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

Abstract

Background: While 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.

Methods: Data 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.

Results: Mean 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).

Conclusions: Hepatic 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.

Keywords: Gallbladder carcinoma; Hepatic resection; Surgical strategies.

Fig. 1

Recurrence pattern of T2 gallbladder carcinoma according to tumor location (n = 81). The incidences of recurrent site in T2 gallbladder carcinoma. There was a different recurrence pattern between T2a and T2b gallbladder carcinoma

Fig. 2

Overall survival rate in T2 gallbladder carcinoma according to tumor location (n = 81). The 3-year cancer-specific survival rate in patients with T2 gallbladder carcinoma was 96.6% in those with T2a gallbladder carcinoma and 76.0% in those with T2b gallbladder carcinoma. There was significant difference in survival according to tumor location (p = 0.041)

Fig. 3

Overall survival rate in T2a gallbladder carcinoma according to hepatic resection (n = 28). The 3-year cancer-specific survival rates of T2a GBC with or without hepatic resection were 94.1% and 100%, respectively (p = 0.552)

Fig. 4

Overall survival rate in T2b gallbladder carcinoma according to hepatic resection (n = 30). The 3-year cancer-specific survival rates of T2b GBC with or without hepatic resection were 70.9% and 100%, respectively (p = 0.365)

Fig. 5

Overall survival rate of T2 GBC patients with or without lymph node metastasis (n = 81). The 3-year cancer-specific survival rates of patients with or without lymph node metastasis were 45.1% and 97.5%, respectively (p < 0.001)

Fig. 6

Cancer-specific overall survival rate in node-positive T2a gallbladder carcinoma according to hepatic resection (n = 5). The 3-year cancer-specific overall survival rate in node-positive T2a GBC between lymph node dissection without hepatic resection and lymph node dissection with hepatic resection were 66.7% and 100%, respectively (p = 0.564)

Fig. 7

Cancer-specific overall survival rate in node-positive T2b gallbladder carcinoma according to hepatic resection (n = 15). The 3-year cancer-specific overall survival rate in node-positive T2b GBC between lymph node dissection without hepatic resection and lymph node dissection with hepatic resection were 33.3% and 100%, respectively (p = 0.683)