Ryusei Matsuyama1, Kenichi Matsuo2, Ryutaro Mori3, Mitsutaka Sugita4, Naotaka Yamaguchi5, Toru Kubota6, Kunio Kameda7, Yasuhisa Mochizuki8, Ryo Takagawa9, Toshiaki Kadokura10, Goro Matsuda11, Noriyuki Kamiya12, Itaru Endo13. 1. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan; ryusei@terra.dti.ne.jp. 2. Department of Surgery, Fujisawa Municipal Hospital, Fujisawa, Japan. 3. Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan. 4. Department of Surgery, Yokosuka Kyousai Hospital, Yokosuka, Japan. 5. Department of Surgery, Yokohama City Minato Red-Cross Hospital, Yokohama, Japan. 6. Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan. 7. Department of Surgery, Yokosuka Municipal Hospital, Yokosuka, Japan. 8. Department of Surgery, Yokohama Municipal Citizens Hospital, Yokohama, Japan. 9. Department of Surgery, Saiseikai Wakakusa Hospital, Yokohama, Japan. 10. Department of Surgery, Yokohama Senin Hoken Hospital, Yokohama, Japan. 11. Department of Surgery, Yokohama Medical Center, Yokohama, Japan. 12. Department of Surgery, Ito Municipal Hospital, Ito, Japan. 13. Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Abstract
BACKGROUND/AIM: Current expert consensus recommends re-resection for incidental gallbladder cancer (IGBC) of pT1b-3. This study examined whether this consensus was reasonably applicable to patients with IGBC in one Japanese region. PATIENTS AND METHODS: This was a multicenter, retrospective analysis of cholecystectomies for presumed benign diseases between January 2000 and December 2009. RESULTS: IGBC was diagnosed in 70 (1.0%) out of 6,775 patients undergoing cholecystectomy. Five-year disease-specific cumulative survival was 100% in 19 patients with pT1a, 80.0% in five with pT1b, 49.5% in 33 with pT2, and 23.1% in 13 with pT3. Re-resection was not performed for the 24 patients with pT1a/1b disease, whereas 24 out of 46 patients with pT2/3 underwent re-resection. Regardless of re-resection, independent factors associated with a poor prognosis on multivariate analysis were grade 2 or poorer disease and bile spillage at prior cholecystectomy. In the 24 patients with pT2/3 re-resection, 11 patients without either of these two factors had significantly better 5-year disease-specific cumulative survival than the 13 patients with one or two independent factors associated with a poor prognosis (72.7% vs. 30.8%, p=0.009). CONCLUSION: This Japanese regional study suggests that indication of re-resection for IGBC should not be determined by pT-factor alone and that much more attention should be paid to pathological and intraoperative findings at prior cholecystectomy. Copyright
BACKGROUND/AIM: Current expert consensus recommends re-resection for incidental gallbladder cancer (IGBC) of pT1b-3. This study examined whether this consensus was reasonably applicable to patients with IGBC in one Japanese region. PATIENTS AND METHODS: This was a multicenter, retrospective analysis of cholecystectomies for presumed benign diseases between January 2000 and December 2009. RESULTS: IGBC was diagnosed in 70 (1.0%) out of 6,775 patients undergoing cholecystectomy. Five-year disease-specific cumulative survival was 100% in 19 patients with pT1a, 80.0% in five with pT1b, 49.5% in 33 with pT2, and 23.1% in 13 with pT3. Re-resection was not performed for the 24 patients with pT1a/1b disease, whereas 24 out of 46 patients with pT2/3 underwent re-resection. Regardless of re-resection, independent factors associated with a poor prognosis on multivariate analysis were grade 2 or poorer disease and bile spillage at prior cholecystectomy. In the 24 patients with pT2/3 re-resection, 11 patients without either of these two factors had significantly better 5-year disease-specific cumulative survival than the 13 patients with one or two independent factors associated with a poor prognosis (72.7% vs. 30.8%, p=0.009). CONCLUSION: This Japanese regional study suggests that indication of re-resection for IGBC should not be determined by pT-factor alone and that much more attention should be paid to pathological and intraoperative findings at prior cholecystectomy. Copyright
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