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

2023; Elsevier BV; Volume: 59; Linguagem: Inglês

10.1016/j.eclinm.2023.101951

2589-5370

Anita Balakrishnan, Petros Barmpounakis, Nikolaos Demiris, Asif Jah, Harry Spiers, Shibojit Talukder, Jack L. Martin, Paul Gibbs, Simon Harper, Emmanuel Huguet, Vasilis Kosmoliaptsis, Siong S Liau, Raaj Praseedom, Bristi Basu, X. De Aretxabala, Javier Lendoire, Shishir K. Maithel, Alejandro Brañes, Bodil Andersson, Alejandro Serrablo, Volkan Adsay, Tomoyuki Abe, Mohammad Abu Hilal, Maria del Mar Achalandabaso Boira, Mustapha Adham, Mohamed Adam, Maryam Ahmad, Bilal Al‐Sarireh, Maite Albiol, Nassir Alhaboob, Adnan Alseidi, Houssem Ammar, Akshay Anand, Bodil Andersson, Pantelis Antonakis, Verónica Araya, Stanley W. Ashley, Georgi Atanasov, Fabio Ausania, Ricardo Balestri, Abhirup Banerjee, Sudeep Banerjee, Vin Shen Ban, Giedrius Barauskas, F. Bartsch, Andrea Belli, Simona Beretta, Frederik Berrevoet, Ramesh Bhandari, Gerardo Blanco‐Fernández, Louisa Bolm, Mathieu Bonal, Emre Bozkurt, Andries E. Braat, Luke Bradshaw, Konstantinos Bramis, Alejandro Brañes, Lyle Burdine, Matthew Byrne, Maria Caceres, Maria Jesús Castro Santiago, Benjamin Chan, Lynn Chong, Ahmet Çöker, María Conde Rodríguez, Daniel Croagh, Alyn Crutchley, Carmen Cutolo, Mathieu D’Hondt, D.M. D'Souza, Freek Daams, Raffaele Dalla Valle, José Davide, Mario De Bellis, M. de Boer, Céline De Meyere, Philip de Reuver, Matthew R. Dixon, Panagiotis Dorovinis, Gabriela Echeverría Bauer, Maria Eduarda, Hasan H. Eker, Joris I. Erdmann, Mert Erkan, Evangelos Felekouras, Emanuele Felli, Eduardo Fernandes, Eduardo Figueroa Rivera, Andras Fulop, D Galun, Michael F. Gerhards, Poya Ghorbani, Fabio Giannone, Luis Gil, Emmanouil Giorgakis, Mario Giuffrida, Felice Giuliante, Ioannis Gkekas, Miguel Ángel Gómez Bravo, Bas Groot Koerkamp, Óscar Guevara, Alfredo Guglielmi, Aistė Gulla, Rahul Gupta, Amit Gupta, Marta Gutiérrez‐Valencia, Abu Bakar Hafeez Bhatti, Jeroen Hagendoorn, Zain Hajee, Abdul Hakeem, Hytham K. S. Hamid, S. Z. Sayed Hassen, Stefan Heinrich, Ryota Higuchi, Daniel Hoffman, David Holroyd, Daniel Hughes, Arpad Ivanecz, Satheesh Iype, Isabel Jaén-Torrejimeno, Shantanu Joglekar, Robert Jones, Klaus Kaczirek, Harsh Kanhere, Ambareen Kausar, Zhanyi Kee, Jessica Keilson, Jorg Kleef, Johannes Klose, Brett Knowles, Jun Kit Koong, Nagappan Kumar, Supreeth Kunnuru, Paleswan Joshi Lakhey, Andrea Laurenzi, Yeong Sing Lee, Felipe León, Voon Meng Leow, Jean-Baptiste Lequeu, Mickaël Lesurtel, Elisabeth Lo, Stefan Löb, Elizabeth Lockie, J. Peter A. Lodge, Dolores López Garnica, Víctor López López, Linda Lundgren, Nikolaos Machairas, Dhiresh Kumar Maharjan, Deep J. Malde, Guillaume Martel, Julie Martin, Michele Mazzola, Arianeb Mehrabi, R. Méméo, Flavio Milana, George Molina, Leah Monette, Haluk Morgül, Demetrios Moris, Antonios Morsi-Yeroyannis, Nicholas Mowbray, Francesk Mulita, Edoardo Maria Muttillo, Malith Nandasena, Pueya Rashid Nashidengo, Arash Nickkholgh, Colin Noel, Masayuki Ohtsuka, Artūrs Ozoliņš, Sanjay Pandanaboyana, Νικόλαος Παραράς, Alessandro Parente, June S. Peng, Arkaitz Perfecto Valero, Julie Périnel, Konstantinos Perivoliotis, Teresa Perra, Patrick Pessaux, Natalie Petruch, Gaetano Piccolo, László Piros, Alberto Porcu, Viswakumar Prabakaran, Rajendra Prasad, Mikel Prieto Calvo, Florian Primavesi, Eva María Pueyo Périz, Alberto Quaglia, José Manuel Ramia, Ashwin Rammohan, Francesco Razionale, Ricardo Robles Campos, Manas Kumar Roy, Sophie Rozwadowski, Luis I. Ruffolo, Natalia Ruiz, Andrea Ruzzenante, Lily V. Saadat, Mohamed Amine Said, Edoardo Saladino, Gabriel Saliba, Per Sandström, Carlo Alberto Schena, Anthony J. Scholer, Christoph Schwarz, Lorenzo Serafini, Pablo E. Serrano, Deepak Sharma, Aali J. Sheen, Vishwanath Siddagangaiah, Michael Silva, Saurabh Singh, Ajith K. Siriwardena, Michał Skalski, Mante Smig, Faris Soliman, Abhinav Arun Sonkar, Donzília Sousa Silva, Ernesto Sparrelid, Parthi Srinivasan, Malin Sternby Eilard, Oliver Strobel, Urban Stupan, Miguel Ángel Suárez Muñóz, Manisekar Subramaniam, Teiichi Sugiura, Robert Sutcliffe, Hilko A. Swank, Lillian Taylor, Prabin Thapa, Catherine The, Asara Thepbunchonchai, Caman Thieu, Navneet Tiwari, Guido Torzilli, Chutwichai Tovikkai, Blaž Trotovšek, Savvas Tsaramanidis, Georgios Tsoulfas, Katsuhiko Uesaka, Ibrahım Umar Garzali, Lucio Urbani, Michail Vailas, Ronald M. van Dam, Peter van de Boezem, Stijn van Laarhoven, Tomas Vanagas, Mike van Dooren, Manon Viennet, Luca Viganò, Aarathi Vijayashanker, Celia Villodre, Toshifumi Wakai, Aklile Workneh, Li Xu, Masakazu Yamamoto, Zhiying Yang, Robert J. Young, M Zivanovic,

Colorectal and Anal Carcinomas

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).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.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.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.Cambridge Hepatopancreatobiliary Department Research Fund.