Abstract

OBJECTIVES: To characterize the prognostic implication of jaundice and preoperative biliary drainage on postoperative outcomes among patients with gallbladder cancer (GBC) undergoing surgical resection.METHODS: Patients who underwent surgical resection of GBC identified from a multicenter database between January 2000 and December 2019 were retrospectively analyzed. Data on clinical and pathological details, as well as short- and long-term overall survival (OS), were obtained and compared among patients with and without preoperative jaundice and biliary drainage.RESULTS: Among 449 patients with GBC, median and 1-, 3-, and 5-year OS were 17.4months, 63.7%, 28.4%, and 22.1%, respectively. Patients who presented with preoperative jaundice (n=100, 22.3%) were more likely to have advanced disease, a lower incidence of R0 resection (29.0% vs. 69.1%, p<0.001), as well as a higher incidence of postoperative liver failure (4% vs. 0, p=0.002), and worse long-term survival versus patients without jaundice (median OS, 10.4 vs. 27.1months, p<0.001). Preoperative biliary drainage was performed for the majority of jaundiced patients (77.0%) and was associated with decreased risk of postoperative liver failure (1.3% vs. 13.0%, p=0.041); preoperative biliary drainage failed to improve long-term survival (median OS, 10.2months vs. 12.0months, p=0.679). On multivariable analysis, R0 resection (17.5 vs. 7.6months, p<0.001) and adjuvant therapy (15.6 vs. 6.6months, p=0.027) were associated with improved long-term survival among jaundiced patients.CONCLUSIONS: While preoperative biliary drainage of jaundiced GBC patients decreased the risk of postoperative liver failure, it did not impact long-term outcomes. Rather, preoperative jaundice was associated with a lower chance at R0 resection and worse long-term survival.

View details for DOI 10.1007/s11605-022-05523-6

View details for PubMedID 36376722