|PB02 Biliary: Gallbladder Cancer (ePoster)
|Selection of ePoster Presentations from Abstract Submissions
|PB02-02 ||BRD4 Inhibitor and Histone Deacetylase Inhibitor Synergistically Inhibit the Proliferation of Gallbladder Cancer in vitro and in vivo
Shilei Liu, China
S. Liu1,2, W. Gong1,2
1Department of General Surgery, Shanghai Jiao Tong University School of Medicine, China, 2Shanghai Key Laboratory of Biliary Tract Disease Research, China
Introduction: Gallbladder cancer (GBC) is the most common and aggressive malignancy of the biliary tract worldwide. However, the current treatment for GBC is very limited, which makes the development and exploration of novel and effective anticancer agents for GBC treatment becomes vital.
Here, we invested the anticancer effects of BRD4 inhibitor JQ1 and histone deacetylase inhibitor suberoylanilide hydroxamic acid (SAHA) on GBC both in vitro and in vivo.
Method: In this study, we conducted in vitro assays(CCK-8 assay, colony formation assay, Migration and invasion assay, flow cytometry for apoptosis and cell cycle analysis, qRT-PCR and western blot) and in vivo assays(tumor xenograft modules and immunohistochemistry), which demonstrated BRD4 inhibitor JQ1 and histone deacetylase inhibitor SAHA synergistically inhibited the GBC cells both in vitro and in vivo.
Results: Our results showed that cotreatment with JQ1 and SAHA significantly inhibited proliferation, cell viability, metastasis, and induced apoptosis and G2/M arrest in GBC cells, but only minor effects in benign cells. In vivo, tumor volumes and weights of GBC xenograft models were significantly decreased after treated with JQ1 or SAHA, meanwhile the cotreatment showed the strongest effect. Further study indicated that the above anticancer effects was associated with the downregulation of BRD4 and suppression of PI3K/AKT and MAPK/ERK pathways.
Conclusions: These findings highlight JQ1 and SAHA as potential therapeutic agents and their combination as promising therapeutic strategy for GBC.
|PB02-04 ||A Novel Staging System to Forecast the Cancer-Specific Survival of Gallbladder Cancer Patients
Yongcong Yan, China
Y. Yan, K. Mao, J. Lin, H. Liu, C. He, J. Wang, Z. Xiao
Sun Yat-sen University, China
Introduction: Gallbladder cancer (GBC) is one of the most aggressive malignant tumors, and there is no effective and convenient method for predicting cancer-specific survival (CSS). We aim to develop a novel nomogram staging system based on the positive lymph node ratio (pLNR) for GBC patients.
Methods: A total of 1,356 patients enrolled in the study. We evaluated the prognostic value of the pLNR and built a prognostic nomogram staging system based on the pLNR in the training cohort. The concordance index and calibration plots were used to evaluate model discrimination. The predictive accuracy and clinical value of the nomograms were measured by decision curve analysis (DCA). The CSS nomogram was further validated in an internal validation cohort.
Results: The pLNR was an independent prognostic factor for CSS based on Cox regression analyses. A prognostic nomogram that combined T classification, pLNR, M classification, histologic grade, live metastasis and tumor size was formulated with a c-index of 0.763 (95% CI, 0.728-0.798), while the c-indexes for the staging system of AJCC 8th, 7th, and 6th for CSS prediction were 0.718, 0.718, and 0.717, respectively. The calibration curves showed perfect agreement. The DCA showed that the nomogram provided substantial clinical value. The nomogram (the AUCs for one, three, and five years were 0.693, 0.716, and 0.726, respectively) showed high prognostic accuracy.
Conclusion: We have developed a formulated nomogram staging system based on the pLNR that allows more accurate individualized predictions of CSS for resected GBC patients than the AJCC staging systems.
|PB02-06 ||A Rare Case of Gallbladder Paraganglioma with Hemorrhage
Chol Kyoon Cho, Korea, Republic of
C.K. Cho, Y.H. Lee
Surgery, Chonnam National University Medical School, Korea, Republic of
paraganglioma is a very rare tumor and only a few cases have been reported so
far. Most of these tumors
are asymptomatic and confirmed incidentally after operation. The clinical
significance of gallbladder paraganglioma is differential diagnosis with
gallbladder cancer or other gallbladder tumor.
Methods: A 48-year-old woman presented with intermittent abdominal pain. The laboratory tests were all within
normal range including tumor marker. MRI showed 8 cm sized mass lesion in gallbladder body and
fundus with low signal intensity in
images considered as hemorrhage. We planned a laparoscopic
cholecystectomy under the impression of gallbladder tumor with hemorrhage.
