Long-term outcomes of surgical resection for T1b gallbladder cancer: an institutional evaluation

Abstract

Background: There is no comprehensive agreement concerning the overall performance of radical resection for T1b gallbladder cancer (GBC). This research focused on addressing whether T1b GBC may spread loco-regionally and whether radical resection is necessary. Methods: A retrospective analysis was conducted of 1032 patients with GBC who underwent surgical resection at our centre and its affiliated institutions between January 1982 and December 2018. A total of 47 patients with T1b GBC, 29 (62%) of whom underwent simple cholecystectomy and 18 (38%) of whom underwent radical resection with regional lymph node dissection, were enrolled in the study. Results: GBC was diagnosed pre-operatively in 16 patients (34%), whereas 31 patients (66%) had incidental GBC. There was no blood venous or perineural invasion in any patient on histology evaluation, except for lymphatic vessel invasion in a single patient. There were no metastases in any analysed lymph nodes. The open surgical approach was more prevalent among the 18 patients who underwent radical resection (open in all 18 patients) than among the 29 patients who underwent simple cholecystectomy (open in 21; laparoscopic in 8) (P = 0.017). The cumulative 10-and 20-year overall survival rates were 65 and 25%, respectively. The outcome following simple cholecystectomy (10-year overall survival rate of 66%) was akin to that following radical resection (64%, P = 0.618). The cumulative 10-and 20-year disease-specific survival rates were 93 and 93%, respectively. The outcome following simple cholecystectomy (10-year disease-specific survival rate of 100%) was equivalent to that following radical resection (that of 86%, P = 0.151). While age (> 70 years, hazard ratio 5.285, P = 0.003) and gender (female, hazard ratio 0.272, P = 0.007) had a strong effect on patient overall survival, surgical procedure (simple cholecystectomy vs. radical resection) and surgical approach (open vs. laparoscopic) did not. Conclusions: Most T1b GBCs represent local disease. As pre-operative diagnosis, including tumour penetration of T1b GBC, is difficult, the decision of radical resection is justified. Additional radical resection is not required following simple cholecystectomy provided that the penetration depth is restricted towards the muscular layer and that surgical margins are uninvolved.

Current and New Biomarkers for Early Detection, Prognostic Stratification, and Management of Gallbladder Cancer Patients

“…Recently, an international multicenter study analyzed the clinical outcomes of 237 patients with T1b GBC according to the type of surgery (simple versus extended cholecystectomy), and showed that there exist no significant differences in the 5-year overall disease specific survival (DSS) between both treatments, concluding that extended cholecystectomy is not needed for the treatment of T1b GBC [72]. Consistent with this report, Yuza et al [69] evaluated the long-term survival benefit of a surgical procedure in 47 Japanese patients with T1b GBC, showing that both OS and DSS between simple cholecystectomy and radical resection are comparable [69]. A factor that most likely contributes to the conflicting impressions regarding the optimal management of early GBC is the understaging phenomenon that occurs when the surgical specimen is not fully examined (mapped).…”

“…The random sampling protocols employed by most Western countries may explain the low survival rates reported in some studies [68,73]. In contrast, studies using surgical specimens subjected to precise pathological examination and mapping of cancer lesions have reported survival rates over 90%, even for T1b cases [69,72,74].…”

“…However, the management of T1b disease is somewhat controversial due to the variability observed in survival rates, which range from 37.5% to 100% [68]. Thus, whereas the National Comprehensive Cancer Network (NCCN) guidelines recommend radical resection along with portal lymph node dissection for T1b GBC [69], the Korean and Japanese guidelines recommend simple cholecystectomy [70,71]. Recently, an international multicenter study analyzed the clinical outcomes of 237 patients with T1b GBC according to the type of surgery (simple versus extended cholecystectomy), and showed that there exist no significant differences in the 5-year overall disease specific survival (DSS) between both treatments, concluding that extended cholecystectomy is not needed for the treatment of T1b GBC [72].…”

A SARS-CoV-2 –human metalloproteome interaction map

“…Integrin beta-1 is mainly expressed in normal cells and in tumor-associated cells, where they control various developing processes, including angiogenesis, tumor progression, apoptosis, and metastasis [ 59 ]. Recently, flow cytometry showed that ITGB1 was expressed at high levels in clear cell renal cell carcinoma [ 60 ]. Transforming protein RhoA (encoded by RHOA gene ) is a small GTPase protein primarily associated with cytoskeleton regulation, mostly actin stress fibers formation and actomyosin contractility [ 61 ].…”

“…Integrin beta-1 is mainly expressed in normal cells and in tumor-associated cells, where they control various developing processes, including angiogenesis, tumor progression, apoptosis, and metastasis [ 59 ]. Recently, flow cytometry showed that ITGB1 was expressed at high levels in clear cell renal cell carcinoma [ 60 ].…”