Surgical outcomes in gallbladder cancer: evidence from the UK nationwide CAPBIL study.
McClements J., Lee WT., Lucocq J., Koh A., Sellappan H., Blackburn L., Brooks A., Clements J., Ng J., Frampton A., Gulbahar S., Davidson B., Feretis M., Dasari BVM., Papadopoulos G., Karavias D., Rowcroft A., Harrison EM., Morrison-Jones V., Welsh F., Pathanki A., Marangoni G., Bruno P., Skipworth J., Spiers H., Kosmoliaptsis V., Gilbert T., Malik H., Vijayashanker A., Menon K., Patel W., Bekheit M., Jones K., Silva M., Brown C., Kumar N., Triance J., Shah N., Arif A., Bhardwaj N., Saleki M., Mownah O., Yeung KTD., Bhogal R., Ng KC., Farid S., Kuzman M., Pandanaboyana S., Abdelmohsin O., Aroori S., Hajibandeh S., Athwal T., Lodge PA., Gomez D., UK HPB Research Collaborative Group .
BACKGROUND: To report management and survival outcomes of gallbladder cancer (GBC) in the United Kingdom and to identify prognostic factors associated with disease-free survival (DFS) and overall survival (OS). METHODS: Patients undergoing surgery for GBC between January 2014 and December 2022 across 24 UK centres were included. Demographic, treatment, histopathological, and survival data were analysed. RESULTS: 516 patients underwent surgery for GBC, with a median follow-up of 25 months. Patients with T3-T4 tumours more frequently presented with jaundice, had non-incidental disease, and underwent major hepatectomy compared with those with T1-T2 tumours. Advanced stage, nodal metastasis, vascular invasion, and perineural invasion were more common in patients undergoing major hepatectomy, which was also associated with higher major morbidity and 30-day mortality. Propensity score-matched analysis demonstrated no significant benefit in DFS or OS among patients who received adjuvant therapy compared with those who did not. On multivariable analysis, T3-T4 stage, nodal disease, and perineural invasion predicted poorer DFS, while T3-T4 stage and nodal disease predicted worse OS. DISCUSSION: This nationwide study demonstrates the evolution of management practices for GBC in the UK. Adverse tumour biology remains the principal determinant of survival following surgery for GBC.