(Boston)—With the growing complexity of oncologic surgery, the decision-making process has become increasingly challenging. It demands not only advanced technical expertise but also meticulous patient selection to ensure that surgical interventions provide meaningful oncologic benefits while minimizing unnecessary risks.
Gallbladder cancer (GBC), one of the most frequent biliary tract malignancies, is associated with a poor prognosis, particularly in advanced stages. The median survival for advanced GBC is approximately five months, and early recurrence (ER) is common, occurring in up to one-third of patients. Most patients with gallbladder cancer are not candidates for surgery because they present with advanced-stage disease that is not amenable to curative resection. While surgery remains the only curative option for GBC, only about 25% of patients are candidates for resection.
A new study led by researchers from Boston University Chobanian & Avedisian School of Medicine have discovered key risk factors that can help predict when surgery for gallbladder cancer may not be beneficial, leading to ER or complications.
"Our findings provide doctors with a tool to assess whether surgery is the best option for a patient with gallbladder cancer. Using this predictive model, surgeons can avoid operations that are unlikely to help and instead explore alternative treatments, such as chemotherapy or other targeted therapies," explains corresponding author Eduardo Vega, MD, assistant professor of surgery.
The researchers analyzed data from 788 patients who underwent GBC surgery across 18 international hospitals. They compared patients who had a good outcome after surgery with those whose surgery was deemed futile, meaning they either had an early recurrence (within five months) or died within 90 days. Using statistical models, they identified three main risk factors that increase the likelihood of a futile surgery: advanced tumor stage (T3-T4), lymph node involvement and the need for multi-organ resection.
According to the researchers, this study has significant implications for gallbladder cancer treatment and surgical decision-making and highlights the need for careful patient selection before surgery. "Additionally, the concept of personalized, data-driven decision-making could be extended to other cancers where aggressive surgery is debated," adds Vega.
These findings appear online in the Annals of Surgical Oncology.
