Korean J Hepatobiliary Pancreat Surg.  2013 Aug;17(3):113-117. 10.14701/kjhbps.2013.17.3.113.

Prognosis of patients with pT1b/T2 gallbladder carcinoma who have undergone laparoscopic cholecystectomy as an initial operation

• Park YJ
• Hwang S
• Kim KH
• Lee YJ
• Ahn CS
• Moon DB
• Park KM
• Ha TY
• Song GW
• Jung DH
• Park GC
• Lee JH
• Lee SG

• KMID: 1472526
• DOI: http://doi.org/10.14701/kjhbps.2013.17.3.113

Abstract

BACKGROUNDS/AIMS
Laparoscopic cholecystectomy (LC) has become a standard procedure for treatment of benign gallbladder diseases. There has been a small proportion of gallbladder cancer (GBC) which was incidentally found in the gallbladder specimen, and LC has been tried in some patients with faintly suspected GBC. This study intended to analyze the prognosis of patients with pT1b/T2 GBC who have undergone LC and the outcome of extended re-operation.
METHODS
After analyzing the institutional profiles of 500 GBC patients who have undergone surgical resection, we selected 64 patients who underwent LC initially from January 1996 to December 2008 and whose gallbladder pathology was confined to pT1b or pT2 lesions. Of them, 34 patients (53.1%) underwent extended reoperation. Their medical records were reviewed retrospectively.
RESULTS
In the LC only group (n=30), mean age of the 16 pT1 patients was 65.7+/-12.5 years and mean age of the 14 pT2 patients was 66.7+/-10.1 years. In the reoperation group (n=34), mean age of the 8 pT1b patients was 52.6+/-9.9 years and in 26 pT2 patients, mean age was 59.2+/-7.9 years. The reoperation group showed a younger patient age pattern than the LC only group (p=0.001). The types of reoperation were liver resection with lymph node (LN) dissection in 17, bile duct resection with LN dissection in 2, and hepatectomy and bile duct resection with LN dissection in 15. In the LC only group, the 5-year survival rate (5-YSR) was 70.3% in pT1b and 43.2% in pT2. In the reoperation group, 5-YSR was 62.5% in pT1b (n=8) and 59.5% in pT2 (n=26). A survival comparison between the two groups showed no significant survival gain in pT1 patients (p=0.69) and in pT2 patients (p=0.14). In our whole database analysis, 5-YSR of pT1bNx lesions was 70% after cholecystectomy and 78% after extended cholecystectomy. Lymph node metastasis was identified in 11% of pT1b lesions. For pT2N0 lesions, overall 5-YSR was 62% after R0 resection, showing no survival difference between primary extended surgery and LC-redo operation (p=0.45).
CONCLUSIONS
The survival gain of reoperation was not evident in pT1b lesions. In contrast, some noticeable but not statistically significant survival difference was observed in pT2 lesions. Thus, reoperation for pT1b/T2 GBC following LC is indicated for individualized reasons, especially in patients with pT1b lesions. Old age was one of the important factors in deciding not to reoperate.

Keyword

Gallbladder carcinoma; Laparoscopic cholecystectomy; Extended cholecystectomy; Recurrence; Reoperation

MeSH Terms

Bile Ducts
Cholecystectomy
Cholecystectomy, Laparoscopic
Gallbladder
Gallbladder Diseases
Gallbladder Neoplasms
Hepatectomy
Humans
Liver
Lymph Nodes
Medical Records
Neoplasm Metastasis
Prognosis
Recurrence
Reoperation
Survival Rate

Figure

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  Fig. 1 Comparison of overall patient survival in pT1b gallbladder patients who underwent laparoscopic cholecystectomy (LC) as the first operation.

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  Fig. 2 Comparison of overall patient survival in pT2 gallbladder patients who underwent laparoscopic cholecystectomy (LC) as the first operation.

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