Re-radical surgery is the only curative therapy for unsuspected gallbladder carcinoma (UGC). The aim of this study was to compare prognosis of pT3 UGC patients receiving anatomic hepatectomy (AH) or wedge hepatectomy (WH) combined with en bloc local-regional lymphadenectomy of the hepatoduodenal ligament using propensity score-matching (PSM) analysis.
Materials and Methods:
A retrospective study was carried out on 81 consecutive pT3 UGC patients who underwent radical re-resection at Eastern Hepatobiliary Surgery Hospital from 2006 to 2015. Overall survival (OS) was estimated using Kaplan–Meier method. The difference in OS between the AH and WH groups was analyzed using the log-rank test and the PSM method.
Result:
The AH and WH groups showed no significant difference in OS (P > .05) by either log-rank test or PSM analysis.
Conclusions:
Both AH and WH radical re-resections are effective treatments for UCG patients with pT3 tumors.
Get full access to this article
View all access options for this article.
References
1.
EthunCG, PostlewaitLM, LeN, PawlikTM, BuettnerS, PoultsidesG, et al.A novel pathology-based preoperative risk score to predict locoregional residual and distant disease and survival for incidental gallbladder cancer: A 10-institution study from the U.S. extrahepatic biliary malignancy consortium. Ann Surg Oncol, 2017; 24:1343–1350.
2.
FuksD, RegimbeauJM, Le TreutYP, BachellierP, RaventosA, PruvotFR, et al.Incidental gallbladder cancer by the AFC-GBC-2009 Study Group. World J Surg, 2011; 35:1887–1897.
3.
GoetzeTO, PaolucciV. Adequate extent in radical re-resection of incidental gallbladder carcinoma: Analysis of the German Registry. Surg Endosc, 2010; 24:2156–2164.
4.
HuemanMT, VollmerCMJr, PawlikTM. Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol, 2009; 16:2101–2115.
5.
ValleJ, WasanH, PalmerDH, CunninghamD, AnthoneyA, MaraveyasA, et al.Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med, 2010; 362:1273–1281.
6.
KimY, AminiN, WilsonA, MargonisGA, EthunCG, PoultsidesG, et al.Impact of Chemotherapy and external-beam radiation therapy on outcomes among patients with resected gallbladder cancer: A multi-institutional analysis. Ann Surg Oncol, 2016; 23:2998–3008.
PawlikTM, GleisnerAL, ViganoL, KoobyDA, BauerTW, FrillingA, et al.Incidence of finding residual disease for incidental gallbladder carcinoma: Implications for re-resection. J Gastrointest Surg, 2007; 11:1478–1486.
9.
ButteJM, WaughE, MenesesM, ParadaH, De La FuenteHA. Incidental gallbladder cancer: Analysis of surgical findings and survival. J Surg Oncol, 2010; 102:620–625.
10.
ShibataK, UchidaH, IwakiK, KaiS, OhtaM, KitanoS. Lymphatic invasion: An important prognostic factor for stages T1b-T3 gallbladder cancer and an indication for additional radical resection of incidental gallbladder cancer. World J Surg, 2009; 33:1035–1041.
11.
MakerAV, ButteJM, OxenbergJ, KukD, GonenM, FongY, et al.Is port site resection necessary in the surgical management of gallbladder cancer?. Ann Surg Oncol, 2012; 19:409–417.
12.
GoetzeTO, PaolucciV. Benefits of reoperation of T2 and more advanced incidental gallbladder carcinoma: Analysis of the German Registry. Ann Surg, 2008; 247:104–108.
13.
AraidaT, HiguchiR, HamanoM, KoderaY, TakeshitaN, OtaT, et al.Hepatic resection in 485 R0 pT2 and pT3 cases of advanced carcinoma of the gallbladder: Results of a Japanese Society of Biliary Surgery Survey—A multicenter study. J Hepatobiliary Pancreat Surg, 2009; 16:204–215.
14.
ReddySK, MarroquinCE, KuoPC, PappasTN, ClaryBM. Extended hepatic resection for gallbladder cancer. Am J Surg, 2007; 194:355–361.
