Surgical treatment of gallbladder cancer:An eight-year experience in a single center

BACKGROUND Gallbladder cancer(GBC)is the most common biliary malignancy and has the worst prognosis,but aggressive surgeries[e.g.,resection of the extrahepatic bile duct(EHBD),major hepatectomy and lymph node(LN)dissection]may improve long-term survival.GBC may be suspected preoperatively,identified intraoperatively,or discovered incidentally on histopathology.AIM To present our data together with a discussion of the therapeutic strategies for GBC.METHODS We retrospectively investigated nineteen GBC patients who underwent surgical treatment.RESULTS Nearly all symptomatic patients had poor outcomes,while suspicious or incidental GBCs at early stages showed excellent outcomes without the need for two-stage surgery.Lymph nodes around the cystic duct were reliable sentinel nodes in suspicious/incidental GBCs.Intentional LN dissection and EHBD resection prevented metastases or recurrence in early-stage GBCs but not in advanced GBCs with metastatic LNs or invasion of the nerve plexus.All patients with positive surgical margins(e.g.,the biliary cut surface)showed poor outcomes.Hepatectomies were performed in sixteen patients,nearly all of which were minor hepatectomies.Metastases were observed in the left-sided liver but not in the caudate lobe.We may need to reconsider the indications for major hepatectomy,minimizing its use except when it is required to accomplish negative bile duct margins.Only a few patients received neoadjuvant or adjuvant chemoradiation.There were significant differences in overall and disease-free survival between patients with stages≤IIB and≥IIIA disease.The median overall survival and disease-free survival were 1.66 and 0.79 years,respectively.CONCLUSION Outcomes for GBC patients remain unacceptable,and improved therapeutic strategies,including neoadjuvant chemotherapy,optimal surgery and adjuvant chemotherapy,should be considered for patients with advanced GBCs.

Do liver metastases from gastric cancer contraindicate aggressive surgical resection?A 14-year single-center experience

BACKGROUND Advanced gastric cancer(GC)with liver metastasis is often characterized by multiple and bilobular metastases and may also be associated with extrahepatic metastatic lesions.Hence,many physicians consider that radical surgeries are contraindicated for liver metastases from GC(LMGC).According to the 2017 Japanese treatment guideline for GC,a smaller number of liver metastases without unresectable factors may be an indication for liver resection(LR)with curability.The actual 5-year overall survival(OS)rate ranges from 0 to 0.37.AIM To present the institutional indications for LR for LMGC and identify important factors for prognostic outcomes.METHODS In total,30 patients underwent LR for LMGC during a 14-year period,and we evaluated the clinical,surgical,and oncological findings.In all patients,radical surgery with intentional lymphadenectomy was performed for the primary GC.The median follow-up duration after the initial LR was 33.7 mo,and three patients with no recurrence died of causes unrelated to the LMGC.The OS and recurrence-free survival rates after the initial LR were assessed.RESULTS Seventeen patients had metachronous LMGC.The initial LR achieved curability in 29 patients.Perioperative chemotherapy was introduced in 23 patients.The median greatest LMGC dimension was 30 mm,and the median number of LMGC was two.Twenty-two patients had unilobular LMGC.The 5-year OS and recurrence-free survival rates were 0.48 and 0.28,respectively.The median survival duration and recurrence-free duration after the initial LR were 16.8 and 8.6 mo,respectively.Twenty-one patients developed recurrence after the initial LR.Additional surgeries for recurrence were performed in nine patients,and these surgeries clearly prolonged the patients’survival.Pathological serosal invasion was an independent predictor of a poor prognostic outcome after the initial LR.Aggressive LR may be indicated for carefully selected patients with LMGC.CONCLUSION Our results of LR for LMGC seem acceptable.Additional surgeries for recurrence after the initial LR might prolong OS.Pathological serosal invasion is important for poor prognostic outcomes.