Hyeong Seok Kim

Background: Gallbladder cancer (GBC) is a rare and aggressive malignancy with poor prognosis and high recurrence rates, even after curative surgical resection. Early recurrence, defined as recurrence within one year after surgery, remains a major clinical concern. This study aimed to identify preoperative prognostic factors and develop a predictive model for early recurrence and overall survival in resected GBC patients. Methods: We retrospectively analyzed data from 251 patients who underwent curative-intent resection for GBC between 2008 and 2017. Logistic regression was used to identify preoperative factors associated with early recurrence. Significant variables were used to construct a nomogram, which was externally validated using a cohort of 176 patients from three independent tertiary centers. Results: The independent predictors of early recurrence included male sex, chronic liver disease, preoperative symptoms, elevated carcinoembryonic antigen (CEA), sarcopenic obesity, clinical T3 or higher stage, and suspected metastatic lymph nodes. The nomogram demonstrated strong predictive performance with an AUC of 0.872 (95% CI: 0.817–0.927) in internal validation and 0.703 (95% CI: 0.613–0.793) in external validation. Conclusions: We developed and externally validated a novel nomogram that predicts early recurrence in GBC using only preoperative factors. This model may support individualized risk assessment and aid surgeons and patients in shared decision-making prior to high-risk surgery.

Background: Margin status is one of the most significant prognostic factors after curative surgery for middle bile duct (MBD) cancer. Bile duct resection (BDR) is commonly converted to pancreaticoduodenectomy (PD) to achieve R0 resection. Additionally, adjuvant treatment is actively performed after surgery to improve survival. However, the wider the range of surgery, the higher the chance of complications; this, in turn, makes adjuvant treatment impossible. Nevertheless, no definitive surgical strategy considers the possible complication rates and subsequent adjuvant treatment. We aimed to investigate the appropriate surgical type considering the margin status, complications, and adjuvant treatment in MBD cancer. Materials and Methods: From 2008 to 2017, 520 patients diagnosed with MBD cancer at the Samsung Medical Center were analyzed retrospectively according to the operation type, margin status, complications, and adjuvant treatment. The R1 group was defined as having a carcinoma margin. Results: The 5-year survival rate for patients who underwent R0 and R1 resection was 54.4% and 33.3%, respectively (p = 0.131). Prognostic factors affecting the overall survival were the age, preoperative CA19-9 level, T stage, and N stage, but not the operation type, margin status, complications, or adjuvant treatment. The complication rates were 11.5% and 29.8% in the BDR and PD groups, respectively (p < 0.001). We observed no significant difference in the adjuvant treatment ratio according to complications (p = 0.675). Patients with PD who underwent R0 resection and could not undergo chemotherapy because of complications reported better survival rates than those with BDR who underwent R1 resection after adjuvant treatment (p = 0.003). Conclusion: The survival outcome of patients with R1 margins who underwent BDR did not match those with R0 margins after PD, even after adjuvant treatment. Due to improvements in surgical techniques and the ability to resolve complications, surgical complications exert a marginal effect on survival. Therefore, surgeons should secure R0 margins to achieve the best survival outcomes.