Results: We performed laparoscopic cholecystectomy
successfully. In the
gallbladder lumen, several black stones less than 1 cm in diameter and large
hematoma were observed. And about 1 cm sized polypoid lesion was detected in the
fundus. In microscopic examination of polypoid lesion showes
cuboidal cells including granular
cytoplasm surrounded by a fibrous septum containing blood vessels. The chief cell
was nested in the inside and the spindle shape sustentacular cells surrounded
by the Zellballen cellular arrangement. Synaptophysin, CD56, chromogranin
staining were strongly positive for chief cells. In the histopathologic
examinations, the diagnosis was gallbladder paraganglioma with hemorrhage.
Conclusions: Gallbladder paraganglioma is extremely rare tumor and usually
diagnosed incidentally after operation. We need to aware of this disease entity
for differentiation of this tumor with other gallbladder tumors.
|PB02-10 ||Outcomes and Prognostic Factors in Patients with Gallbladder Carcinoma with Multimodality Treatment
Sneha Jha, India
A. Pandey, S. Jha, S. Masood, S. Chauhan, D. Kumar, S. Kumar, S. M.M
Ram Manohar Lohia Institute of Medical Sciences, India
Introduction: India is a high incidence area for
Gall Bladder Cancer (GBC). GBC has short median survivals reflecting its
aggressive behaviour. Early GBC can be managed by radical surgery which is
possible in 10% cases. The tumour is often unresectable at presentation
requiring multimodality approach for management.
inpatients of suspected GBC from January 2013 to July 2019 at a tertiary centre
in North India were analysed. Patients were grouped as - Potentially resectable, Locally advanced
unresectable and metastatic disease. Radical cholecystectomy was performed for resectable GBC. Duration of hospital stay, complications
and Survival were analyzed.
Results: Out of 173
suspected GBC ,113 patients were resectable. Radical cholecystectomy was performed in 56
patients (72.7%) ,9 (11.6%) required bile duct excision, 6 (7.7%) additional
organ resection. Major morbidity and mortality rate was 1.7% and 1.7%
estimated OS of stage I and II was 100% and 91.6%, respectively whereas 66.9%
for stage III and 0% for stage IV disease. The median survival of stage I and
II was 60.1 months which dropped to 23.9 months in stage IIIB
and 6.3 months in stage IVB. Although adjuvant chemotherapy has
increased the OS by 8.2 months but not statistically significant.
Conclusion: We are still
facing challenges in early diagnosis as patients often presents late in our setting. Careful patient
selection with combination of surgery and peri-operative chemotherapy has
resulted in favourable outcomes in stage II/III disease. Potentially multimodality
treatment may add meaningful survival for this disease with inherently
aggressive tumor biology.
|PB02-12 ||Clinicopathological Differences in T2 Gallbladder Cancer According to Tumor Location
Wan--Bae Kim, Korea, Republic of
W.-J. Kim, T.-W. Lim, P.-J. Park, S.-B. Choi, W.--B. Kim
Korea University Guro Hospital, Korea, Republic of
aimed to identify clinicopathological differences and factors affecting
survival outcomes of stage T2a and T2b gallbladder cancer (GBC) and validate
the oncological benefits of regional lymphadenectomy and hepatic resection in
methods: This single-center study enrolled
patients who were diagnosed with pathologically confirmed T2 GBC and underwent
curative resection between January 1995 and December 2017. Eighty-two patients
with T2a and 50 with T2b GBCs were identified, and clinical information was
retrospectively collected from medical records and analyzed
and 5-year overall survival rates were 96.8% and 96.8% and 80.7% and 80.7% in
T2a and T2b groups, respectively (p=0.007). Three- and 5-year survival rates
among all T2 GBC patients without and with lymph node metastasis were 97.2% and
94.4% and 81.3% and 81.3%, respectively (p=0.029). There was no difference in
survival rates between the two groups according to whether hepatic resection
was performed (p=0.320). However, in the T2b group, those who underwent hepatic
resection demonstrated a better survival rate than those who did not (p=0.029).
