W Kwon1, H Kim1, Y Han1, Y J Hwang2,3, S G Kim2,3, H J Kwon2,3, E Vinuela4, N Járufe4, J C Roa5, I W Han6, J S Heo6, S-H Choi6, D W Choi6, K S Ahn7, K J Kang7, W Lee8, C-Y Jeong8, S-C Hong8, A T Troncoso9, H M Losada9, S-S Han10, S-J Park10, S-W Kim10, H Yanagimoto11, I Endo12, K Kubota13, T Wakai14, T Ajiki15, N V Adsay16,17, J-Y Jang1. 1. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea. 2. School of Medicine, Kyungpook National University, Daegu, South Korea. 3. Kyungpook National University Chilgok Hospital, Daegu, South Korea. 4. Department of Digestive Surgery, Santiago, Chile. 5. Pathology, Faculty of Medicine, Catholic University of Chile, Santiago, Chile. 6. Department of Surgery, Samsung Medical Centre, Sungkyunkwan University College of Medicine, Seoul, South Korea. 7. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Keimyung University Dongsan Medical Centre, Daegu, South Korea. 8. Department of Surgery, Gyeongsang National University College of Medicine, Jinju, South Korea. 9. Department of Surgery, Universidad de la Frontera, Temuco, Chile. 10. Department of Surgery, Centre for Liver Cancer, National Cancer Centre, Goyang, South Korea. 11. Department of Surgery, Kansai Medical University, Hirakata, Japan. 12. Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan. 13. Department of Gastroenterological Surgery, Dokkyo Medical University, Tochigi, Japan. 14. Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. 15. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. 16. Department of Pathology, Koc University, Istanbul, Turkey. 17. Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA.
Abstract
BACKGROUND: In gallbladder cancer, stage T2 is subdivided by tumour location into lesions on the peritoneal side (T2a) or hepatic side (T2b). For tumours on the peritoneal side (T2a), it has been suggested that liver resection may be omitted without compromising the prognosis. However, data to validate this argument are lacking. This study aimed to investigate the prognostic value of tumour location in T2 gallbladder cancer, and to clarify the adequate extent of surgical resection. METHODS: Clinical data from patients who underwent surgery for gallbladder cancer were collected from 14 hospitals in Korea, Japan, Chile and the USA. Survival and risk factor analyses were conducted. RESULTS: Data from 937 patients were available for evaluation. The overall 5-year disease-free survival rate was 70·6 per cent, 74·5 per cent for those with T2a and 65·5 per cent among those with T2b tumours (P = 0·028). Regarding liver resection, extended cholecystectomy was associated with a better 5-year disease-free survival rate than simple cholecystectomy (73·0 versus 61·5 per cent; P = 0·012). The 5-year disease-free survival rate was marginally better for extended than simple cholecystectomy in both T2a (76·5 versus 66·1 per cent; P = 0·094) and T2b (68·2 versus 56·2 per cent; P = 0·084) disease. Five-year disease-free survival rates were similar for extended cholecystectomies including liver wedge resection versus segment IVb/V segmentectomy (74·1 versus 71·5 per cent; P = 0·720). In multivariable analysis, independent risk factors for recurrence were presence of symptoms (hazard ratio (HR) 1·52; P = 0·002), R1 resection (HR 1·96; P = 0·004) and N1/N2 status (N1: HR 3·40, P < 0·001; N2: HR 9·56, P < 0·001). Among recurrences, 70·8 per cent were metastatic. CONCLUSION: Tumour location was not an independent prognostic factor in T2 gallbladder cancer. Extended cholecystectomy was marginally superior to simple cholecystectomy. A radical operation should include liver resection and adequate node dissection.
BACKGROUND: In gallbladder cancer, stage T2 is subdivided by tumour location into lesions on the peritoneal side (T2a) or hepatic side (T2b). For tumours on the peritoneal side (T2a), it has been suggested that liver resection may be omitted without compromising the prognosis. However, data to validate this argument are lacking. This study aimed to investigate the prognostic value of tumour location in T2 gallbladder cancer, and to clarify the adequate extent of surgical resection. METHODS: Clinical data from patients who underwent surgery for gallbladder cancer were collected from 14 hospitals in Korea, Japan, Chile and the USA. Survival and risk factor analyses were conducted. RESULTS: Data from 937 patients were available for evaluation. The overall 5-year disease-free survival rate was 70·6 per cent, 74·5 per cent for those with T2a and 65·5 per cent among those with T2b tumours (P = 0·028). Regarding liver resection, extended cholecystectomy was associated with a better 5-year disease-free survival rate than simple cholecystectomy (73·0 versus 61·5 per cent; P = 0·012). The 5-year disease-free survival rate was marginally better for extended than simple cholecystectomy in both T2a (76·5 versus 66·1 per cent; P = 0·094) and T2b (68·2 versus 56·2 per cent; P = 0·084) disease. Five-year disease-free survival rates were similar for extended cholecystectomies including liver wedge resection versus segment IVb/V segmentectomy (74·1 versus 71·5 per cent; P = 0·720). In multivariable analysis, independent risk factors for recurrence were presence of symptoms (hazard ratio (HR) 1·52; P = 0·002), R1 resection (HR 1·96; P = 0·004) and N1/N2 status (N1: HR 3·40, P < 0·001; N2: HR 9·56, P < 0·001). Among recurrences, 70·8 per cent were metastatic. CONCLUSION:Tumour location was not an independent prognostic factor in T2 gallbladder cancer. Extended cholecystectomy was marginally superior to simple cholecystectomy. A radical operation should include liver resection and adequate node dissection.