Optimal surgical treatment in patients with T1b gallbladder cancer: An international multicenter study

Abstract

Background There is no consensus on the optimal treatment of T1b gallbladder cancer (GBC) due to the lack of evidence and the difficulty of anatomy and pathological standardization. Methods A total of 272 patients with T1b GBC who underwent surgical resection at 14 centers with specialized hepatobiliary-pancreatic surgeons and pathologists in Korea, Japan, Chile, and the United States were studied. Clinical outcomes including diseasespecific survival (DSS) rates according to the types of surgery were analyzed. Results After excluding patients, the 237 qualifying patients consisted of 90 men and 147 women. Simple cholecystectomy (SC) was performed in 116 patients (48.9%) and extended cholecystectomy (EC) in 121 patients (51.1%). The overall 5-year DSS was 94.6%, and it was similar between SC and EC patients (93.7% vs. 95.5%, P = 0.496). The 5-year DSS was similar between SC and EC patients in America (82.3% vs. 100.0%, P = 0.249) as well as in Asia (98.6% vs. 95.2%, P = 0.690). The 5-year DSS also did not differ according to lymph node metastasis (P = 0.688) or tumor location (P = 0.474). Conclusions SC showed similar clinical outcomes (including recurrence) and survival outcomes as EC; therefore, EC is not needed for the treatment of T1b GBC.

Role of tumour location and surgical extent on prognosis in T2 gallbladder cancer: an international multicentre study

“…However, controversy remains regarding the extent of surgical resection for gallbladder cancer. Whether simple cholecystectomy is adequate and extended cholecystectomy can be omitted in T1 gallbladder cancer varies among published guidelines and has yet to be established, especially for T1b gallbladder cancer. It is also controversial whether minimally invasive surgery can be applied to gallbladder cancer operations.…”

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

“…The most recent study by Kim et al [5], including 14 tertiary centres, stated that there was no difference in 5year disease-specific survival among patients with open cholecystectomy and laparoscopic cholecystectomy (94.9% vs. 92.8%, respectively, P = 0.267), without any trocar-site recurrence in the laparoscopic cholecystectomy group. Professional surgeons with a great deal of expertise in laparoscopic cholecystectomy and careful handling of specimens using retrieval bags will encourage the safety of laparoscopic procedures in GBCs [5]. However, it would be interesting to gauge the impact of incidental iatrogenic perforation of the gallbladder in relation to long-term outcomes of patients with T1b GBC.…”

“…Controversy exists as to whether T1b GBC may have spread locally, regionally, or systemically by the timing of presentation. The frequency of lymph node metastasis in T1b GBC has been reported to range from 0 to 15.6% [4,5,8,11,18]. This difference in incidence may be due to histopathological examination, in which T-stage migration occurs, implying that some T2 GBCs may be diagnosed as T1b.…”

“…In the multivariate analysis (Table 3), age (> 70 years) and gender (male) were found to have robust adversative effects on patient overall survival; on the other hand, no survival benefit of surgical procedure (simple cholecystectomy vs. radical resection) was shown in patients with T1b GBC. In the latest multicentral study by Kim et al [5], incorporating 272 patients with T1b GBC revealed that simple cholecystectomy is acceptable, and there were no overall survival benefits or prevention of recurrence with extended or radical resection. Another systemic review by Lee et al [8] advocated that a simple cholecystectomy including a laparoscopic approach is justifiable for T1b GBC.…”

“…Nevertheless, the type of operative procedure for T1b GBC continues to be contentious. The explanation for this difference in operative approach might be that the likelihood of GBC is comparatively minimal, which makes it challenging to obtain adequate cases to provide treatment guidelines for each stage, and the prognostic outcomes of GBC may differ on account of variations in regional occurrence [5]. Furthermore, the gallbladder wall is very thin, and it is quite difficult to histologically evaluate, and dysplasia is presented as inflammation, which makes the proper diagnosis of cancer and T stage complicated, leading to variations in pathological reviews from centre to centre [6,7].…”