Multivariate analysis revealed that lymph node metastasis, vascular invasion,
tumor location, and adjuvant chemotherapy were significant independent
resection was not always necessary in patients with peritoneal-side GBC. Considering
the clinicopathological features and recurrence patterns of hepatic-side GBC, a
systematic treatment plan, including radical resection and adjuvant
chemotherapy, should be established.
|PB02-14 ||Characteristics and Management of Incidental Gallbladder Cancer: Impact and Limitation of Laparoscopic Whole Layer Cholecystectomy
Jun Muto, Japan
J. Muto, K. Hashida, M. Yokota, Y. Nagahisa, S. Nishina, M. Okabe, H. Kitagawa, T. Park, K. Kawamoto
Department of Surgery, Kurashiki Central Hospital, Japan
Introduction: Incidental Gallbladder Cancer (IGBC) is a status of gallbladder cancer (GBC) that has not been diagnosed as cancer preoperatively. Efficacy of laparoscopic whole layer cholecystectomy (LWC) for early stage GBC is reported. However, there is no report about effect of LWC on IGBC. We are reporting the risk factors of recurrence of IGBC and strategy for IGBC from experience of a high-volume center in Japan.
Methods: We retrospectively investigated on 3166 patients who were undergone cholecystectomy with preoperative diagnosis of benign disease in our hospital from 2009 to 2018.
Results: Fifty-one patients (1.61%) were diagnosed as IGBC. Preoperative diagnoses were acute cholecystitis (16/1106, 1.45%), chronic cholecystitis (4/117, 3.42%), gallbladder polyp (19/151, 10.60%), adenomyomatosis (3/107, 2.80%) and gallbladder stone (9/1580, 0.57%). Post-operative recurrence was observed on 19 cases. Risk factors for recurrence on univariate analysis were bile spillage (p=0.001), advanced stage (p=0.002), positive surgical margin (p=0.005) and non-LWC (p=0.047). On multivariate analysis, bile spillage was only significant factor of recurrence (p=0.024, OR=11.43). No bile spillage was occurred on any of 10 patients performed LWC. Six patients of T1 were undergone LWC and no patients were relapsed. Risk factor of recurrence among advanced stage patients were non-additional resection (p=0.010) and bile spillage (p=0.036), but LWC was not significant (p=0.228).
Conclusion: Bile spillage was significant risk factor of recurrence on IGBC. LWC is an efficacious procedure on T1 IGBC, and LWC is recommended on IGBC suspected disease such as gallbladder polyp. For advanced stage, additional resection should be performed.
|PB02-17 ||GLI2/Hedgehog Signaling Contributes to the Induction of Malignant Phenotype of Gallbladder Cancer
Shu Ichimiya, Japan
S. Ichimiya1, H. Onishi1, S. Matsushita2, S. Koga1, Y. Fujioka1, K. Nakayama1, A. Fujimura1, Y. Oyama1, M. Nakamura3
1Department of Cancer Therapy and Research, Graduate School of Medical Sciences, Kyushu University, Japan, 2Department of Surgery, Gokeikai Osaka Kaisei Hospital, Japan, 3Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan
Background: We have previously shown that
Hedgehog (Hh) signaling is reactivated in GBC. However, which and how three GLI proteins; GLI1.
GLI2 and GLI3 contribute to the induction of malignant phenotype of GBC is
still unclear. To develop a new therapeutic strategy for refractory GBC,
the biological significance of GLI1, GLI2 and GLI3 was investigated.
1) In vitro experiment; GLI
proteins were inhibited
using siRNA. GLI expressing 3
GBC cell lines (NOZ, TGBC2TKB, and
TYGBK−1) were used for invasion assay and proliferation assay.
2) In vivo experiment; In xenograft
mice model, tumorigenesis of GLI
inhibited cells (NOZ) was analyzed.
3) Clinical experiment; 67
patients with GBC who underwent curative surgical resection were enrolled in
this study. Correlation between GLI expression and clinicopathological findings
was analyzed immunohistochemically.
vitro results; GLI2 siRNA but not GLI1/GLI3 siRNA transfection
significantly inhibited the invasiveness and proliferation ability of GBC
2) In vivo results; Tumor volume from mice injected with GLI2 siRNA
transfected cells was
significantly lower than that in control tumors.
3) Clinical results; The expression levels of GLI2 in
human GBC specimens were higher than those in normal gallbladder tissue. GBC
specimens with high GLI2 expression had significantly high level of PD-L1
expression and low number of infiltrated CD3 positive lymphocytes.
