Ann Hepatobiliary Pancreat Surg.  2021 Nov;25(4):485-491. 10.14701/ahbps.2021.25.4.485.

Bi-segmentectomy versus wedge hepatic resection in extended cholecystectomy for T2 and T3 gallbladder cancer: A matched case-control study

• Nag HH
• Nekarakanti PK
• Sachan A
• Nabi P
• Tyagi S

• KMID: 2523052
• DOI: http://doi.org/10.14701/ahbps.2021.25.4.485

Abstract

Backgrounds/Aims
Extended cholecystectomy (EC) is the mainstay of treatment in most patients with potentially curable gallbladder cancer (GBC). The optimum extent of hepatic resection in EC is debatable.
Methods
This retrospective study was conducted on patients with GBC who received EC from May 2009 to February 2019. Based on the extent of hepatic resection, patients were divided into ECB (EC involving bi-segmentectomy s4b&5) and ECW (EC involving wedge hepatic resection) groups. Patients with T1 GBC, T4 GBC, and benign diseases were excluded. Post-exclusion, both groups were matched for T and N stage. Matched groups were then compared.
Results
Out of a total of 161 patients who received EC, 86 patients had ECB and 75 patients had ECW. After exclusion and matching, both ECB and ECW groups had 35 patients. Their demographic and clinical profiles were comparable. Surgical blood loss (p = 0.005) and postoperative complication rate (p = 0.035) were significantly less in the ECB group. For ECB vs. ECW, mean recurrence-free survival (RFS) was 58.2 months vs. 42.3 months (p = 0.264) and overall survival (OS) was 61.5 months vs. 43.4 months (p = 0.161). On univariate analysis, higher T and N stages were associated with poor prognosis. On multivariate analysis, higher T stage, N stage, and American Society of Anaesthesiologists grade were associated with poor RFS and OS.
Conclusions
The survival after ECB for T2 and T3 GBC was not significantly superior to that after ECW. However, surgical blood loss and postoperative complications were lower following ECB.

Keyword

Gallbladder neoplasms; Extended cholecystectomy; Radical cholecystectomy; Bi-segmentectomy; Wedge hepatic resection

Figure

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  Fig. 1 Flow diagram showing the selection of study subjects. ECB, extended cholecystectomy involving bi-segmentectomy s4b&5; ECW, extended cholecystectomy involving wedge hepatic resection.

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  Fig. 2 Kaplan–Meier recurrence-free survival curves for ECB and ECW groups. ECB, extended cholecystectomy involving bi-segmentectomy s4b&5; ECW, extended cholecystectomy involving wedge hepatic resection; HR, hazard ratio; CI, confidence interval.

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  Fig. 3 Kaplan–Meier overall survival curves for ECB and ECW groups. ECB, extended cholecystectomy involving bi-segmentectomy s4b&5; ECW, extended cholecystectomy involving wedge hepatic resection; HR, hazard ratio; CI, confidence interval.

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