Skip to main content
Journal cover image

Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma: Surgical and Survival Outcomes.

Publication ,  Conference
Creasy, JM; Goldman, DA; Dudeja, V; Lowery, MA; Cercek, A; Balachandran, VP; Allen, PJ; DeMatteo, RP; Kingham, TP; D'Angelica, MI; Jarnagin, WR
Published in: J Am Coll Surg
May 2017

BACKGROUND: Preoperative chemotherapy is a strategy for converting to resection and/or assessing disease biology before operation. The utility of such an approach in gallbladder carcinoma (GBCA) is unknown. This study evaluated outcomes of GBCA patients treated with chemotherapy for locally advanced or lymph node-involved tumors. STUDY DESIGN: Patients who received systemic chemotherapy for locally advanced or lymph node-positive GBCA were identified from a departmental database. Patients were excluded if there was any evidence of distant metastases or if records were inadequate to determine initial chemotherapy and response. Response Evaluation Criteria in Solid Tumors (RECIST), operative results, and overall survival (OS) were assessed. RESULTS: Seventy-four patients were included, from 1992 to 2015. Eighty-nine percent of patients (n = 64) were treated with gemcitabine and 57% with gemcitabine/platinum (n = 42). At initial response assessment, 17 patients (23%) had progression. The remaining patients had stable disease (n = 38, 51%) or partial response (n = 19, 26%). Twenty-two patients (30%) underwent attempt at resection, which was definitive for 10 patients (14%). Median OS for the entire cohort was 14 months (95% CI 11.3 to 17.9). Among patients with surgery, definitive resection was associated with a median OS of 51 months (95% CI 11.7 to 55.3) compared with 11 months (95% CI 4.1 to 23.6) for those with unresectable disease (p = 0.003). CONCLUSIONS: Even without distant metastases, locally advanced or lymph node-positive GBCA is associated with poor outcomes. Definitive resection was possible in a subset of patients selected for surgery after a favorable response to chemotherapy and was associated with long-term survival. We recommend surgical re-evaluation after chemotherapy to select potential operative candidates.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

May 2017

Volume

224

Issue

5

Start / End Page

906 / 916

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Lymph Nodes
  • Humans
  • Gallbladder Neoplasms
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Creasy, J. M., Goldman, D. A., Dudeja, V., Lowery, M. A., Cercek, A., Balachandran, V. P., … Jarnagin, W. R. (2017). Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma: Surgical and Survival Outcomes. In J Am Coll Surg (Vol. 224, pp. 906–916). United States. https://doi.org/10.1016/j.jamcollsurg.2016.12.058
Creasy, John M., Debra A. Goldman, Vikas Dudeja, Maeve A. Lowery, Andrea Cercek, Vinod P. Balachandran, Peter J. Allen, et al. “Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma: Surgical and Survival Outcomes.” In J Am Coll Surg, 224:906–16, 2017. https://doi.org/10.1016/j.jamcollsurg.2016.12.058.
Creasy JM, Goldman DA, Dudeja V, Lowery MA, Cercek A, Balachandran VP, et al. Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma: Surgical and Survival Outcomes. In: J Am Coll Surg. 2017. p. 906–16.
Creasy, John M., et al. “Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma: Surgical and Survival Outcomes.J Am Coll Surg, vol. 224, no. 5, 2017, pp. 906–16. Pubmed, doi:10.1016/j.jamcollsurg.2016.12.058.
Creasy JM, Goldman DA, Dudeja V, Lowery MA, Cercek A, Balachandran VP, Allen PJ, DeMatteo RP, Kingham TP, D’Angelica MI, Jarnagin WR. Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma: Surgical and Survival Outcomes. J Am Coll Surg. 2017. p. 906–916.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

May 2017

Volume

224

Issue

5

Start / End Page

906 / 916

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Rate
  • Surgery
  • Retrospective Studies
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Lymph Nodes
  • Humans
  • Gallbladder Neoplasms