Surgical management of gallbladder cancer: Routine vs. selective resection of the common bile duct

Electronic Poster Abstracts Methods: From January 2007 to December 2012, total 467 patients who underwent curative resectionwith GB cancer were retrospectively reviewed, and 181 patients with T2 GB cancer patients were conducted. Surgical treatments was categorized as cholecystectomy alone (n = 65), radical resection following cholecystectomy (n = 23), simultaneous radical resection (n = 81), or other extensive surgery (n = 12). The extent of radical resection was liver wedge resection with regional lymphadenectomy. Each surgical treatments and their association with survival were analyzed. Results: Median follow-up periods was 45.5 months. Simultaneous radical resection showed significant survival benefit rather than cholecystectomy alone.(5-year survival 69.8% vs 48.7% P = 0.003) Radical resection following cholecystectomy also showed significant survival benefit rather than cholecystectomy alone.(5-year survival 89.7% vs 48.7% P = 0.001). And extensive surgery showed a survival benefit similar to simultaneous radical resection. (5-year survival 56.2% vs 69.8% P = 0.795). Conclusion: Radical resection showed definite survival benefit rather than simple cholecystectomy alone. Therefore, radical resection should be performed for T2 GB cancer and subsequent radical resection is also needed in patients with incidentally found T2 GB cancer after simple cholecystectomy. Extensive surgery can be considered as treatment strategy in T2 GB cancer.

FP15-11 SURGICAL MANAGEMENT OF GALLBLADDER CANCER: ROUTINE VS. SELECTIVE RESECTION OF THE COMMON BILE DUCT F. Gani1, S. Maithel2, G. Poultsides3, K. Idrees4, R. Fields5, S. Weber6, C. Scoggins7, P. Shen8, C. Schmidt9, I. Hatzaras10 and T. Pawlik11 1 Department of Surgery, Johns Hopkins Hospital, 2 Department of Surgery, Emory University, 3Department of Surgery, Stanford University School of Medicine, 4 Department of Surgery, Vanderbilt University Medical Center, 5Department of Surgery, Washington University School of Medicine in St. Louis, 6Department of Surgery, University of Wisconsin School of Medicine and Public Health, 7Department of Surgery, University of Louisville, 8 Department of Surgery, Wake Forest University, 9 Department of Surgery, The Ohio State University Wexner Medical Center, 10Department of Surgery, New York University School of Medicine, and 11Johns Hopkins Hospital, United States Background: Most gallbladder cancers (GBC) are diagnosed incidentally. Although a radical re-resection has been advocated, the optimal extent of re-resection remains unknown. The current study aimed to assess the impact of extent of resection on survival among patients undergoing surgery for GBC. Methods: Patients undergoing curative-intent surgery for GBC were identified using a multi-institutional cohort of patients. OS was estimated using the Kaplan Meir method and differences assessed using the log-rank test.

HPB 2016, 18 (S1), e1ee384

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Results: Among the 217 patients identified, 74.1%(n = 160) of patients had incidental GBC. Among these, 142 (88.8%) also underwent a lymphadenectomy (LND) while 45 (28.7%) underwent a concomitant common bile duct (CBD) resection. The median number of lymph nodes harvested was 4 (IQR,2-8) and did not differ between LND vs. LND+CBD (p = 0.479). Residual disease was noted in 50 patients (31.3%). The most common sites of residual disease were the liver (n = 27,16.9%) and bile duct (n = 13,8.1%). The overall recurrence rate was 33.1%(n = 53). All patients with a positive cystic duct margin developed a recurrence (p = 0.04). Although no differences in OS were noted relative to CBD resection, patients who had residual disease demonstrated a poor prognosis (5-year OS:53.0%[95%CI 38.0e65.9] vs. 31.4%[95%CI 15.8e48.2], p = 0.002). On multivariable analysis, residual disease in the liver was most strongly associated with an increased risk of death (HR 2.74,95%CI 1.32e5.67, p = 0.007). Conclusions: CBD resection was not associated with an increase in LN yield or an improvement in OS. Routine CBD excision may be unwarranted and should only be performed among select patients who have a positive cystic duct margin.

FP15-12 IMPROVEMENT IN CLINICAL OUTCOME OF PATIENTS WITH GALLBLADDER CANCER: A CHRONOLOGICAL ANALYSIS OF 692 PATIENTS IN A SINGLE CENTER J. Chang, J. -Y. Jang, M. J. Kang, Y. C. Shin, H. Kim, D. -H. Lee and S. -W. Kim Suery, Seoul National University College of Medicine, Republic of Korea Objectives: To determine the effect of radical curative surgery with aggressive policy on the survival outcome of gallbladder cancer (GBC) by chronological analysis, and to identify prognostic factors of GBC. Methods: A retrospective review of 692 consecutive GBC patients receiving surgical treatment between 1987 and 2014 was conducted. Clinicopathologic changes were explored according to the treatment period (P), P1 (1987e 2000, n = 255) and P2 (2001e2014, n = 437). Survival outcome and prognostic factors were investigated. Results: Mean age was 63.3 years and 52.6% (n = 364) were female. Curative resection was achieved in 55.5% (n = 384). Overall five-year survival rate (5-YSR) after curative resection reached 65.6%. Comparing P1 and P2, mean age (61.1 versus 64.5, p < 0.001), incidental radiologic diagnosis (14.1% versus 35.7%, p < 0.001), extended cholecystectomy (27.8% versus 52.9%, p < 0.001), curative resection (39.2% versus 65.0%, p < 0.001), adjuvant chemotherapy (16.9% versus 36.2%, p < 0.001), and tumor  T2 (45.6% versus 68.6%, p < 0.001) were significantly increased in P2, while CEA >5 ng/ml (34.4% versus 10.8%, p < 0.001), open biopsy or bypass surgery (10.3% versus 1.4%, p < 0.001), and metastasis detected during surgery (23.5% versus 10.7%, p < 0.001) were significantly decreased in P2. Overall 5-YSR after curative surgery (57.0% versus 69.2%) was better in P2 (p = 0.008). In curative resection group,