Conclusion: GLI2 contributes to the induction of
malignant phenotype of GBC and could be a potential
therapeutic target for GBC.
|PB02-19 ||Extended Resections for Advanced Gallbladder Cancer: Results from a Nationwide Cohort Study
Elise de Savornin Lohman, Netherlands
H. Kuipers1, E. de Savornin Lohman2, D. Braat3, F. Daams4, J. Erdmann5, J. Hagendoorn6, B. Groot Koerkamp7, P. de Reuver2, M. de Boer1, National Gallbladder Cancer Collaborative
1Surgery, UMCG, Netherlands, 2Surgery, Radboudumc, Netherlands, 3Surgery, LUMC, Netherlands, 4Surgery, Amsterdam UMC, VUmc, Netherlands, 5Surgery, Amsterdam UMC, AMC, Netherlands, 6Surgery, UMC Utrecht, Netherlands, 7Surgery, Erasmus MC, Netherlands
Background: Extended resections (i.e. major hepatectomy and/or pancreatoduodenectomy)
are rarely performed for gallbladder cancer (GBC) as outcomes remain inconclusive.
Little data is available from Western centers.
In this Dutch, multicenter cohort study outcomes of patients who underwent
extended resections for locally advanced GBC are analyzed.
with GBC who underwent extended resection with curative intent from 2000 to 2018 were identified from the Netherlands Cancer Registry
(NCR). Extended resection was defined as a major hepatectomy (resection of ≥
3 liver segments) and/or a pancreatoduodenectomy. Post-operative morbidity,
mortality, survival and characteristics of short- and long-term survivors were
total of 33 patients was included. R0-resection margins were achieved in 16
patients. Major post-operative complications (≥CD3A) occurred in 19
patients and post-operative mortality
< 90 days in four. Recurrence occurred in 24 patients. Median overall
survival (OS) was 12.8 months (95% CI 6.5 - 19.0). Two-year survival was achieved in 10 patients (30%) and
5-year survival in 5 patients (15%). Jaundice, common bile duct-, liver-, perineural- and
perivascular invasion were associated with reduced survival. All (3) recurrence-free patients had R0
resection margins and no liver invasion.
Median OS after extended
resections for advanced GBC was 12.8 months in this cohort. Although
post-operative morbidity and mortality were significant, long term survival (≥
2 years) was achieved in a subset of patients. Therefore, GBC requiring major
surgery does not preclude long-term survival and a subgroup of patients benefit
|Age (IQR)||64 (57- 69)|
|Gender (male)||13 (39%)|
|ASA classification <3||19 (76%)|
|Pre-operative biliary drainage (yes)||20 (61%)|
|Portal Vein Embolization performed||5 (15%)|
|Extended hepatectomy||7 21%)|
|Hepatectomy + pancreatoduodenectomy||2 (6%)|
|Pancreatoduodenectomy + liver wedge resection||21 (36%)|
|Portal vein reconstruction||10 (30%)|
[Patient and operative characteristics of GBC patients that underwent extended resection]
[A: Survival of patients with GBC and extended resection. B: Survival according to resection margin.]
|PB02-20 ||Gallbladder Cancer in Australian Capital Territory: A 20 Years Analysis of Incidence, Management, and Outcomes
Krishanth Naidu, Australia
K. Naidu1,2, T. Yiu1, R. Shanmugasundaram2, J. Salim1, D. Yip2,3, S. Gananadha1,2
1Department of General Surgery - HPB Unit, Canberra Hospital, Canberra, Australia, 2Australian National University, Canberra, Australia, 3Department of Medical Oncology, Canberra Hospital, Canberra, Australia
Introduction: Gallbladder cancer (GBC) is a rare malignancy in Australia with an incidence of less than 6 per 100000 population. There is marked geographic variation in incidence with the majority of the literature from these endemic regions. The aim of the paper is to assess the incidence, characteristics and outcomes of GBC in a non-endemic region.
Methods: A retrospective review of all patients diagnosed with GBC in the Australian Capital territory over a 10-year period was undertaken. This included hospital medical records and a prospectively collected cancer database. Cases were also identified from ACT-wide pathology laboratories where specimens were sent for histological analysis. Adults with GBCs regardless of metastatic state were included. Patient characteristics including presenting features, histology, treatment received and survival were assessed.
Results: 58 GBCs (Primary=74.1%) were identified. The incidence of primary GBC was 2.7/100,000 person-years with a mean age of onset at 68.5 years with a female preponderance (~72.5%). The mean survival was 2.3 years with an overall five-year survival of 51%. 88.4% of patients were symptomatic with right upper quadrant pain and/or a mass, jaundice or weight loss. Incidental GBC was found in 11.6% of the patients. Adenocarcinoma was noted in 93% of primary cases with most being at Stage 3A on diagnosis. 60.5% underwent surgery.
