International Study Evaluates Outcomes of Oncologic Extended Resection for GallBladder Cancer
In the United States, approximately 55% of resected gallbladder cancer (GBC) patients undergo oncologic surgery without additional systemic treatment. However, as GBC progresses to the advanced tumor sizes T3 (locally or regionally advanced) or T4 (cancer has usually spread to distant places in the body) category, the tumor frequently infiltrates adjacent organs, leading to the consideration of different therapeutic strategies, including major liver resection alone or combine by adjacent organs (duodenum, stomach and colon) or vascular structures ) (removal of the tumor extends beyond the primary site) with chemotherapy and radiotherapy either before or after surgery.
Despite these recommendations, the optimal extent of surgical resection for advanced gallbladder cancer remains a matter of ongoing debate. While it is well recognized that outcomes for advanced GBC remain poor, controversy persists over the appropriate aggressiveness of surgery, particularly due to limited effective chemotherapy.
In a new multi-center study led by Boston University Chobanian & Avedisian School of Medicine, researchers have found that aggressive surgery in patients with advanced gallbladder cancer (T3/T4) can lead to high complication and mortality rates, especially in those in the T4 patients that invade adjacents organs of the disease.
“Our study supports more careful selection after systemic treatment of patients for major surgery and highlights when it might be better to avoid aggressive procedures that may not help and could even cause harm,” explains corresponding author Eduardo Vega, MD, assistant professor of surgery.
The researchers reviewed the medical records of more than 1,000 patients with GBC from 17 hospitals across seven countries. They were grouped based on how advanced their cancer was (T3 or T4) and analyzed as to how different oncologic factors were linked to surgical outcomes, complications and survival. The researchers found advanced-stage GBC outcomes varied with resection status and removal of the tumor beyond the primary site (OER) was associated with increased morbidity, especially in T4 patients, where survival benefits were limited.
According to the researchers, this study introduces the idea that more personalized treatment—guided by individual risk factors such as jaundice or lymph node involvement—can lead to better, more customized outcomes and should play a central role in surgical decision-making.
“By tailoring treatment to the individual, we hope to reduce morbidity and improve quality of life for those facing this aggressive disease. It also highlights the power of international collaboration to advance cancer care, especially for understudied diseases like gallbladder cancer,” adds Vega who also is a hepato-bilio-pancreatic surgeon at Boston Medical Center.
These findings appear online in the Journal of Gastrointestinal Surgery.