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Introduction: Chemotherapy (CT) is the standard of care in advanced gallbladder cancer (GBC). Should locally advanced GBC (LA-GBC) with response to CT and good performance status (PS) be offered as consolidation chemoradiation (cCTRT) to delay progression and improve survival? There is a scarcity of literature on this approach in the English literature. We present our experience with this approach in LA-GBC. Materials and Methods: After obtaining ethics approval, we reviewed the records of consecutive GBC patients from 2014 to 2016. Out of 550 patients, 145 were LA-GBC who were initiated on chemotherapy. A contrast-enhanced computed tomography (CECT) abdomen was done to evaluate the response to treatment, according to the RECIST (Response Evaluation Criteria in Solid Tumors) criteria. All responders to CT (PR and SD) with good PS but unresectable were treated with cCTRT. Radiotherapy was given to GB bed, periportal, common hepatic, coeliac, superior mesenteric, and para-aortic lymph nodes up to a dose of 45 to 54 Gy in 25 to 28 fractions along with concurrent capecitabine at the rate of 1,250 mg/m2. Treatment toxicity, overall survival (OS), and factors affecting OS were computed based on Kaplan–Meier and Cox regression analysis. Results: The median age of patients was 50 years (interquartile range [IQR] = 43–56 years), and men to women ratio was 1:3. A total of 65% and 35% patients received CT and CT followed by cCTRT, respectively. The incidence of Grade 3 gastritis and diarrhea was 10% and 5%, respectively. Responses were partial response (PR; 65%), stable disease (SD; 12%), progressive disease (PD; 10%), and nonevaluable (NE; 13%) because they did not complete six cycles of CT or were lost to follow-up. Among PR, 10 patients underwent radical surgery (six after CT and four after cCTRT). At a median follow-up of 8 months, the median OS was 7 months with CT and 14 months with cCTRT (P = 0.04). The median OS was 57 months, 12 months, 7 months, and 5 months for complete response (CR) (resected), PR/SD, PD, and NE (P = 0.008), respectively. OS was 10 months and 5 months for Karnofsky performance status (KPS) >80 and <80 (P = 0.008), respectively. PS (hazard ratio [HR] = 0.5), stage (HR = 0.41), and response to treatment (HR = 0.05) were retained as independent prognostic factors.
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Background: The minimally invasive surgery (MIS) in GBC is being increasingly performed with superior short term results and non-inferior oncological outcomes. Most of the studies on minimally invasive radical cholecystectomy (MIRC) included patients with GBC limited to the gall bladder. Bile duct or adjacent viscera has been resected only in a very few studies. One of the reasons perhaps for not imbibing MIS in advanced GBC is the innate complexity of resection of the involved adjacent organs and need performing a bilioenteric anastomosis. Aim of this study is to assess safety, feasibility and short-term outcomes of locally advanced GBC patients who underwent MIRC with adjacent bile duct or viscera resection. Methods: Retrospective analysis of prospectively maintained data of 11 patients who underwent MIRC with adjacent viscera resection for suspected case of GBC in a single surgical unit between January 2017 to December 2019 at Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, a tertiary referral teaching institute. Results: During the study period 11 patients underwent adjacent viscera resection along with MIRC.Ten patients had Common bile duct (CBD) excision (4 choledochal cyst and 6 direct tumor infiltration), four patients had gastroduodenal resection (3 sleeve duodenectomy and 1 distal gastrectomy with proximal duodenectomy) and three patients had colonic resection (2 sleeve resection and 1 segmental resection). Seven patients had single organ resection (3 CBD and 4 CDC), 2 of them had double organ (CBD & duodenum, duodenum & colon) and 2 patients had triple organ resection (CBD, duodenum and colon). Conclusion: The minimally invasive approach inGBC patients who need extrahepatic adjacent viscera resection was found to be feasible and safe with favourable perioperative and oncological outcomes.Further studies are needed from high-volume centres engaged in minimally invasive hepatobiliary surgery.