Extended Indications of Curative Surgery in Oligometastatic Gallbladder Cancers: Survival Benefit

Abstract

Introduction: Treatment with a curative intent in setting of low volume metastatic gallbladder cancer (GBC) is uncertain and not defined. Methods: Patients of GBC with low burden metastatic disease who were operated over 10 years (2010 – 2019) were screened and analysed. Results: 234 patients with low-volume metastatic disease (defined as single site or single organ confined disease) were identified, of which 63 patients underwent curative radical surgery, 10 patients underwent port site excision and remaining 161 were offered only palliative chemotherapy. Patients who underwent radical surgery included 25 patients (10.7%) with N2 nodal disease on final histopathology and 38 patients (16.2%) with single site disease (nodule over adherent omentum, single peritoneal nodule, single inapparent station 16 node) which was resected en-bloc. The remaining 161 patients included those who had metastatic station 16 node (47, 20.1%), radiologically inapparent and intraoperatively detected either liver (17, 7.3%) or peritoneal disease (97, 41.5%). Patients who were offered curative treatment had higher median overall survival– isolated port site metastases-23 months, en-bloc resected oligometastases-19 months, N2 disease – 19 months as opposed to those who were offered only palliative chemotherapy – Peritoneal disease – 12 months, Station 16 node – 11 months, Liver metastases-8 months (p value for OS = 0.001). Similar benefit was observed with regards to disease free interval in favor of patients treated with curative intent (p value for DFS = 0.000). Conclusions: Curative treatment may be offered to a highly selected group patients with low burden metastatic disease in patients with gallbladder cancer. Tabled 1EP03B-029Site of metastatic diseaseOverall survival (months)Disease free survival (months)Median95% C.I.Median95%C.I.N2 disease19.00012.4 – 25.60.00111.0007.4 – 14.6.000Inter-aortocaval node11.0007.8 – 14.25.0003.4 – 6.6Peritoneal12.00010.3 – 13.74.0002.5 – 5.5Liver metastases8.0006.9 – 9.03.0000.5 – 5.5Oligo-metastases19.00013.3 – 24.79.0007.0 – 10.9Port site metastases23.00016.8 – 29.213.0005.2 – 20.7 Open table in a new tab