Conclusion: GBC is rare cancer in the Australian population with majority of the symptomatic patients being diagnosed at a late stage. Incidental cancers are a significant proportion of patients. The overall outcome of this cancer is poor.
|PB02-22 ||Analysis of the Cases with Carcinoma Gallbladder (CA GB) in a Tertiary Level Hospital of Nepal
Romi Dahal, Nepal
R. Dahal, B. Ghimire, P. Kansakar, R.S. Bhandari, P.J. Lakhey
GI and General Surgery, Tribhuvan University Teaching Hospital, Nepal
Introduction: Gallbladder cancer (GC) is a rare disease in some parts of world but is common in countries like Chile, Japan, India and Nepal. Nepal stands as one of the five countries with the highest mortality.
Methods: A retrospective analysis of the consecutive operated and non-operated admitted cases of GC in TUTH from 2018 to 2019 was done. Patient demographics, disease characteristics, diagnostic modalities and various curative and palliative treatment variables were analyzed.
Results: Of the 59 patients, 33 females (56%) outnumbered the 26 males(44%) with a male is to female ratio of 0.7:1. The median age at diagnosis was 56 years with younger than 60 years comprising 62.7% of the disease. Among all, the most common presenting symptom was abdominal pain followed by jaundice. Onset of first symptoms was within mean duration of 40 days (SD 37.45 days).
USG and CT availability (100%) lead to preoperative diagnosis in majority. Curative resection (extended cholecystectomy) was done in 16 (27%).The most common anatomic location of mass was fundic followed by neck. Of the advanced metastatic Ca GB in 30% of cases, the most common site of metastasis was liver. Most cases were adenocarcinoma with mean survival after diagnosis in advanced cases being 4.5 months.
Conclusion: CA GB is more common in Nepal, more among females and younger patients often presenting with pain abdomen and jaundice. Most are advanced at the time of diagnosis. Radical surgery can be offered to few patients where the outcome seems reasonably good.
|PB02-23 ||A Study of Advanced Gallbladder Cancer to Evaluate Surgical Procedure and Poor Prognostic Factors
Keisuke Okamura, Japan
K. Okamura, T. Noji, Y. Nakanishi, K. Tanaka, T. Asano, T. Nakamura, T. Tsuchikawa, S. Hirano
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Japan
Background: It is important to consider the selection of the suitable procedure and
identification of poor prognostic factors in the treatment of gallbladder
Objective: This study was aimed to evaluate each operative
procedure for GBC and to identify poor prognostic factors for advanced GBC after
Methods: We reviewed medical records of 53 patients without
resection and 87 patients who underwent resection. All patients in the
resection had subserosal or deeper invasion (advanced GBC). Overall survival curves
and poor prognostic factors of advanced GBC in the radical resection were analyzed.
Results: Surgical procedures included partial liver resection with bile
duct resection in 37 patients, major hepatectomy with bile duct resection in
30, hepatopancreatoduodenectomy (including minor hepatectomy) in 11,
pancreatoduodenectomy in 10, and bile duct resection (including only
cholecystectomy) in 19 patients. The R0 rate was 90% (78 patients). In total, 3
patients (3.8％) from the radical resection group died during hospital stay due to worsening
of complications. In advanced GBC, the median survival time for radical
resection was 26 months. It was significantly longer than the 3 months for the
palliative resection and the 10 months for the non-resection (p< 0.0001 in
both ). Pathological distant metastasis was the only independent prognostic
factor based on univariate analysis (hazard ratio: 8.8, 95% C.I: -1.67～-0.41, p=0.0031).
Conclusion: Radical resection, according to
preoperative imaging for advanced GBC, achieved high R0 resection rate. Developments
of preoperative methods are expected to exclude patients with liver metastasis
or para-aortic lymph node.
|PB02-24 ||The Role of Pancreaticoduodenectomy in the Surgical Management of Gallbladder Carcinoma
Jun Sakata, Japan
J. Sakata, Y. Hirose, K. Yuza, K. Miura, T. Katada, K. Takizawa, H. Nagaro, T. Kobayashi, T. Wakai
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Japan
study aimed to elucidate indications and limitations of pancreaticoduodenectomy
(PD) for gallbladder carcinoma (GBC).
study retrospectively analyzed the long-term outcomes of 37 patients undergoing
PD for GBC. PD was indicated for tumors with evident peripancreatic nodal
metastasis and/or massive invasion of the pancreas/duodenum/bile duct. Primary
end point was overall survival (OS). The median follow-up time was 264 months.
