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

• Type of Material: Article
• Authors: Anita Balakrishnan, Cambridge University Hospitals NHS Foundation Trust; Petros Barmpounakis, Cambridge University Hospitals NHS Foundation Trust; Nikolaos Demiris, Cambridge University Hospitals NHS Foundation Trust; Asif Jah, Cambridge University Hospitals NHS Foundation Trust; Harry VM Spiers, Cambridge University Hospitals NHS Foundation Trust; Shibojit Talukder, Cambridge University Hospitals NHS Foundation Trust; Jack L Martin, Cambridge University Hospitals NHS Foundation Trust; Paul Gibbs, Cambridge University Hospitals NHS Foundation Trust; Simon JF Harper, Cambridge University Hospitals NHS Foundation Trust; Emmanuel L Huguet, Cambridge University Hospitals NHS Foundation Trust; Vasilis Kosmoliaptsis, Cambridge University Hospitals NHS Foundation Trust; Siong S Liau, Cambridge University Hospitals NHS Foundation Trust; Raaj K Praseedom, Cambridge University Hospitals NHS Foundation Trust; Bristi Basu, Cambridge University Hospitals NHS Foundation Trust; Xavier de Aretxabala, Hospital Dr. Sotero del Rio; Javier Lendoire, Universidad de Buenos Aires; Shishir Maithel, Emory University; Alejandro Branes, Hospital Dr. Sotero del Rio; Bodil Andersson, Skånes Universitetssjukhus; Alejandro Serrablo, Hospital Miguel Servet; Volkan Adsay, Koç Üniversitesi
• Language: English
• Date: 2023-05-01
• Publisher: Elsevier Ltd
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s)
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.eclinm.2023.101951
• Title of Journal or Parent Work: eClinicalMedicine
• Volume: 59
• Start Page: 101951
• End Page: 101951
• Keywords: Surgical outcomes; Liver resection; Cholangiocarcinoma; Gallbladder cancer
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

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.