Woohyung Lee1, Chi-Young Jeong1, Jae Yool Jang1, Young Hoon Kim2, Young Hoon Roh2, Kwan Woo Kim2, Sung Hwa Kang2, Myung Hee Yoon3, Hyung Il Seo3, Sung Pil Yun3, Jeong-Ik Park4, Bo-Hyun Jung4, Dong Hoon Shin5, Young Il Choi5, Hyung Hwan Moon5, Chong Woo Chu3, Je Ho Ryu3, Kwangho Yang3, Young Mok Park3, Soon-Chan Hong6. 1. Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea. 2. Department of Surgery, Dong-A University Hospital, Dong-A University, College of Medicine, Busan, Republic of Korea. 3. Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University, College of Medicine, Busan, Republic of Korea. 4. Department of Surgery, Inje University Haeundae Paik Hospital, Inje University, College of Medicine, Busan, Republic of Korea. 5. Department of Surgery, Kosin University Gospel Hospital, Kosin University, College of Medicine, Busan, Republic of Korea. 6. Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University, College of Medicine, Jinju, Republic of Korea. Electronic address: hongsc@gnu.ac.kr.
Abstract
BACKGROUND: Tumor location is a prognostic factor for survival in patients with T2 gallbladder cancer. However, the optimal extent of resection according to tumor location remains unclear. METHODS: We reviewed the records of 192 patients with T2 gallbladder cancer who underwent R0 or R1 resection at 6 institutions. Perioperative and oncologic outcomes were compared according to the extent of resection between hepatic-sided (n = 93) and peritoneal-sided (n = 99) tumors. RESULTS: After a median follow-up of 30 months, the 5-year overall survival (84.9% vs 71.8%, P = .048) and recurrence-free survival (74.6% vs 62.2%, P = .060) were greater in peritoneal-sided T2 patients than in hepatic-sided T2 patients. Among hepatic-sided T2 patients, the 5-year overall survival was greater in patients who underwent radical cholecystectomy including lymph node dissection with liver resection than in patients who underwent lymph node dissection without liver resection (80.3% vs 30.0%, P = .032), and the extent of liver resection was not associated with overall survival (P = .526). Lymph node dissection without liver resection was an independent prognostic factor for overall survival in hepatic-sided T2 gallbladder cancer (hazard ratio 5.009, 95% confidence interval 1.512-16.596, P = .008). In peritoneal-sided T2 patients, the 5-year overall survival was not significantly different between the lymph node dissection with liver resection and the lymph node dissection without liver resection subgroups (70.5% vs 54.8%, P = .111) and the extent of lymph node dissection was not associated with overall survival (P = .395). CONCLUSION: In peritoneal-sided T2 gallbladder cancer, radical cholecystectomy including lymph node dissection without liver resection is a reasonable operative option. Radical cholecystectomy including lymph node dissection with liver resection is suitable for hepatic-sided T2 gallbladder cancer.
BACKGROUND:Tumor location is a prognostic factor for survival in patients with T2 gallbladder cancer. However, the optimal extent of resection according to tumor location remains unclear. METHODS: We reviewed the records of 192 patients with T2 gallbladder cancer who underwent R0 or R1 resection at 6 institutions. Perioperative and oncologic outcomes were compared according to the extent of resection between hepatic-sided (n = 93) and peritoneal-sided (n = 99) tumors. RESULTS: After a median follow-up of 30 months, the 5-year overall survival (84.9% vs 71.8%, P = .048) and recurrence-free survival (74.6% vs 62.2%, P = .060) were greater in peritoneal-sided T2 patients than in hepatic-sided T2 patients. Among hepatic-sided T2 patients, the 5-year overall survival was greater in patients who underwent radical cholecystectomy including lymph node dissection with liver resection than in patients who underwent lymph node dissection without liver resection (80.3% vs 30.0%, P = .032), and the extent of liver resection was not associated with overall survival (P = .526). Lymph node dissection without liver resection was an independent prognostic factor for overall survival in hepatic-sided T2 gallbladder cancer (hazard ratio 5.009, 95% confidence interval 1.512-16.596, P = .008). In peritoneal-sided T2 patients, the 5-year overall survival was not significantly different between the lymph node dissection with liver resection and the lymph node dissection without liver resection subgroups (70.5% vs 54.8%, P = .111) and the extent of lymph node dissection was not associated with overall survival (P = .395). CONCLUSION: In peritoneal-sided T2 gallbladder cancer, radical cholecystectomy including lymph node dissection without liver resection is a reasonable operative option. Radical cholecystectomy including lymph node dissection with liver resection is suitable for hepatic-sided T2 gallbladder cancer.
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