(≥ Clavien-Dindo IIIB) and in-hospital mortality were 19% (n = 7) and 8% (n =
3), respectively. For all 37patients, OS following resection was 31% at 5 years
and 25% at 10 years (median survival time, 20 months). Multivariate analysis
identified residual tumor status (P = 0.009) and the extent of disease (P =
0.025) as independent prognostic factors. The 5-year OS in patients with and
without residual tumor was 43% and 0%, respectively (P < 0.001). The 5-year
OS in patients with peripancreatic nodal disease (n = 12), organ involvement
other than the liver (n = 12), and the both (n = 13) was 52%, 37%, and 8%,
respectively (P = 0.001). There were 10 5-year survivors; all the patients
underwent R0 resection. Of the 10 patients, 6 had peripancreatic nodal disease;
3 had ≥ 3 positive nodes.
Conclusions: PD provides
survival benefit for some patients with advanced GBC only if R0 resection is
feasible. Patients with both peripancreatic nodal disease and organ involvement
other than the liver are not good candidates for PD. PD may be beneficial in selected patients with peripancreatic nodal
|PB02-25 ||An Unusual Case of Choledochal Cyst Coexisting with Gallbladder Cancer
Vivek Kaje, India
V. Kaje1, H. B2, V. M3, R. Shetty3, R. Fernandes2, P. S2
1Surgical Gastroenterology, Yenepoya Medical College, India, 2General Surgery, Yenepoya Medical College, India, 3Surgical Oncology, Yenepoya Medical College, India
Cyst is a rare condition. Even rarer is a choledochal cyst in association with
a gallbladder carcinoma.
Aim: Report an unusual case of choledochal cyst
coexisting with gallbladder Cancer.
Case Details: A 49 years old male with no comorbidities
presented with vague upper abdominal pain for 1 month. Clinical examination was
normal. On evaluating with blood investigations including complete hemogram,
LFT, USG abdomen with CECT abdomen and MRCP, it was diagnosed as type IC choledochal
cyst with cancer gallbladder (fundal region). He underwent staging laparoscopy
followed by open radical cholecystectomy with choledochal cyst excision and
Roux en y hepaticojejunostomy. In the postoperative period he had bile leak
which settled by itself on POD 8. Histopathology report revealed
adenocarcinomaT3N0M0 with 0/17 lymphnodes were involved. Postoperatively he has
received gemcitabine chemotherapy.
Conclusion: Choledochal cyst with gallbladder cancer is a
rare condition, early detection and radical surgery is the only hope for
|PB02-30 ||A Study for the Expression of FAM83H, ZNF16, and FAM83H-related Proteins in Gallbladder Cancer
Jae Do Yang, Korea, Republic of
J.D. Yang1, S.W. Ahn1, H.C. Yu1, S.E. Hwang2
1Surgery, Chonbuk National University Hospital, Korea, Republic of, 2Daesion Sun Honspital, Korea, Republic of
is mostly known for its role in amelogenesis, however, recent reports suggest
FAM83H might be involved in tumorigenesis. A search of the public database
shows a significant association between FAM83H and ZNF16 in various carcinomas
including biliary tract cancer. Although the studies of FAM83H in gallbladder
cancer are limited, we inferred gallbladder cancer has similar traits with
other biliary cancers.
evaluated the clinicopathological significance of the immunohistochemical
expression of FAM83H and ZNF16 in 105 gallbladder cancer patients.
expression of FAM83H and ZNF16 were significantly associated with each other.
In univariate analysis, individual, and co-expression pattern of FAM83H and
ZNF16 was significantly associated with shorter overall survival (OS) and
relapse-free survival (RFS) of gallbladder cancer patients: nuclear expression
of FAM83H (OS; P <
0.001,), cytoplasmic expression of FAM83H (OS; P < 0.00), nuclear expression of ZNF16
(OS; P <
0.001), cytoplasmic expression of ZNF16 (OS; P = 0.032). In multivariate analysis,
nuclear expression of FAM83H (OS; P <
0.001) and the co-expression pattern of nuclear FAM83H and ZNF16 (OS; P < 0.001) were
independent indicators of shorter survival of gallbladder patients.
