Advanced gallbladder cancer (T3 and T4): insights from an international multicenter study

Abstract

Background: Surgical resection is the only curative treatment of gallbladder cancer (GBC). However, the role of oncologic extended resection (OER) in advanced GBC (T3/T4) remains unclear. This study aimed to evaluate the effect of OER in patients with advanced GBC. Methods: This retrospective, multicenter study analyzed 419 patients diagnosed with GBC at 17 institutions across 7 countries between 1997 and 2022. Adjusted logistic regression was used to examine factors affecting R1 resection and lymph node positivity. Survival was assessed using Kaplan-Meier curves and multivariate Cox proportional hazards. Results: Of the cohort, 369 patients with T3 GBC and 50 patients with T4 GBC were identified. Predictors of R1 status for patients with T3/T4 GBC included jaundice before surgery (odds ratio [OR], 3.03 [95% CI, 1.68–5.45]), perineural and/or lymphovascular invasion (OR, 2.43 [95% CI, 1.35–4.39]), adjacent organ resection (OR, 2.05 [95% CI, 1.09–3.85]), overall morbidity (OR, 1.64 [95% CI, 1.01–2.66]), and lymph node metastasis (OR, 2.69 [95% CI, 1.55–4.66]). Morbidity was higher in patients (64.8%) with T4 GBC than in patients (38.2%) with T3 GBC, with severe morbidity at 46.3% and 17.1%, respectively. Of note, 90-day mortality was 4.1% for patients with T3 GBC and 12% for patients with T4 GBC. The 3-year overall survival rate was 33% for patients with T3 GBC and 4% for patients with T4 GBC (log-rank P