Is it significant for surgical treatment for gallbladder cancer with jaundice?

Abstract

Introduction: Gallbladder cancer (GBC) is still one of the few cancers found in advanced stage. Traditionally, GBC with jaundice has advanced, so it is considered to be a sign of unresectable or poor prognosis. Method: Of the 351 resected GBC from 1985 to 2016, excluding incidental GBC and palliative resection, were included. We examined the surgical outcomes, multivariate analysis contributing to survival, and subgroup analysis in jaundice cases, with background comparison based on the presence or absence of jaundice in cases excluding surgical death. T-Bil 2 mg/dl or more was defined as jaundice. Result: Jaundice were found in 19% of the total (67 cases). The surgical mortality rate had declined at or after 2000 (no jaundice 4.6% overall, 0.8% from 2000; with jaundice 9% overall, from 2000 4.4%, p=NS). Major hepatectomy (11 vs 59%, p=0.001), biliary resection (or PD) (47 vs 100%, p<0.001), vascular resection (8 vs 34%, p<0.001), advanced stage (T3/4 38% vs. 100%, N 1: 42 vs 75%, M 1: 19 vs 39%, p< 0.05), adjuvant chemotherapy (14 vs 30%, p=0.04) and low curative resection rate (79 vs 39%, p<0.001) were more common in the jaundice group. Five-year survival rate was 59.1% in without jaundice group and 16.7% in jaundice group (p<0.05). In multivariate analysis in all cases, jaundice was not significant. Type of drainage, JSBS M stage and postoperative complication (CD≥3) were significant in patients with jaundice. Survival analysis by predictive prognostic factors before surgery (Type of drainage, JSBS M), 5-year survival rate was 36.4% in patients without prognostic factor, 10.9% in patients with one prognostic factor and 4.6% in patients with two prognostic factors. Conclusion: In patients with GBC with jaundice, there were a small number of long-term survivors. Therefore, in selected patients, there may be a significance of surgical resection for GBC with jaundice.