Abstract
Background: Extended resections (i.e. major hepatectomy and/or pancreatoduodenectomy) are rarely performed for gallbladder cancer (GBC) as outcomes remain inconclusive. Little data is available from Western centers. In this Dutch, multicenter cohort study outcomes of patients who underwent extended resections for locally advanced GBC are analyzed. Design: Patients with GBC who underwent extended resection with curative intent from 2000 to 2018 were identified from the Netherlands Cancer Registry (NCR). Extended resection was defined as a major hepatectomy (resection of ≥ 3 liver segments) and/or a pancreatoduodenectomy. Post-operative morbidity, mortality, survival and characteristics of short- and long-term survivors were assessed. Results: A total of 33 patients was included. R0-resection margins were achieved in 16 patients. Major post-operative complications (≥CD3A) occurred in 19 patients and post-operative mortality < 90 days in four. Recurrence occurred in 24 patients. Median overall survival (OS) was 12.8 months (95% CI 6.5 − 19.0). Two-year survival was achieved in 10 patients (30%) and 5-year survival in 5 patients (15%). Jaundice, common bile duct-, liver-, perineural- and perivascular invasion were associated with reduced survival. All (3) recurrence-free patients had R0 resection margins and no liver invasion. Conclusion: Median OS after extended resections for advanced GBC was 12.8 months in this cohort. Although post-operative morbidity and mortality were significant, long term survival (≥ 2 years) was achieved in a subset of patients. Therefore, GBC requiring major surgery does not preclude long-term survival and a subgroup of patients benefit from surgery.Tabled 1Patient and operative characteristics of GBC patients that underwent extended resectionAge (IQR)64 (57- 69)Gender (male)13 (39%)ASA classification <319 (76%)Pre-operative biliary drainage (yes)20 (61%)Portal Vein Embolization performed5 (15%)Hepatectomy12 (36%)Extended hepatectomy7 21%)Hepatectomy + pancreatoduodenectomy2 (6%)Pancreatoduodenectomy + liver wedge resection21 (36%)Portal vein reconstruction10 (30%) Open table in a new tab
Highlights
Extended resections are rarely performed for gallbladder cancer (GBC) as outcomes remain inconclusive
GBC specimens with high GLI2 expression had significantly high level of PD-L1 expression and low number of infiltrated CD3 positive lymphocytes
GLI2 contributes to the induction of malignant phenotype of GBC and could be a potential therapeutic target for GBC
Summary
Extended resections (i.e. major hepatectomy and/or pancreatoduodenectomy) are rarely performed for gallbladder cancer (GBC) as outcomes remain inconclusive. 3) Clinical experiment; 67 patients with GBC who underwent curative surgical resection were enrolled in this study. Correlation between GLI expression and clinicopathological findings was analyzed immunohistochemically. SiRNA transfection significantly inhibited the invasiveness and proliferation ability of GBC cells. 2) In vivo results; Tumor volume from mice injected with GLI2 siRNA transfected cells was significantly lower than that in control tumors.
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