Yonsei Med J.  2019 Dec;60(12):1138-1145. 10.3349/ymj.2019.60.12.1138.

Oncologic Outcomes of Extended Lymphadenectomy without Liver Resection for T1/T2 Gallbladder Cancer

• Chong JU
• Lee WJ

• KMID: 2463792
• DOI: http://doi.org/10.3349/ymj.2019.60.12.1138

Abstract

PURPOSE
This study provides a standardized operative strategical algorithm that can be applied to patients with T1/T2 gallbladder cancer (GBC). Our aim was to determine the oncologic outcome of radical cholecystectomy with para-aortic lymph node dissection without liver resection in T1/T2 GBC.
MATERIALS AND METHODS
From January 2005 to December 2017, 164 patients with GBC underwent operations by a single surgeon at Severance Hospital. A retrospective review was performed for 113 of these patients, who were pathologically determined to be in stages T1 and T2 according to American Joint Committee on Cancer 7th guidelines.
RESULTS
Of the 113 patients, 109 underwent curative resection for T1/T2 GBC; four patients who underwent palliative operations without radical cholecystectomies were excluded from further analyses. For all T1b and T2 lesions, radical cholecystectomy with para-aortic lymph node dissection was performed without liver resection. There were four GBC-related mortalities, and 5-year disease-specific survival was 97.0%. The median follow-up was 50 months (range: 5-145 months). In all T stages, the median was not reached for survival analysis. Five-year disease-specific survival for T1a, T1b, and T2 were 100%, 94.1%, and 97.1%, respectively. Five-year disease-free survival for T1a, T1b, and T2 were 100%, 87.0%, and 91.8%, respectively.
CONCLUSION
Our results suggest that the current operative protocol can be applied to minimal invasive operations for GBC with similar oncologic outcomes as open approach. For T1/T2 GBC, radical cholecystectomy, including para-aortic lymph node dissection, can be performed safely with favorable oncologic outcomes.

Keyword

Gallbladder neoplasms; cholecystectomy; lymph node dissection; survival analysis

MeSH Terms

Cholecystectomy
Disease-Free Survival
Follow-Up Studies
Gallbladder Neoplasms*
Gallbladder*
Humans
Joints
Liver*
Lymph Node Excision*
Mortality
Retrospective Studies
Survival Analysis

Figure

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  Fig. 1 Treatment algorithm for gallbladder carcinoma. US, ultrasonography; CT, computed tomography; PET: positron emission tomography; EUS, endoscopic ultrasonography; LN, lymph node.

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  Fig. 2 Oncologic outcomes according to T stage. (A) Disease-specific survival (DSS). (B) Disease-free survival (DFS).

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  Fig. 3 Oncologic outcomes according to N stage. (A) Disease-specific survival (DSS). (B) Disease-free survival (DFS).

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  Fig. 4 Oncologic outcomes according to tumor location. (A) Disease-specific survival (DSS). (B) Disease-free survival (DFS). (C) DSS for T2. (D) DFS for T2.

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  Fig. 5 Oncologic outcomes according to surgical approach. (A) Disease-specific survival (DSS). (B) Disease-free survival (DFS).

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