15.
DindoD, DemartinesN, ClavienPA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004; 240:205–213.
16.
TsirlisT, AusaniaF, WhiteSA, FrenchJJ, JaquesBC, CharnleyRM, et al.Implications of the index cholecystectomy and timing of referral for radical resection of advanced incidental gallbladder cancer. Ann R Coll Surg Engl, 2015; 97:131–136.
17.
AgarwalAK, KalayarasanR, JavedA, GuptaN, NagHH. Role of staging laparoscopy in primary gall bladder cancer- an analysis of 409 patients: A prospective study to evaluate the role of staging laparoscopy in the management of gallbladder cancer. Ann Surg, 2012; 258:318–323.
18.
ChanKM, YehTS, JanYY, ChenMF. Laparoscopic cholecystectomy for early gallbladder carcinoma: Long-term outcome in comparison with conventional open cholecystectomy. Surg Endosc, 2006; 20:1867–1871.
19.
KangCM, ChoiGH, ParkSH, KimKS, ChoiJS, LeeWJ, et al.Laparoscopic cholecystectomy only could be an appropriate treatment for selected clinical R0 gallbladder carcinoma. Surg Endosc, 2007; 21:1582–1587.
20.
GoetzeT, PaolucciV. Does laparoscopy worsen the prognosis for incidental gallbladder cancer?. Surg Endosc, 2006; 20:286–293.
21.
ShihSP, SchulickRD, CameronJL, LillemoeKD, PittHA, ChotiMA, et al.Gallbladder cancer: The role of laparoscopy and radical resection. Ann Surg, 2007; 245:893–901.
22.
EndoI, ShimadaH, TakimotoA, FujiiY, MiuraY, SugitaM, et al.Microscopic liver metastasis: Prognostic factor for patients with pT2 gallbladder carcinoma. World J Surg, 2004; 28:692–696.
23.
MisraMC, GuleriaS. Management of cancer gallbladder found as a surprise on a resected gallbladder specimen. J Surg Oncol, 2006; 93:690–698.
24.
PawlikTM, ChotiMA. Biology dictates prognosis following resection of gallbladder carcinoma: Sometimes less is more. Ann Surg Oncol, 2009; 16:787–788.
25.
GlauserPM, StrubD, KäserSA, MattielloD, RiebenF, MaurerCA. Incidence, management, and outcome of incidental gallbladder carcinoma: Analysis of the database of the Swiss association of laparoscopic and thoracoscopic surgery. Surg Endosc, 2010; 24:2281–2286.
26.
YoshimitsuK, HondaH, KuroiwaT, IrieH, AibeH, TajimaT, et al.Liver metastasis from gallbladder carcinoma: Anatomic correlation with cholecystic venous drainage demonstrated by helical computed tomography during injection of contrast medium in the cholecystic artery. Cancer, 2001; 92:340–348.
27.
OhtsukaM, MiyazakiM, ItohH, NakagawaK, AmbiruS, ShimizuH, et al.Routes of hepatic metastasis of gallbladder carcinoma. Am J Clin Pathol, 1998; 109:62–68.
28.
MiyazakiM, ShimizuH, OhtsukaM, YoshidomeH, KatoA, YoshitomiH, et al.Hepatic S4a + S5 and bile duct resection for gallbladder carcinoma. J Hepatobiliary Pancreat Sci, 2012; 19:225–229.
29.
AusaniaF, TsirlisT, WhiteSA, FrenchJJ, JaquesBC, CharnleyRM, et al.Incidental pT2–T3 gallbladder cancer after a cholecystectomy: outcome of staging at 3 months prior to a radical resection. HPB, 2013; 15:633–673.
30.
EthunCG, PostlewaitLM, LeN, PawlikTM, BuettnerS, PoultsidesG, et al.Association of optimal time interval to re-resection for incidental gallbladder cancer with overall survival: A multi-institution analysis from the US extrahepatic biliary malignancy consortium. JAMA Surg, 2017; 152:143–914.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