Conclusion: These results suggest that FAM83H and ZNF16 might be
involved in the progression of GB cancer, and their expression might be used as
novel progression indicator for GB cancer patients.
|PB02-32 ||Prediction of Malignancy Using Skin Autofluorescence in Patients with Gallbladder Carcinoma
Marcin Morawski, Poland
M. Morawski, M. Krasnodębski, M. Grąt, J. Borkowski, P. Krawczyk, J. Stypułkowski, A. Zhylko, W. Figiel, K. Zieniewicz
Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Poland
Introduction: Increased accumulation of advanced glycation end products (AGEs) may correlate with progression of numerous diseases, including some cancers. Skin autofluorescence (SAF) measurement in a non-invasive test that quantifies tissue AGEs. The aim of this study was to assess utility of SAF in prediction of malignancy in patients with gallbladder carcinoma (GBC).
Methods: This prospective study comprised 29 patients (7 men and 22 women) with suspected or confirmed GBC who underwent surgery in the Department of General, Transplant and Liver Surgery of the Medical University of Warsaw between September 2018 and November 2019. SAF was based on 3 separate preoperative measurements on the anterior side of the forearm and expressed in arbitrary units (AU). Data on patients' weight, height, BMI, and diabetes were collected preoperatively.
Results: Gallbladder carcinoma was diagnosed in 22 out of 29 patients (75.86%). Median SAF was 2.2 AU (IQR = 1.925 - 2.675) and 2.2 AU (IQR = 1.8 - 2.5) in GBC patients and individuals without cancer, respectively. There was no difference in SAF between patients with GBC and individuals without cancer (p=0.700). The lack of significant difference was unmodified by patient sex, presence of diabetes or BMI>25 (p=0.662, p=0.643, and p=0.629, respectively).
Conclusions: Although SAF may have predictive value in some cancers, this study does not provide evidence for increased accumulation of AGEs in patients with GBC.
|PB02-33 ||Incidence of Inter Aortocaval Lymph Node Positivity in Early Gall Bladder Carcinoma
Smita Chauhan, India
S. Chauhan, S. Jha, S. Masood, A. Panday
Surgical Gastroenterology, Ram Manohar Lohia Institute of Medical Sciences, India
Introduction: Inter aortocaval (IAC) lymph node involvement
in Gallbladder cancer (GBC) is considered metastatic (M1) disease . This study
aimed to evaluate the incidence of IAC positivity in early GBC (T1/2 lesions), deemed
resectable on pre-operative imaging.
Methods: A retrospective analysis of patients with suspected
GBC, was undertaken, from a prospectively maintained data base, between Jan 2013
to July 2019. All patients deemed resectable on preoperative evaluation
underwent staging laparoscopy followed by IAC sampling. During these procedures
if no metastasis was evident, resection with R0 intent was attempted. Data was
analysed using SPSS version16 and Chi square test for significance
Results: Of 245 suspected GBC patients, 105 (42.8%)
were deemed operable on preoperative imaging. Nineteen of these were found to
have Xanthogranulomatous cholecystitis on final histopathology hence excluded
from the analysis. Of the remaining 86 patients, 27 were found to have
disseminated disease on staging laparoscopy/laparotomy of which 13 (15.1%) had IAC
lymph node positive for malignancy on sampling. Incidence of IAC involvement in
GBC cases taken up for surgery was 15.1%. One of the thirteen (7.6%) IAC lymph
node positive patients had T2 lesion (T1+T2=33) while twelve (92.3%) were T3+T4(53)
tumours.Thus incidence of IAC lymph node metastasis in early GBC was one in
thirty three cases that is 3% (p< 0.014).
Conclusions: Gall bladder cancer, even if confined within
the gallbladder, has a significantly high incidence of metastasis to
interaortocaval lymph nodes which in turn upstages the disease from potentially
resectable to metastatic.
|PB02-34 ||Technical Feasibility and Surgical Outcomes of Modified Right Hepatectomy in Patients with Gall Bladder Neck Cancer with Jaundice : A Study of 22 Patients
Ram Daga, India
R. Daga, N. Jangir, L. Yadav, R. Rao, S. Gupta, G. Chauhan
Surgical Gastroenterology, SMS Medical College, India
with Gall Bladder Neck Cancer with jaundice are difficult to manage and have
high mortality. We operated these patients with Right Hepatectomy, Resection of
Seg IVb of Liver, resection of extrahepatic biliary tree and regional
lymphadenectomy (Modified Right Hepatectomy). We evaluated Perioperative
results and surgical outcomes in these patients.
