Validation of the oncologic effect of hepatic resection for T2 gallbladder cancer: a retrospective study

Abstract

BackgroundWhile extended cholecystectomy is recommended for T2 gallbladder cancer (GBC), the role of hepatic resection for T2 GBC is unclear. This study aimed to identify the necessity of hepatic resection in patients with T2 GBC.MethodsData of 81 patients with histopathologically proven T2 GBC who underwent surgical resection between January 1999 and December 2017 were enrolled from a retrospective database. Of these, 36 patients had peritoneal-side (T2a) tumors and 45 had hepatic-side (T2b) tumors. To identify the optimal surgical management method, T2 GBC patients were classified into the hepatic resection group (n = 44, T2a/T2b = 20/24) and non-hepatic resection group (n = 37, T2a/T2b = 16/21). The recurrence pattern and role of hepatic resection for T2 GBC were then investigated.ResultsMean age of the patients was 69 (range 36–88) years, and the male-to-female ratio was 42:39 (male, 51.9%; female, 48.1%). Hepatic-side GBC had a higher rate of recurrence than peritoneal-side GBC (44.4% vs. 8.3%, p = 0.006). The most common type of recurrence in T2a GBC was para-aortic lymph node recurrence (n = 2, 5.6%); the most common types of recurrence in T2b GBC were para-aortic lymph node recurrence (n = 7, 15.6%) and intrahepatic metastasis (n = 6, 13.3%). Hepatic-side GBC patients had worse survival outcomes than peritoneal-side GBC patients (76.0% vs. 96.6%, p = 0.041). Hepatic resection had no significant treatment effect in T2 GBC patients (p = 0.272). Multivariate analysis showed that lymph node metastasis was the only significant prognostic factor (p = 0.002).ConclusionsHepatic resection is not essential for curative treatment in T2 GBC, and more systemic treatments are needed for GBC patients, particularly for those with T2b GBC.

Prognostic impact of tumor location in resected gallbladder cancer: A national cohort analysis

“…20 Finally, a more recent study of 81 patient with T2 gallbladder cancers by Cho et al demonstrated that while overall survival significantly differed between the hepatic-and peritoneal-side tumors, this prognostic utility was lost on multivariate analysis. 6 The present study addresses this question using a larger clinical oncology database. We found granular information regarding tumor location and resection in a significant number of patients, allowing us to perform a robust analysis in this cohort.…”

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Korea Tumor Registry System Biliary Pancreas (KOTUS-BP) Database Analysis

“…However, compared with T1, T3, and T4 GBC, the prognosis of T2 GBC is very heterogeneous and is difficult to predict. Recently, the heterogeneous prognosis of T2 GBC has been demonstrated to be related in part to its location; a T2 GBC on the peritoneal side has a better prognosis, while a tumor on the hepatic side has worse prognosis [ 1 , 2 , 3 , 4 , 5 , 6 ]. The newly published American Joint Committee on Cancer (AJCC), eighth edition has subdivided T2 GBC into two categories according to the location of the primary tumor: peritoneal side tumor (pT2a) and hepatic side tumor (pT2b) [ 7 ].…”

“…The newly published American Joint Committee on Cancer (AJCC), eighth edition has subdivided T2 GBC into two categories according to the location of the primary tumor: peritoneal side tumor (pT2a) and hepatic side tumor (pT2b) [ 7 ]. Since Shindoh and colleagues reported that GBC on the peritoneal side is associated with a higher five-year survival rate than that on the hepatic side [ 1 ], the superior prognosis of T2a over T2b GBC has been reproduced in several studies [ 2 , 3 , 4 , 5 , 6 ].…”

Identifying Cystic Vein Perfusion Area Employing Indocyanine Green Fluorescence Imaging during Laparoscopic Extended Cholecystectomy for Clinical T2 Gallbladder Cancer

“…The theoretical mechanism of hepatic spread of GBC includes direct invasion, hematogenous metastasis, and lymphatic transmission [8]. Currently, extended cholecystectomy is performed with three aims: (1) to achieve a negative resection margin, (2) to prevent local recurrence near the gallbladder bed, and (3) to prevent potential invasion of the hepatoduodenal ligament via the right Glissonean sheath and gallbladder plate [3]. Although intrahepatic spread of GBC via the cystic vein is currently not a mainstream consideration because of the histopathological lymphatic spread via the Glissonean sheath to the hilar plate, 25% of perfusion flow from the cystic vein is anatomically confluent to the anterior branch of the portal vein [9].…”

“…For clinical T2 GBC, extended cholecystectomy, consisting of cholecystectomy and gallbladder bed resection, and regional lymphadenectomy of the hepatoduodenal ligament is the recommended procedure [2]. However, a strict definition of the gallbladder bed in the liver has not yet been clarified, and surgeons therefore perform extended cholecystectomy without any clear indication of the hepatic parenchyma that should be resected [3]. Against this background, we employed indocyanine green (ICG) fluorescence imaging to identify the perfusion area of the cystic vein for the purpose of determining the distinguishing features of the gallbladder bed.…”