer. Journal of Gastrointestinal Cancer, 45, 245-255. https://doi.org/10.1007/s12029-014-9597-8
