Surgery of gallbladder carcinoma: current standards validated on a European cohort

Abstract

Gallbladder cancer (GBC) is a highly aggressive malignancy with a poor prognosis and varied global incidence. Despite surgical resection being the primary treatment, optimal approaches remain heterogeneous and debated due to limited high-quality evidence. This study aims to validate current surgical recommendations in a European real-world cohort. We retrospectively analyzed data from 150 GBC patients who underwent surgery at the University Hospital of Essen, Germany (2008–2023). Patient and tumor characteristics (UICC/TNM stage, incidental diagnosis, surgical approach), perioperative outcomes (mortality, morbidity, length of hospital stay), and overall survival (OS) were recorded. Congruence with established surgical recommendations was assessed, and its impact on OS analyzed using multivariate regression. Our cohort, predominantly female (60%) with a mean age of 64.9 years, included 42% of incidental cases. Overall mortality was 6.3%, and morbidity was 24.6%. Curative intent resection was performed in 57% of patients. Major resections and extrahepatic bile duct resections were associated with higher perioperative risk. R0 resection, regardless of extent, yielded better OS than palliative treatment (21–27 months vs. 8.4 months p  = 0.001). OS correlated with UICC stage (hazard ratio [HR] 2.23, p  = 0.001). Importantly, noncongruence with surgical recommendations was significantly associated with worse OS (HR 5.1, p  = 0.006). Our findings validate current recommendations for GBC surgery, emphasizing the importance of adherence to achieve optimal outcomes. Despite high morbidity in advanced resections, R0 status remains crucial. These data from a European cohort contribute to bolstering evidence for current surgical standards in GBC management.