Method: Retrospective analysis of Prospective database of
patient with Modified Right Hepatectomy for Gall Blader neck cancer with
jaundice in term of perioperative complications and survival outcomes was done
Results: Between January 2013 and December 2018, After
preoperative imaging and evaluation 49 patients were planned for Modified Right
Hepatectomy. All patients underwent Staging Laparoscopy, out of which 12
patients had metastatic disease. 15 patients had locally advance disease (bulky
lymph nodes, Tumor extension to left duct), so surgery was deferred. Modified
Right Hepatectomy was completed in 22 patients (17 Females, 5 Males). There was
no perioperative mortality. Surgical
Site Infection was the most common complication (4 patients, 18.2 %). Grade A Post
Hepatectomy Liver Failure and Bile leak
were othe important complication seen in 2 patients (9.1%) each. One year
survival in 19 patients was 84.2%(16 patients). 3 years survival in 12 patients
was 25% (3 patients)
Conclusions: In selected Gall Bladder Neck cancer patients
with Jaundice Modified Right Hepatectomy can be performed with minimal morbidity and have reasonable survival
|PB02-36 ||Meso-hepatectomy in a Locally Advanced Carcinoma Gallbladder in 21st Century: Is it Justified?
Soumen Roy, India
S. Roy1, S. Paikaray2, S. Mohanty3, M. Bhoi4
1Department of GI-HPB Surgery, AMRl Hospital, India, 2Medical Oncology, Bluewheel Hospital, India, 3Department of GI SURGERY, AMRl Hospital, India, 4Pathology, Bluewheel Hospital, India
Introduction: Based on the 2017 systematic review and meta-analysis meso-hepatectomy appears to be safe and comparable in both peri-operative and long term outcomes while comparing patients undergoing extended hepatectomy. Majority included hepatocellular carcinomas(>95%), cholangiocarcinomas but none have carcinoma(ca) gallbladder(gb). Right extended hepatectomy after biliary drainage and portal vein embolisation is the treatment modality for advanced ca gb. It is common in low socioeconomic strata of India(South Asia). Majority(90%) of them don't achieve R0 resection due to disease progression and procedural complications. Chemotherapy can't be given unless bilirubin< 5. The main difference between cholangiocarcinoma and ca gb is that cholangiocarcinoma spreads along ducts but ca gb infiltrates locallly. Hence meso-hepatectomy is not an inferior oncologic surgery in advanced ca gb.
Methods: 30 year old male presented with jaundice, weight loss. Scan showed gall bladder mass with hilar block and right hepatic artery(RHA) involvement. Maximum bilirubin was 24. He underwent biliary drainage and bilirubin came down to 14. Ultrasound doppler showed RHA block with good intra-hepatic flow. He underwent meso-hepatectomy with RHA excision and hepaticojejunostomy to right posterior sectoral duct and left duct. Blood loss was 1 litre with a duration of 10 hour. Post operatively neither there was liver failure nor bile leak. Histopathology report was T4N2Mx(ductal margins negative). He completed adjuvant chemotherapy and on follow up of 18 months found to have segment 6 metastasis and still on chemotherapy without jaundice.
Conclusion: Meso-hepatectomy is a safer onco-surgical alternative to extended hepatectomy in selected cases of advanced gall bladder cancers.
|PB02-37 ||Rare Presentation of the Type I Choledochal Cyst in a Young Adult
Neelendra Yesaswy Muppalla, India
N.Y. Muppalla1, S. Sankar2
1GI Surgery, Sri Ramachandra Medical College and Research Institute, India, 2Sri Ramachandra Medical College and Research institute, India
of malignancy in choledochal cyst is 7.5%.
Most Common malignancy is cholangiocarcinoma (70%), Gall bladder
adenocarcinoma (20%), rest others. It is more common in
females, and as the age increases the incidence of malignancy increases, the
mean age of presentation is 32 years. Although Type I choledochal cysts are
more common, the incidence of malignancy is higher in type IV choledochal cysts.
Japanese and Koreans have seen High Incidence of Gall bladder cancer in
Pancreatico biliary maljuction(PBM).
Case report: We present
a rare primary presentation of choledochal cyst in 34yrs/male who presented with complaints of vague right upper quadrant Pain for 4 months. On further
evaluation with imaging studies he was diagnosed to have Type I
Choledochal cyst with Gall bladder malignancy along with pancreatico biliary
maljunction. Patient underwent Radical cholecystectomy with cyst excision and hepaticojejunostomy.
Choledochal cyst presentation is usually in form of complication -
Cystolithiasis, Infection, Pancreatitis, portal HTN, biliary cirrhosis, and
malignancy. Mere Primary presentation of GB cancer along with Choledochal Cyst is
quite unusual. We present this
case as it is quite rare presentation.