Abstract
BackgroundThe indications for extrahepatic bile duct (EHBD) resection remain a major controversy in the surgical management of patients with gallbladder cancer. On the other hand, perineural invasion (PNI) was reported as an important factor in patients with gallbladder cancer because gallbladder cancer cells frequently spread to the tissues surrounding the EHBD via perineural routes. We assessed the correlation of PNI with clinicopathological factors in patients with gallbladder cancer to elucidate EHBD resection indications specifically in patients with PNI.MethodsThis retrospective study assessed the PNI status of 50 patients with gallbladder cancer who underwent curative resection and examined the correlation between the presence of PNI and clinicopathological factors.ResultsThirteen patients (26%) were PNI positive. PNI was significantly correlated with male sex, proximal-type tumor, lymphatic and vascular invasion, and advanced T stage. Multivariate analysis found that PNI positivity (p < 0.001), lymphatic invasion (p = 0.007), and nodal stage (p < 0.001) were independent prognostic factors. PNI was never observed in patients with stage T1 cancer. Conversely, PNI was detected rarely in distal-type tumors, all of whom developed various types of recurrences.ConclusionsThese results clearly demonstrated the prognostic impact of PNI in patients with gallbladder cancer. We suggest that EHBD resection in combination with cholecystectomy may not be useful for distal-type tumors from a perspective of PNI.
Highlights
Gallbladder cancer is recognized as one of the most aggressive tumors, with a dismal prognosis [1]; even after curative surgery, the prognosis ranges from 17 to 45% [2]
We diagnosed all cases as gallbladder cancer using computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS) before surgery; there was no incidental cancer
perineural invasion (PNI) did not correlate with other clinicopathological factors such as N stage, numbers of resected lymph nodes, and lymph node ratio (Table 2)
Summary
Gallbladder cancer is recognized as one of the most aggressive tumors, with a dismal prognosis [1]; even after curative surgery, the prognosis ranges from 17 to 45% [2]. We assessed correlations between PNI and clinicopathological factors in patients with gallbladder cancer who underwent surgical resection with or without EHBD resection and elucidated the indications for EHBD resection with a focus on the clinical significance of PNI. The indications for extrahepatic bile duct (EHBD) resection remain a major controversy in the surgical management of patients with gallbladder cancer.
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