Effects of the gross types in patients with T2 gallbladder cancer

Abstract

Introduction: The 8th edition of the American Joint Committee on Cancer(AJCC) guidelines categorize T2 gallbladder cancers according to pathologic tumor location: peritoneal tumors are categorized as peritoneal-side(T2a) tumors and hepatic tumors are categorized as hepatic-side(T2b) tumors. This change in classification was based on the results of an international multicenter study that take into account the impact of tumor location. We hypothesize that the tumor gross type of gallbladder cancer is more important than tumor location. This study aimed to investigate the role of gross type of gallbladder cancers in T2 stage. Method: We performed 86 cholecystectomy in patients with gallbladder cancer from Feb. 2008 to Dec. 2017. We reviewed retrospectively medical records of 30 patients who had pathologically confirmed T2 stage Gallbladder cancer. Result: Twenty-six patients underwent initially simple cholecystectomy and among them, five patients underwent re-operation after diagnosis. Only four patients underwent extended cholecystectomy. The number of expansive type is 8(26.7%), infiltrative type is 18(60%) and unknown type is 4(13.3%). The rate of lymph node (LN) metastasis (n=8, 44.4%), lymphovascular invasion (n=12, 66.7%) and perineural invasion (n=8, 44.4%) are more high in infiltrative type group. Mean disease free survival (DFS) (77month vs 36month, p=0.059) and overall survival (OS) (64 month vs 40 month, p=0.161) are also poor in infiltrative type group. However it did not show significant difference. Conclusion: Although Our results did not show significant DFS and OS difference because of small sample size, the tumor gross type of T2 gallbladder cancer may be important prognostic factor. Using the more larger scale data, the whether the tumor gross type or tumor location are more important prognostic factor must be evaluated.