Anatomical hepatic resection versus wedge resection for gallbladder cancer: analysis of multi-center database

Aim. To evaluate the technical feasibility and oncologic safety of laparoscopic radical cholecystectomy (LRC) for primary or incidental early gallbladder cancer (GBC) treatment. Methods. Articles reporting LRC for GBC were reviewed from the first case reported in 2010 to 2015 (129 patients). 116 patients had a preoperative diagnosis of gallbladder cancer (primary GBC). 13 patients were incidental cases (IGBC) discovered during or after a laparoscopic cholecystectomy. Results. The majority of patients who underwent LRC were pT2 (62.7% GBC and 63.6% IGBC). Parenchyma-sparing operation with wedge resection of the gallbladder bed or resection of segments IVb-V were performed principally. Laparoscopic lymphadenectomy was carried out according to the reported depth of neoplasm invasion. Lymph node retrieved ranged from 3 to 21. Some authors performed routine sampling biopsy of the inter-aorto-caval lymph nodes (16b1 station) before the radical treatment. No postoperative mortality was documented. Discharge mean day was POD 5th. 16 patients had post operative morbidities. Bile leakage was the most frequent post-operative complication. 5 y-survival rate ranged from 68.75 to 90.7 months. Conclusion. Laparoscopy can not be considered as a dogmatic contraindication to GBC but a primary approach for early case (pT1b and pT2) treatment.

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Clinicopathological Differences in T2 Gallbladder Cancer According to Tumor Location

Cancer Control ◽

10.1177/1073274820915514 ◽

2020 ◽

Vol 27 (1) ◽

pp. 107327482091551

Author(s):

Wan-Joon Kim ◽

Tae-Wan Lim ◽

Pyoung-Jae Park ◽

Sae-Byeol Choi ◽

Wan-Bae Kim

Keyword(s):

Lymph Node ◽

Lymph Node Metastasis ◽

Hepatic Resection ◽

Gallbladder Cancer ◽

Treatment Plan ◽

Survival Rates ◽

Tumor Location ◽

Node Metastasis ◽

Regional Lymphadenectomy ◽

Recurrence Patterns

We aimed to identify clinicopathological differences and factors affecting survival outcomes of stage T2a and T2b gallbladder cancer (GBC) and validate the oncological benefits of regional lymphadenectomy and hepatic resection in these patients. This single-center study enrolled patients who were diagnosed with pathologically confirmed T2 GBC and underwent curative resection between January 1995 and December 2017. Eighty-two patients with T2a and 50 with T2b GBCs were identified, and clinical information was retrospectively collected from medical records and analyzed. Five-year overall survival rates were 96.8% and 80.7% in T2a and T2b groups, respectively ( P = .007). Three- and 5-year survival rates among all patients with T2 GBC without and with lymph node metastasis were 97.2% and 94.4% and 81.3% and 81.3%, respectively ( P = .029). There was no difference in survival rates between the 2 groups according to whether hepatic resection was performed ( P = .320). However, in the T2b group, those who underwent hepatic resection demonstrated a better survival rate than those who did not ( P = .029). The T2b group had more multiple recurrence patterns than the T2a group, and the lymph nodes were the most common site in both groups. Multivariate analysis revealed that lymph node metastasis, vascular invasion, and tumor location were significant independent prognostic factors. Hepatic resection was not always necessary in patients with peritoneal-side GBC. Considering clinicopathological features and recurrence patterns, a systematic treatment plan, including radical resection and adjuvant treatment, should be established for hepatic-side GBC.

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