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

John M. Creasy, Debra A. Goldman, Vikas Dudeja, Maeve A. Lowery, Andrea Cercek, Vinod P. Balachandran, Peter J. Allen, Ronald P. DeMatteo, T. Peter Kingham, Michael I. D'Angelica, William R. Jarnagin

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)906-916
Number of pages11
JournalJournal of the American College of Surgeons
Volume224
Issue number5
DOIs
StatePublished - May 1 2017
Externally publishedYes

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Gallbladder
Carcinoma
Drug Therapy
Survival
gemcitabine
Lymph Nodes
Neoplasm Metastasis
Platinum
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Surgery

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Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma : Surgical and Survival Outcomes. / Creasy, John M.; Goldman, Debra A.; Dudeja, Vikas; Lowery, Maeve A.; Cercek, Andrea; Balachandran, Vinod P.; Allen, Peter J.; DeMatteo, Ronald P.; Kingham, T. Peter; D'Angelica, Michael I.; Jarnagin, William R.

In: Journal of the American College of Surgeons, Vol. 224, No. 5, 01.05.2017, p. 906-916.

Research output: Contribution to journalArticle

Creasy, JM, Goldman, DA, Dudeja, V, Lowery, MA, Cercek, A, Balachandran, VP, Allen, PJ, DeMatteo, RP, Kingham, TP, D'Angelica, MI & Jarnagin, WR 2017, 'Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma: Surgical and Survival Outcomes', Journal of the American College of Surgeons, vol. 224, no. 5, pp. 906-916. https://doi.org/10.1016/j.jamcollsurg.2016.12.058
Creasy, John M. ; Goldman, Debra A. ; Dudeja, Vikas ; Lowery, Maeve A. ; Cercek, Andrea ; Balachandran, Vinod P. ; Allen, Peter J. ; DeMatteo, Ronald P. ; Kingham, T. Peter ; D'Angelica, Michael I. ; Jarnagin, William R. / Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma : Surgical and Survival Outcomes. In: Journal of the American College of Surgeons. 2017 ; Vol. 224, No. 5. pp. 906-916.
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title = "Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma: Surgical and Survival Outcomes",
abstract = "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.",
author = "Creasy, {John M.} and Goldman, {Debra A.} and Vikas Dudeja and Lowery, {Maeve A.} and Andrea Cercek and Balachandran, {Vinod P.} and Allen, {Peter J.} and DeMatteo, {Ronald P.} and Kingham, {T. Peter} and D'Angelica, {Michael I.} and Jarnagin, {William R.}",
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T1 - Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma

T2 - Surgical and Survival Outcomes

AU - Creasy, John M.

AU - Goldman, Debra A.

AU - Dudeja, Vikas

AU - Lowery, Maeve A.

AU - Cercek, Andrea

AU - Balachandran, Vinod P.

AU - Allen, Peter J.

AU - DeMatteo, Ronald P.

AU - Kingham, T. Peter

AU - D'Angelica, Michael I.

AU - Jarnagin, William R.

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N2 - 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.

AB - 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.

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