An International Survey of the Operative Management of Gallbladder Cancer (OMEGA-S) – Global Consistency or Widespread Heterogeny?

Introduction: The rarity of gallbladder cancer (GBC) means that definitive evidence for optimal management is lacking. The extent of variability in diagnostic workup and management of GBC across HPB units globally has not been hitherto assessed. Method: A survey on the management of GBC was designed by the EAHPBA Scientific and Research committee and OMEGA study collaborators and disseminated to EAHPBA, A-PHPBA and AHPBA members. Results: Over 110 surgeons responded from more than 35 countries. Pre-operative staging was mainly via CT, while PET was predominantly performed for suspected metastases. Factors considered contraindications to resection varied between centres. Solitary right-sided liver metastasis or main portal vein involvement were only considered contraindications to resection by around 50% of centres. Half the centres would abort planned surgery if coeliac, SMA or para-aortic nodal involvement was suspected preoperatively for any stage of disease. However, for T3/4 tumours, regardless of pre-operative imaging appearances, a quarter of centres always resected this group of lymph nodes and 50% of centres always sampled para-aortic nodes for frozen section. SIVb/V resections were more commonly performed for T2b compared to T2a tumours, and extent of liver resection increased with stage of disease. Hepaticojejunostomy was always performed for T3/4 disease in 20% of units regardless of cystic duct margin histology. Conclusions: This is the first survey of GBC management across HPB units internationally, highlighting areas of consistency but also surprising areas of heterogeneity. More robust evidence and clinical trials are required to help guide the management and improve outcomes from GBC.