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. 2021 Feb 27;13(2):176-186.
doi: 10.4240/wjgs.v13.i2.176.

Prognostic significance of regional lymphadenectomy in T1b gallbladder cancer: Results from 24 hospitals in China

Tai Ren  1 , Yong-Sheng Li  2 , Xue-Yi Dang  3 , Yang Li  2 , Zi-Yu Shao  1 , Run-Fa Bao  1 , Yi-Jun Shu  1 , Xu-An Wang  2 , Wen-Guang Wu  2 , Xiang-Song Wu  1 , Mao-Lan Li  1 , Hong Cao  4 , Kun-Hua Wang  5 , Hong-Yu Cai  6 , Chong Jin  7 , Hui-Han Jin  8 , Bo Yang  9 , Xiao-Qing Jiang  10 , Jian-Feng Gu  11 , Yun-Fu Cui  12 , Zai-Yang Zhang  13 , Chun-Fu Zhu  14 , Bei Sun  15 , Chao-Liu Dai  16 , Lin-Hui Zheng  17 , Jing-Yu Cao  18 , Zhe-Wei Fei  19 , Chang-Jun Liu  20 , Bing Li  21 , Jun Liu  22 , Ye-Ben Qian  23 , Yi Wang  24 , Ya-Wei Hua  25 , Xi Zhang  26 , Chang Liu  27 , Wan-Yee Lau  28 , Ying-Bin Liu  2
Affiliations

Prognostic significance of regional lymphadenectomy in T1b gallbladder cancer: Results from 24 hospitals in China

Tai Ren et al. World J Gastrointest Surg. .

Abstract

Background: Whether regional lymphadenectomy (RL) should be routinely performed in patients with T1b gallbladder cancer (GBC) remains a subject of debate.

Aim: To investigate whether RL can improve the prognosis of patients with T1b GBC.

Methods: We studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China. The log-rank test and Cox proportional hazards model were used to compare the overall survival (OS) of patients who underwent cholecystectomy (Ch) + RL and those who underwent Ch only. To investigate whether combined hepatectomy (Hep) improved OS in T1b patients, we studied patients who underwent Ch + RL to compare the OS of patients who underwent combined Hep and patients who did not.

Results: Of the 121 patients (aged 61.9 ± 10.1 years), 77 (63.6%) underwent Ch + RL, and 44 (36.4%) underwent Ch only. Seven (9.1%) patients in the Ch + RL group had lymph node metastasis. The 5-year OS rate was significantly higher in the Ch + RL group than in the Ch group (76.3% vs 56.8%, P = 0.036). Multivariate analysis showed that Ch + RL was significantly associated with improved OS (hazard ratio: 0.51; 95% confidence interval: 0.26-0.99). Among the 77 patients who underwent Ch + RL, no survival improvement was found in patients who underwent combined Hep (5-year OS rate: 79.5% for combined Hep and 76.1% for no Hep; P = 0.50).

Conclusion: T1b GBC patients who underwent Ch + RL had a better prognosis than those who underwent Ch. Hep + Ch showed no improvement in prognosis in T1b GBC patients. Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines, RL was only performed in 63.6% of T1b GBC patients. Routine Ch + RL should be advised in T1b GBC.

Keywords: Gallbladder cancer; Hepatectomy; Lymphadenectomy; Prognosis; Staging; Surgery.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram of participant selection and analysis. CRGGC: Chinese Research Group of Gallbladder Cancer; GBC: Gallbladder cancer.
Figure 2
Figure 2
Kaplan-Meier analysis of the overall survival of T1b gallbladder cancer patients who underwent cholecystectomy alone or cholecystectomy combined with regional lymphadenectomy. Ch: Cholecystectomy; Ch + RL: Cholecystectomy combined with regional lymphadenectomy.
Figure 3
Figure 3
Overall survival of cholecystectomy combined with regional lymphadenectomy patients who underwent hepatectomy and who did not undergo hepatectomy. Hep: Hepatectomy; No Hep: Did not undergo hepatectomy.
See this image and copyright information in PMC

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