Dataset Information

Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study.

ABSTRACT:

Background

Gallbladder cancer (GBC) is rare but aggressive. The extent of surgical intervention for different GBC stages is non-uniform, ranging from cholecystectomy alone to extended resections including major hepatectomy, resection of adjacent organs and routine extrahepatic bile duct resection (EBDR). Robust evidence here is lacking, however, and survival benefit poorly defined. This study assesses factors associated with recurrence-free survival (RFS), overall survival (OS) and morbidity and mortality following GBC surgery in high income countries (HIC) and low and middle income countries (LMIC).

Methods

The multicentre, retrospective Operative Management of Gallbladder Cancer (OMEGA) cohort study included all patients who underwent GBC resection across 133 centres between 1st January 2010 and 31st December 2020. Regression analyses assessed factors associated with OS, RFS and morbidity.

Findings

On multivariable analysis of all 3676 patients, wedge resection and segment IVb/V resection failed to improve RFS (HR 1.04 [0.84-1.29], p = 0.711 and HR 1.18 [0.95-1.46], p = 0.13 respectively) or OS (HR 0.96 [0.79-1.17], p = 0.67 and HR 1.48 [1.16-1.88], p = 0.49 respectively), while major hepatectomy was associated with worse RFS (HR 1.33 [1.02-1.74], p = 0.037) and OS (HR 1.26 [1.03-1.53], p = 0.022). Furthermore, EBDR (OR 2.86 [2.3-3.52], p < 0.0010), resection of additional organs (OR 2.22 [1.62-3.02], p < 0.0010) and major hepatectomy (OR 3.81 [2.55-5.73], p < 0.0010) were all associated with increased morbidity and mortality. Compared to LMIC, patients in HIC were associated with poorer RFS (HR 1.18 [1.02-1.37], p = 0.031) but not OS (HR 1.05 [0.91-1.22], p = 0.48). Adjuvant and neoadjuvant treatments were infrequently used.

Interpretation

In this large, multicentre analysis of GBC surgical outcomes, liver resection was not conclusively associated with improved survival, and extended resections were associated with greater morbidity and mortality without oncological benefit. Aggressive upfront resections do not benefit higher stage GBC, and international collaborations are needed to develop evidence-based neoadjuvant and adjuvant treatment strategies to minimise surgical morbidity and prioritise prognostic benefit.

Funding

Cambridge Hepatopancreatobiliary Department Research Fund.

SUBMITTER: Balakrishnan A

PROVIDER: S-EPMC10130604 | biostudies-literature | 2023 May

REPOSITORIES: biostudies-literature

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Publications

Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study.

Balakrishnan Anita A Barmpounakis Petros P Demiris Nikolaos N Jah Asif A Spiers Harry V M HVM Talukder Shibojit S Martin Jack L JL Gibbs Paul P Harper Simon J F SJF Huguet Emmanuel L EL Kosmoliaptsis Vasilis V Liau Siong S SS Praseedom Raaj K RK Basu Bristi B de Aretxabala Xavier X Lendoire Javier J Maithel Shishir S Branes Alejandro A Andersson Bodil B Serrablo Alejandro A Adsay Volkan V

EClinicalMedicine 20230413

<h4>Background</h4>Gallbladder cancer (GBC) is rare but aggressive. The extent of surgical intervention for different GBC stages is non-uniform, ranging from cholecystectomy alone to extended resections including major hepatectomy, resection of adjacent organs and routine extrahepatic bile duct resection (EBDR). Robust evidence here is lacking, however, and survival benefit poorly defined. This study assesses factors associated with recurrence-free survival (RFS), overall survival (OS) and morbi ...[more]

PMID: 37125405

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Dataset Information

Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study.

Background

Methods

Findings

Interpretation

Funding

Publications

Surgical outcomes of gallbladder cancer: the OMEGA retrospective, multicentre, international cohort study.

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