Survival Benefits of Simple Versus Extended Cholecystectomy and Lymphadenectomy for Patients With T2 Gallbladder Cancer: A Propensity-Matched Population-Based Study (2010 to 2015)

ObjectiveThis article aims to evaluate the survival benefits of simple cholecystectomy, extended cholecystectomy, as well as scope regional lymphadenectomy for T2 gallbladder cancer (GBC) patients.MethodsWe identified eligible patients from the Surveillance, Epidemiology, and End Results database. The confounding factors were controlled via propensity score matching. The log-rank test was utilized to compare overall survival. The multivariate Cox regression was then used to determine risk factors.ResultsOverall, data from 1,009 patients were obtained. The median overall survival (OS) of 915 patients that underwent simple cholecystectomy was 15 months; the median OS of 94 patients that underwent extended cholecystectomy was 17 months. There were no significant differences before and after propensity score matching (p = 0.542 and p = 0.258). The patients who received regional lymphadenectomy did show significant survival benefit, compared to those who did not receive regional lymphadenectomy. Furthermore, this benefit is observed in the N0 stage, but not observed in the N1 stage. In addition, the OS of patients who received lymphadenectomy for four or more regions was significantly better than those who received one to three regions lymphadenectomy. Age, the scope of regional lymphadenectomy, N stage, and tumor size were identified as prognostic factors.ConclusionsExtended cholecystectomy was not observed to significantly improve postoperative prognosis of patients with T2 GBC. However, there was a significant survival benefit shown for those with regional lymphadenectomy, particularly for patients with negative lymph nodes. Future studies on the control of potential confounding factors and longer follow-ups are still needed.

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Systematic Review and Meta-Analysis

(1) Background: The AJCC Cancer Staging Manual, Eighth Edition, subdivided T2 GBC into T2a and T2b. However, there still exist a lack of evidence on the prognostic significance of tumor location. The aim of the present study was to examine the existing evidence to determine the prognostic significance of tumor location of T2 gallbladder cancer (GBC) and to evaluate the optimal surgical extent according to tumor location. (2) Methods: We searched for relevant literature published in the electronic databases PubMed, MEDLINE, Web of Science, Cochrane Library, and Embase before September 2020 using search terms related to gallbladder, cancer, and stage. Data were weighted and pooled using random-effects modeling. (3) Results: Seven studies were deemed eligible for inclusion, representing a cohort of 1789 cases of resected T2 GBC. The overall survival for T2b tumor was significantly worse than that for T2a tumor (HR, 2.141; 95% confidence interval (CI), 1.140 to 4.023; I2 = 71.4%; Pchi2 = 0.007). The rate of lymph node metastasis was lower in the T2a group (26.6%) than in the T2b group (36.6%) (OR, 2.164; 95% CI, 1.309 to 3.575). There was no evidence of a survival difference between the patients who underwent extended cholecystectomy and simple cholecystectomy in T2a GBC (OR, 0.802; 95% CI, 0.618 to 1.042) and T2b GBC (OR, 0.820; 95% CI, 0.620 to 1.083). (4) Conclusions: Hepatic side tumor was a significant poor prognostic factor in T2 GBC. Extended cholecystectomy and simple cholecystectomy showed comparable survival outcomes in T2 GBC, and additional large-scale prospective studies are warranted to establish evidence-based treatment guidelines for T2 GBC.

Leptomeningeal carcinomatosis from gallbladder cancer after curative resection: A case report and review of literature

Introduction Only 12 cases of gallbladder (GB) cancer associated with leptomeningeal carcinomatosis (LMC) have been reported so far. Herein, we report the first known case of LMC originating from GB cancer after curative resection and discuss the risk factors of LMC associated with GB cancer. Case Presentation An 85-year-old Japanese woman presented with vomiting and impaired awareness 2 years after curative extended cholecystectomy for GB cancer . Computed tomography showed hydronephrosis of the right kidney and ureteral thickening. Magnetic resonance imaging revealed areas of hyperintense reflecting lesions along the cerebral sulci, suggesting meningitis. A spinal tap showed an elevated cerebrospinal fluid pressure of > 270 mmH 2 O, and cytological examination of the spinal fluid revealed the presence of adenocarcinoma cells. The patient was diagnosed with retroperitoneal metastasis and LMC originating from GB cancer. The patient was given palliative care and died 4 weeks after the onset of symptoms. Conclusion The findings of this study show that LMC could occur even after curative resection of GB cancer and should be considered when patients present with neurological symptoms. Retroperitoneal metastases and poorly differentiated tumors are possible risk factors of LMC originating from GB cancer.

Laparoscopic Extended Cholecystectomy for Early Gall Bladder Cancer

Background: Laparoscopic approach for early gall bladder cancer (T1b and T2) has been seen to have equal or better early outcomes and late outcomes in terms of overall survival rate and recurrence rate.Methods: This is a prospective cross sectional observational study performed including all consecutive patients who were diagnosed with gall bladder cancer by a single surgical team from August 2018 to February 2020 at Kathmandu Medical College Teaching Hospital or referred from outside for completion extended cholecystectomy where laparoscopic cholecystectomy was done in some other centre.Results: The mean age of the patients was 51.01±9.42 years in the laparoscopic extended cholecystectomy (N=10) group and 49.6±8.35 years in the open extended cholecystectomy (N=10) group (p value=0.711). Conversion rate was 20% in laparoscopic group. The operative time was longer in the laparoscopic group (287 +/-66.50 minutes, 120.0 to 446 minutes vs. 200+/-66.50 minutes, 100 to 405.0 minutes; p< 0.004.However, the laparoscopic extended cholecystectomy group showed faster time to oral intake and time to first passage of flatus and had shorter hospital stay by 2.2 days (4.8+/-0.78 days) than open approach 7+/-0.81 days.(p value=0.00).There were no significant differences between the groups in the tumour size (p=0.079) and number of harvested lymph nodes 9.3 (5 to 13) in laparoscopic group vs. 11.2 (8 to 15) in open extended cholecystectomy group (p=0.250).Conclusions: Laparoscopic extended cholecystectomy is feasible in early gall bladder cancer along with achievement of oncological safety.Keywords: Gall bladder cancer; laparoscopic extended cholecystectomy; open extended cholecystectomy